Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

Weltens, Irene; Bak, Maarten; Verhagen, Simone; Vandenberk, Emma; Domen, Patrick; van Amelsvoort, Thérèse; Drukker, Marjan

doi:10.1371/journal.pone.0258346

Cited by 200Workplace Violence and BullyingPsychiatric care and mental health servicesHealthcare Decision-Making and Restraints

The DOI matches its Crossref record; 181 of the 181 references it cites were found in a registry or an index.

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

Open access

Weltens, Irene, Bak, Maarten, Verhagen, Simone, Vandenberk, Emma, Domen, Patrick, van Amelsvoort, Thérèse, Drukker, Marjan·2021·PLOS ONE

DOI 10.1371/journal.pone.0258346PMC PMC8500453

Open this paper in CoChat — free account Open PDF

Abstract

Introduction: On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. Method: In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. Results: The prevalence of aggressive behaviour on psychiatric wards varied (8–76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. Conclusion: Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0258346

Cites

181 of 181 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

One probable link between smoking and ASB is attributed to the influence of nicotine on the CNS via exaggerated stress sensitivity and changed epigenetic regulation.
“One of the probable links between smoking and ASB is attributed to the influence of nicotine on the CNS via exaggerated stress sensitivity (Weltens et al., 2021) and changed in epigenetic regulation (Gould et al., 2023).”
From Using polygenic scores to assess liability to antisocial behavior (2025) · cites this paper as Weltens et al., 2021
The Results sections on patient and ward factors report associations between cigarette craving, smoking-related ward conditions, and aggression. They do not explain the link through nicotine’s effects on the CNS or exaggerated stress sensitivity. The epigenetic-regulation clause is attributed to a different citation and is not assessed here; page numbers were unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement
PRISMA-P Group, Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015) · Systematic Reviews · doi:10.1186/2046-4053-4-1 · Cited by 26,223
The world report on violence and health
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11133-0 · Cited by 9,110
Risk Factors for Violence in Psychosis: Systematic Review and Meta-Regression Analysis of 110 Studies
Witt, K., Dorn, R. A. V., & Fazel, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055942 · Cited by 630
Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis
Iozzino, L., Ferrari, C., Large, M. M. B., Nielssen, O. B., & de Girolamo, G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0128536 · Cited by 404
Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends
Steinert, T., Lepping, P., Bernhardsgrütter, R., Conca, A., Hatling, T., Janssen, W. A., Keski-Valkama, A., Mayoral, F., & Whittington, R. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0132-3 · Cited by 382
Causes and management of patient aggression and violence: staff and patient perspectives
Duxbury, J. A., & Whittington, R. (2005) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2005.03426.x · Cited by 360
Aggression in psychiatry wards: A systematic review
Cornaggia, C., Beghi, M., Pavone, F., & Barale, F. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.12.024 · Cited by 329
Assessment and management of agitation in psychiatry: Expert consensus
Garriga, M., Pacchiarotti, I., Kasper, S. F., Zeller, S. L., Allen, M. H., Vázquez, G. H., Baldaçara, L., San, L., McAllister-Williams, H., Fountoulakis, K. Ν., et al. (2016) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1132007 · Cited by 314
A review and meta‐analysis of the patient factors associated with psychiatric in‐patient aggression
Dack, C., Ross, J., Papadopoulos, C., Stewart, D., & Bowers, L. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12053 · Cited by 264 · cited 1×
“An earlier review by Dack (2013) found this decrease in risk for aggression for depression, bipolar disorder, adjustment disorder and substance abuse First colum is first author and year of publication and reference, χ2: Chi-square, df: degrees of freedom, r: correlation…”
Background
Non‐somatic effects of patient aggression on nurses: a systematic review
