Putting aggression into context: An investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital

The contribution of contextual factors to aggressive incidents in psychiatric hospitals has tended to be ignored. This study used a functional analysis framework to investigate 130 incidents. Staff interviews were used to identify antecedents and management strategies employed. Reported aggression rates varied greatly between wards including those serving similar functions. No difference was found between the number of aggressive incidents reported by the secure units and admission wards when compared with other wards. When compared with each other, the two secure units and two admission wards reported significantly different numbers of incidents (p<0.001 and p<0.01, respectively). Staff victims were more likely to be male than female (p<0.01). Incidents in general were more likely to be preceded by 'external' than 'internal' antecedents (p<0.05). More incidents were managed with physical than verbal interventions (p<0.001). The findings suggest that environmental and interpersonal variables may have influenced the rate of aggressive incidents. The implications for incident management, and aggression-reducing strategies, are discussed.