Psychiatric intensive care units provide care for mental health patients in psychiatric crises, often involving violent behaviour. This study aimed to examine the ability of the Dynamic Appraisal of Situational Aggression (DASA) to predict violent acts of different proximal causes in patients. We collected 2467 DASA predictions from 352 patients who had committed 366 violent incidents. All incidents were recorded using a Modified Overt Aggression Scale (MOAS). Receiver operating characteristic (ROC) curve analysis was used to assess the DASA predictive values. DASA demonstrated an overall area under the curve (AUC) of 0.76 (95% confidence interval CI 0.72, 0.79), with similar values for impulsive (AUC = 0.75, 95% CI 0.70, 0.81) and psychotic (AUC = 0.75, 95% CI 0.70, 0.79) aetiologies. Notably, the AUC for females was 0.80 (95% CI 0.75, 0.86), indicating a particularly high predictive validity for women. We also observed that higher DASA scores predict higher incident severity assessed by MOAS scores (Spearman’s ρ = 0.13, p = 0.03). Most employed nursing interventions included de‐escalation techniques (18%) and one‐to‐one nursing. In patients with high‐risk scores, interventions also involved psychopharmacological or even coercive methods. The DASA shows satisfactory predictive validity for both psychotic and impulsive aetiological incidents and demonstrates better predictive validity for women. This study evaluated the predictive validity of DASA for different types of violent acts (psychotic, impulsive and predatory) in both sexes and implemented a set of corresponding interventions. These interventions should be customised to address the specific risk factors in each patient.
Páv et al. (Thu,) studied this question.