Needham, I., Abderhalden, C., Halfens, R. J. G., Fischer, J. E., & Dassen, T. W. N. (2005) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2004.03286.x · Cited by 261
Prevalence and Precipitants of Aggression in Psychiatric Inpatient Units
Barlow, K., Grenyer, B. F. S., & Ilkiw‐Lavalle, O. (2000) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/000486700271 · Cited by 232
Aggressive behaviour on acute psychiatric wards: prevalence, severity and management
Foster, C., Bowers, L., & Nijman, H. L. I. (2007) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04169.x · Cited by 227
Violence in Inpatients With Schizophrenia: A Prospective Study
Arango, C., Barba, A. C., González-Salvador, T., & Ordóñez, A. C. (1999) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033396 · Cited by 217
Situational variables and institutional violence: A systematic review of the literature
Gadon, L., Johnstone, L., & Cooke, D. J. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.02.002 · Cited by 207
The antecedents of violence and aggression within psychiatric in‐patient settings
Papadopoulos, C., Ross, J., Stewart, D., Dack, C., James, K., & Bowers, L. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01827.x · Cited by 196
Predictors of violent behavior among acute psychiatric patients: Clinical study
Amore, M., Menchetti, M., Tonti, C., Scarlatti, F., Lundgren, E., Esposito, W., & Berardi, D. (2008) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2008.01790.x · Cited by 190
Prevalence and Determinants of Workplace Violence of Health Care Workers in a Psychiatric Hospital in Taiwan
Chen, W., Hwu, H., Kung, S., et al. (2008) · Journal of Occupational Health · doi:10.1539/joh.l7132 · Cited by 182
Psychopathology and violence: A review of literature
Krakowski, M., Volavka, J., & Brizer, D. A. (1986) · Comprehensive Psychiatry · doi:10.1016/0010-440x(86)90022-2 · Cited by 175
Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards
Bowers, L., Allan, T., Simpson, A., Jones, J., Van Der Merwe, M., & Jeffery, D. (2009) · Issues in Mental Health Nursing · doi:10.1080/01612840802710829 · Cited by 171
A systematic review and meta‐analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff
Edward, K., Stephenson, J. R., Ousey, K. J., Lui, S., Warelow, P. J., & Giandinoto, J. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.13019 · Cited by 168
Categorization of Aggressive Acts Committed by Chronically Assaultive State Hospital Patients
Quanbeck, C., McDermott, B. E., Lam, J., Eisenstark, H., Sokolov, G., & Scott, C. L. (2007) · Psychiatric Services · doi:10.1176/ps.2007.58.4.521 · Cited by 166
Gender Differences in Violent Behaviors: Relationship to Clinical Symptoms and Psychosocial Factors
KRAKOWSKI, M. I., & Czobor, P. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.3.459 · Cited by 163
Characteristics of violent behaviour in acute psychiatric in-patients: a 5-year Italian study
Grassi, L. G., Peron, L., Marangoni, C., Zanchi, P., & Vanni, A. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00292.x · Cited by 147
Incidence, Type, Related Factors, and Effect of Workplace Violence on Mental Health Nurses: A Cross-sectional Survey
Yang, B. X., Stone, T. E., Petrini, M. A., & Morris, D. L. (2017) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2017.09.013 · Cited by 146
Risk Factors and Correlates of Violence Among Acutely Ill Adult Psychiatric Inpatients
Soliman, A. E.-D. M., & Reza, H. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.1.75 · Cited by 143
Frequency and risk factors of workplace violence on psychiatric nurses and its impact on their quality of life in China
Zeng, J.-Y., An, F., Xiang, Y., Qi, Y.-K., Ungvari, G. S., Newhouse, R. P., Yu, D. S. F., Lai, K. Y. C., Yu, L.-Y., Ding, Y.-M., et al. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.06.013 · Cited by 143
Aggressive Behavior Against Self and Others Among First-Admission Patients With Schizophrenia
Steinert, T., Wiebe, C., & Gebhardt, R. P. (1999) · Psychiatric Services · doi:10.1176/ps.50.1.85 · Cited by 142
Staff and patient perceptions of seclusion: has anything changed?
Meehan, T., Bergen, H. A., & Fjeldsoe, K. (2004) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2004.03062.x · Cited by 138
Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards
d’Ettorre, G., & Pellicani, V. (2017) · Safety and Health at Work · doi:10.1016/j.shaw.2017.01.004 · Cited by 132
Course of Violence in Patients With Schizophrenia: Relationship to Clinical Symptoms
