Risk factors and interventions for patient aggression and violence towards healthcare workers: An umbrella review of emergency and psychiatric settings

Background Violence against healthcare workers (HCWs) is a global concern, particularly in emergency departments (EDs) and psychiatric departments (PDs) settings. We synthesised evidence on the risk factors of patient violence towards HCWs and interventions aimed to reduce such violence and aggression. Methods We searched Medline, EMBASE, PsychINFO and the Cochrane of Systematic Reviews from inception to May 2025. Eligible studies included reviews examining risk factors for violence and systematic reviews of randomised controlled trials (RCTs) evaluating interventions in EDs and PD settings. Risk factor reviews were assessed using AMSTAR 2, while individual RCTs were assessed using the PEDro scale. Two researchers independently conducted screening, data extraction, and quality assessment. We summarised and conducted meta-analyses were data allowed. Results Our study included 18 reviews of risk factors and 23 reviews examining interventions (47 RCTs). Violence was linked to patient demographics (e.g., male sex), clinical (e.g., psychiatric symptoms severity), staff (e.g., experience), organisational (e.g., overcrowding), and other factors (e.g., days of the week). Multicomponent organisational and behavioural interventions (e.g., Safewards, screening, staff training, de-escalations, environmental improvement) were most effective to reduce violence against HCWs. Pharmacological interventions were effective for acute agitation response, olanzapine demonstrated clinically meaningful short-term reductions in aggression compared to placebo and clozapine showed the strongest evidence for sustained effect. Conclusion Violence towards HCWs in EDs and PDs is a function of patients, staff, and organisational factors. Evidence supports trauma-informed multicomponent prevention strategies, while evidence-based clinical acute cases management can be effective to improve safety for HCWs.