KRAKOWSKI, M. I., Czobor, P., & Chou, J. C.-Y. (1999) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033397 · Cited by 126
Violence at the workplace—a questionnaire survey of nurses
Merecz‐Kot, D., Rymaszewska, J., Mościcka-Teske, A., et al. (2006) · European Psychiatry · doi:10.1016/j.eurpsy.2006.01.001 · Cited by 121
Reasons for using seclusion and restraint in psychiatric inpatient care
Kaltiala‐Heino, R., Tuohimäki, C., Korkeila, J. A., & Lehtinen, V. (2003) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(02)00210-8 · Cited by 112
Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings
Pekurinen, V., Willman, L. A., Virtanen, M., Mika Kivimaki, B., Vahtera, J., & Valimaki, M. A. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14101245 · Cited by 111
Violence toward mental health staff and safety in the work environment
Privitera, M. R., Weisman, R. L., Cerulli, C., et al. (2005) · Occupational Medicine · doi:10.1093/occmed/kqi110 · Cited by 110
Psychotic symptoms and violence toward others — a literature review of some preliminary findings
Bjørkly, S. K. (2002) · Aggression and Violent Behavior · doi:10.1016/s1359-1789(01)00050-7 · Cited by 109
Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings
Niu, S., Kuo, S.-F., Tsai, H., Kao, C., Traynor, V., & Chou, K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0211183 · Cited by 108
Psychotic symptoms and violence toward others — a literature review of some preliminary findings
Bjørkly, S. K. (2002) · Aggression and Violent Behavior · doi:10.1016/s1359-1789(01)00049-0 · Cited by 108
A Review of Ecological Factors Affecting Inpatient Psychiatric Unit Violence: Implications for Relational and Unit Cultural Improvements
Hamrin, V., Iennaco, J. D., & Olsen, D. P. (2009) · Issues in Mental Health Nursing · doi:10.1080/01612840802701083 · Cited by 106
Differences Between Patient and Staff Perceptions of Aggression in Mental Health Units
Ilkiw‐Lavalle, O., & Grenyer, B. F. S. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.3.389 · Cited by 102
Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study
Lantta, T., Anttila, M., Kontio, R., Adams, C. E., & Valimaki, M. A. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0059-5 · Cited by 100
Ward Crowding and Incidents of Violence on an Acute Psychiatric Inpatient Unit
Ng, B., Kumar, S., Ranclaud, M., & Robinson, E. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.4.521 · Cited by 97
Patient-staff conflict: results of a survey on acute psychiatric wards
Bowers, L., Simpson, A., & Alexander, J. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0648-x · Cited by 95
Assaults by Patients on Psychiatric Residents: A Survey and Training Recommendations
Schwartz, T. L., & Park, T. L. (1999) · Psychiatric Services · doi:10.1176/ps.50.3.381 · Cited by 93
Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan
Chou, K., Lu, R., & Mao, W. (2002) · Archives of Psychiatric Nursing · doi:10.1053/apnu.2002.34394 · Cited by 92
Association Between Staff Factors and Levels of Conflict and Containment on Acute Psychiatric Wards in England
Bowers, L. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.2.231 · Cited by 92
Incidence and risk factors of workplace violence on psychiatric staff
Ridenour, M. L., Lanza, M. L., Hendricks, S. A., et al. (2015) · Work · doi:10.3233/wor-141894 · Cited by 91
Adverse Incidents, Patient Flow and Nursing Workforce Variables on Acute Psychiatric Wards: The Tompkins Acute Ward Study
Bowers, L., Allan, T. F., Simpson, A., Nijman, H. L. I., & Warren, J. (2007) · International Journal of Social Psychiatry · doi:10.1177/0020764007075011 · Cited by 91
Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland
Abderhalden, C., Needham, I., Dassen, T. W. N., Halfens, R. J. G., Fischer, J. E., & Haug, H. (2007) · Clinical Practice and Epidemiology in Mental Health · doi:10.1186/1745-0179-3-30 · Cited by 88
Adverse Incidents in Acute Psychiatric Inpatient Units: Rates, Correlates and Pressures
Carr, V. J., Lewin, T. J., Sly, K. A., Conrad, A. M., Tirupati, S., Cohen, M., Ward, P. B., & Coombs, T. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670701881520 · Cited by 87
Acute psychiatric ward rules: a review of the literature
Alexander, J., & Bowers, L. (2004) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2004.00770.x · Cited by 85
Putting aggression into context: An investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital
MELANIE, S., & TONY, L. (1999) · Journal of Mental Health · doi:10.1080/09638239917535 · Cited by 83
Crowding and Aggression on Inpatient Psychiatric Wards
Nijman, H. L. I., & Rector, G. (1999) · Psychiatric Services · doi:10.1176/ps.50.6.830 · Cited by 83
Hostility and violence of acute psychiatric inpatients.
Raja, M., & Azzoni, A. (2005) · Clinical Practice and Epidemiology in Mental Health · doi:10.1186/1745-0179-1-11 · Cited by 82
Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study
Schneeberger, A. R., Kowalinski, E., Fröhlich, D., Schröder, K., von Felten, S., Zinkler, M., Beine, K. H., Heinz, A., Borgwardt, S., Lang, U. E., et al. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.08.017 · Cited by 81
Locked doors in acute inpatient psychiatry: a literature review
MERWE, M. V. D., Bowers, L., Jones, J., Simpson, A., & HAGLUND, K. (2009) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2008.01378.x · Cited by 80
Understanding the social context of violent and aggressive incidents on an inpatient unit
Secker, J., BENSON, A., Balfe, E., Lipsedge, M., ROBINSON, S., & Walker, J. S. (2004) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2003.00703.x · Cited by 79
Frequency of assault and severity of injury of psychiatric nurses in relation to the nurses' decision to restrain
Moylan, L. B., & Cullinan, M. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01699.x · Cited by 78
Perceiving risk in dangerous situations: risks of violence among mental health inpatients
Trenoweth, S. (2003) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2003.02617.x · Cited by 77
Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder
Nolan, K. A., Volavka, J., Czobor, P., Sheitman, B., Lindenmayer, J., Citrome, L., McEvoy, J. P., & Lieberman, J. A. (2004) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2004.04.010 · Cited by 76
Development of a methodological quality criteria list for observational studies: The observational study quality evaluation
Drukker, M., Weltens, I., van Hooijdonk, C. F. M., Vandenberk, E., & Bak, M. (2021) · Frontiers in Research Metrics and Analytics · doi:10.3389/frma.2021.675071 · Cited by 75
Self-citation
A model of aggression in psychiatric hospitals
Nijman, H. L. I. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.106.s412.30.x · Cited by 73
Situational Determinants of Inpatient Self‐Harm
Nijman, H. L. I., & Campo, J. M. L. G. À. (2002) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.32.2.167.24401 · Cited by 72
Aggression in a high secure hospital: staff and patient attitudes
Pulsford, D., Crumpton, A., BAKER, A., Wilkins, T., Wright, K. M., & Duxbury, J. A. (2012) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2012.01908.x · Cited by 71
PATIENTS LONGING FOR AUTHENTIC PERSONAL CARE: A PHENOMENOLOGICAL STUDY OF VIOLENT ENCOUNTERS IN PSYCHIATRIC SETTINGS
Carlsson, G., Dahlberg, K., Ekebergh, M., & Dahlberg, H. (2006) · Issues in Mental Health Nursing · doi:10.1080/01612840500502841 · Cited by 71
Incidence and Risk Factors of Workplace Violence on Nursing Staffs Caring for Chronic Psychiatric Patients in Taiwan
Chen, W.-C., Sun, Y.-H., Lan, T., & Chiu, H.-J. (2009) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph6112812 · Cited by 70
Neuropsychological and symptom predictors of aggression on the psychiatric inpatient service
Serper, M. R., Beech, D., Harvey, P. D., et al. (2008) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803390701684554 · Cited by 70
Utility of Social Cognition and Insight in the Prediction of Inpatient Violence Among Individuals With a Severe Mental Illness
Waldheter, E. J., Jones, N., Johnson, E., & Penn, D. L. (2005) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000177788.25357.de · Cited by 70
Violence in psychiatric units
Grassi, L. G., Biancosino, B., Marmai, L., Kotrotsiou, V., Zanchi, P., Peron, L., Marangoni, C., Vanni, A., & Barbui, C. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0088-5 · Cited by 69
Violent Behavior in Acute Psychiatric Inpatient Facilities
Biancosino, B., Delmonte, S., Grassi, L. G., Santone, G., Preti, A., Miglio, R., & de Girolamo, G. (2009) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181bb0d6b · Cited by 68
Aggression on a Psychiatric Acute Ward: A Three-Year Prospective Study
Mellesdal, L. (2003) · Psychological Reports · doi:10.2466/pr0.2003.92.3c.1229 · Cited by 67
Characteristics of aggression in a German psychiatric hospital and predictors of patients at risk
Ketelsen, R., Zechert, C., Drießen, M., & Schulz, M. (2007) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2007.01049.x · Cited by 65
Overcrowding in psychiatric wards and physical assaults on staff: data-linked longitudinal study
Virtanen, M., Vahtera, J., Batty, G. D., et al. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.082388 · Cited by 65
Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis
Robson, D., Spaducci, G., McNeill, A. D., Stewart, D., Craig, T., Yates, M., & Szatkowski, L. C. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30209-2 · Cited by 65
Violence experienced by nurses at six university hospitals in T urkey
Atan, Ş. Ü., Arabacı, L. B., Şirin, A., et al. (2012) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12027 · Cited by 64
Violence and aggression: a literature review
Woods, P., & ASHLEY, C. (2007) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2007.01149.x · Cited by 61
The relationship between paranoia and aggression in psychosis: A systematic review
Darrell-Berry, H., Berry, K., & Bucci, S. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.02.009 · Cited by 61
Burnout symptoms in forensic mental health nurses: Results from a longitudinal study
de Looff, P. C., Didden, R., Embregts, P. J. C. M., & Nijman, H. L. I. (2018) · International Journal of Mental Health Nursing · doi:10.1111/inm.12536 · Cited by 61
Systemic perspective of violence and aggression in mental health care: Towards a more comprehensive understanding and conceptualization: Part 2
Cutcliffe, J. R., & Riahi, S. (2013) · International Journal of Mental Health Nursing · doi:10.1111/inm.12028 · Cited by 58
Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards—A cross sectional time series Poisson regression study
Bowers, L., & Crowder, M. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.07.005 · Cited by 57
Violence by Psychiatric In-Patients
Aquilina, C. (1991) · Medicine Science and the Law · doi:10.1177/002580249103100406 · Cited by 56
Characteristics of Staff Victims of Psychiatric Patient Assaults: 20-Year Analysis of the Assaulted Staff Action Program
Flannery, R. B., LeVitre, V., Rego, S., & Walker, A. P. (2010) · Psychiatric Quarterly · doi:10.1007/s11126-010-9153-z · Cited by 56
Predictors of Aggression on the Psychiatric Inpatient Service: Self-Esteem, Narcissism, and Theory of Mind Deficits
Goldberg, B. R., Serper, M. R., Sheets, M., Beech, D., Dill, C. A., & Duffy, K. G. (2007) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000253748.47641.99 · Cited by 55
Mental health nurses’ perspective of workplace violence in Jordanian mental health hospitals
AlAzzam, M., AL‐Sagarat, A. Y., Tawalbeh, L. I., & Poedel, R. J. (2017) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12250 · Cited by 55
Aggression in Asian Patients with First-Episode Psychosis
Verma, S. K., Poon, L. Y., Subramaniam, M., & Chong, S. (2005) · International Journal of Social Psychiatry · doi:10.1177/0020764005060852 · Cited by 53
Emergency Psychiatry: A Review of Assaults by Patients Against Staff at Psychiatric Emergency Centers
Erdos, B. Z., & Hughes, D. H. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.9.1175 · Cited by 52
Markers for aggression in inpatient treatment facilities for adults with mild to borderline intellectual disability
Tenneij, N. H., Didden, R., Stolker, J. J., & Koot, H. M. (2009) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2009.04.006 · Cited by 52
Systemic perspective of violence and aggression in mental health care: Towards a more comprehensive understanding and conceptualization: Part 1
Cutcliffe, J. R., & Riahi, S. (2013) · International Journal of Mental Health Nursing · doi:10.1111/inm.12029 · Cited by 51
Psychiatric wards with locked doors – advantages and disadvantages according to nurses and mental health nurse assistants
Haglund, K., von Knorring, L., & von Essén, L. (2006) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2006.01489.x · Cited by 51
Violence risk–assessment screening tools for acute care mental health settings: Literature review
Anderson, K. K., & Jenson, C. E. (2018) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2018.08.012 · Cited by 51
Substance abuse amplifies the risk for violence in schizophrenia spectrum disorder
Erkıran, M., Özünalan, H., Evren, C., Aytaçlar, S., Kirisci, L., & Tarter, R. E. (2006) · Addictive Behaviors · doi:10.1016/j.addbeh.2005.12.024 · Cited by 51
Violence in the Emergency Department
Stowell, K. R., Hughes, N. P., & Rozel, J. S. (2016) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2016.07.003 · Cited by 50
Physical violence against health staff by mentally ill patients at a psychiatric hospital in Botswana
Olashore, A. A., Akanni, O. O., & Ogundipe, R. M. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3187-6 · Cited by 49
How Common is Violence in Schizophrenia despite Neuroleptic Treatment?
Steinert, T., Sippach, T., & Gebhardt, R.-P. (2000) · Pharmacopsychiatry · doi:10.1055/s-2000-342 · Cited by 48
Relationship between aggression, interpersonal style, and therapeutic alliance during short‐term psychiatric hospitalization
Cookson, A., Daffern, M., & Foley, F. (2012) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2011.00764.x · Cited by 48
A ten‐year prospective study of aggression in a special secure unit for dangerous patients
Bjøkly, S. (1999) · Scandinavian Journal of Psychology · doi:10.1111/1467-9450.00098 · Cited by 48
A Blind Spot? Screening for Mild Intellectual Disability and Borderline Intellectual Functioning in Admitted Psychiatric Patients: Prevalence and Associations with Coercive Measures
Nieuwenhuis, J. G., Noorthoorn, E. O., Nijman, H. L. I., Naarding, P., & Mulder, C. L. (2017) · PLoS ONE · doi:10.1371/journal.pone.0168847 · Cited by 48
Violent behaviour in schizophrenia
Vevera, J., Hubbard, A., Veselý, A., & Papežová, H. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.5.426 · Cited by 47
Violence on Inpatient Psychiatric Units: State of the Science
Johnson, M. E. (2004) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390304264959 · Cited by 47
Aggression in specialist secure and forensic inpatient mental health care: incidence across care pathways
Dickens, G. L., Picchioni, M., & Long, C. G. (2013) · Journal of Forensic Practice · doi:10.1108/jfp-09-2012-0017 · Cited by 46
Incidents of violence in psychiatric inpatient care
Omérov, M., Edman, G., & Wistedt, B. (2002) · Nordic Journal of Psychiatry · doi:10.1080/080394802317607192 · Cited by 44
Locked doors: a survey of patients, staff and visitors
Bowers, L., HAGLUND, K., Muir‐Cochrane, E., Nijman, H. L. I., Simpson, A., & MERWE, M. V. D. (2010) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2010.01614.x · Cited by 44
Social Isolation, Impulsivity and Depression as Predictors of Aggression in a Psychiatric Inpatient Population
Ferguson, C. J., Averill, P. M., Rhoades, H. M., et al. (2005) · Psychiatric Quarterly · doi:10.1007/s11089-005-2335-1 · Cited by 44
Violence in Treatment Resistant Psychotic Inpatients
Ehmann, T. S., Smith, G. N., YAMAMOTO, A., McCarthy, N. A., Ross, D., Au, T., Flynn, S. W., Altman, S., & Honer, W. G. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200110000-00009 · Cited by 43
The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution
Bimenyimana, E., Poggenpoel, M., Myburgh, C. P. H., et al. (2009) · Curationis · doi:10.4102/curationis.v32i3.1218 · Cited by 42
Situational variables related to aggression in institutional settings
Welsh, E. A., Bader, S. M., & Evans, S. E. (2013) · Aggression and Violent Behavior · doi:10.1016/j.avb.2013.10.003 · Cited by 40
Prevalence of Workplace Violence in Psychiatric Wards, Tehran, Iran
Fallahi‐Khoshknab, M., Tamizi, Z., Ghazanfari, N., et al. (2012) · Pakistan Journal of Biological Sciences · doi:10.3923/pjbs.2012.680.684 · Cited by 40
HOVIS – The Hertfordshire/Oxfordshire Violent Incident Study
Spokes, K., Bond, K., Lowe, T., et al. (2002) · Journal of Psychiatric and Mental Health Nursing · doi:10.1046/j.1365-2850.2002.00467.x · Cited by 40
Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units: An Integrative Review
Salzmann‐Erikson, M., & Yifter, L. (2019) · Clinical Nursing Research · doi:10.1177/1054773818823333 · Cited by 40
Violence and threats of violence within psychiatric care – a comparison of staff and patient experience of the same incident
Omérov, M., Edman, G., & Wistedt, B. (2004) · Nordic Journal of Psychiatry · doi:10.1080/08039480410005918 · Cited by 38
Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives
Lamanna, D., Ninkovic, D., Vijayaratnam, V., Balderson, K., Spivak, H., Brook, S., & Robertson, D. (2016) · Journal of Mental Health · doi:10.1080/09638237.2016.1207222 · Cited by 38
An Evaluation of Nurses' Interpersonal Styles and Their Experiences of Violence
Bilgin, H. (2009) · Issues in Mental Health Nursing · doi:10.1080/01612840802710464 · Cited by 37
Survey of Threats and Assaults by Patients on Psychiatry Residents
Dvir, Y., Moniwa, E., Crisp-Han, H., Levy, D., & Coverdale, J. (2012) · Academic Psychiatry · doi:10.1176/appi.ap.10060090 · Cited by 37
Patients' Views of Causes of Aggression by Patients and Effective Interventions
Fagan-Pryor, E. C., Haber, L. C., Dunlap, D., Nall, J. L., Stanley, G., & Wolpert, R. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.4.549 · Cited by 37
Aggressive behaviour in an acute general adult psychiatric unit
El-Badri, S. M., & Mellsop, G. W. (2006) · Psychiatric Bulletin · doi:10.1192/pb.30.5.166 · Cited by 36
Injurious Assault Rates on Inpatient Psychiatric Units: Associations With Staffing by Registered Nurses and Other Nursing Personnel
Staggs, V. S. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400453 · Cited by 36
Use of Multimodal Technology to Identify Digital Correlates of Violence Among Inpatients With Serious Mental Illness: A Pilot Study
Ben‐Zeev, D., Scherer, E. A., Brian, R., Mistler, L. A., Campbell, A. T., & Wang, R. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201700077 · Cited by 36
A data science approach to predicting patient aggressive events in a psychiatric hospital
Suchting, R., Green, C. E., Glazier, S., & Lane, S. D. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.004 · Cited by 36
Nurse staffing, RN mix, and assault rates on psychiatric units
Staggs, V. S. (2012) · Research in Nursing & Health · doi:10.1002/nur.21511 · Cited by 35
Violence and its prediction at a psychiatric hospital
Sjöström, N., Eder, D. N., Malm, U., et al. (2001) · European Psychiatry · doi:10.1016/s0924-9338(01)00607-1 · Cited by 35
Inpatient verbal aggression: content, targets and patient characteristics
Stewart, D., & BOWERS, L. (2012) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2012.01905.x · Cited by 34
Organizational Justice and Collaboration Among Nurses as Correlates of Violent Assaults by Patients in Psychiatric Care
Pekurinen, V., Valimaki, M. A., Virtanen, M., et al. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600171 · Cited by 34
The Nature and Management of Aggressive Incidents in a Medium Secure Unit
Parkes, J. (2003) · Medicine Science and the Law · doi:10.1258/rsmmsl.43.1.69 · Cited by 33
Identification of the “Minimal Triangle” and Other Common Event-to-Event Transitions in Conflict and Containment Incidents
Bowers, L., James, K., Quirk, A., Wright, S., Williams, H., & Stewart, D. (2013) · Issues in Mental Health Nursing · doi:10.3109/01612840.2013.780117 · Cited by 33
Prevalence and correlates of aggression among psychiatric in-patients at Jos University Teaching Hospital
Chukwujekwu, D. C., & Stanley, P. (2011) · Nigerian Journal of Clinical Practice · doi:10.4103/1119-3077.84007 · Cited by 31
Hostility During Admission Interview as a Short-Term Predictor of Aggression in Acute Psychiatric Male Inpatients
Troisi, A., Kustermann, S., Genio, M. D., et al. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n1210 · Cited by 30
New graduate mental health nurse competencies
Patterson, C., Moxham, L. J., & Curtis, J. (2012) · Research Online (University of Wollongong) · Cited by 29
Events Preceding Changes in Conflict and Containment Rates on Acute Psychiatric Wards
Papadopoulos, C., Bowers, L., Quirk, A., & Khanom, H. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201000480 · Cited by 29
Patient characteristics associated with aggression in mental health units
Podubinski, T., Lee, S. J., Hollander, Y., et al. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.078 · Cited by 29
Sleep at night and association to aggressive behaviour; Patients in a Psychiatric Intensive Care Unit
Langsrud, K., Kallestad, H., Vaaler, A., Almvik, R., Palmstierna, T., & Morken, G. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.03.012 · Cited by 29
Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2000–2012
Flannery, R. B., Wyshak, G., Tecce, J. J., et al. (2014) · Psychiatric Quarterly · doi:10.1007/s11126-014-9295-5 · Cited by 28
Psychomotor agitation in subjects hospitalized for an acute exacerbation of Schizophrenia
Sacchetti, E., Valsecchi, P., Tamussi, E., Paulli, L., Morigi, R., & Vita, A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.09.058 · Cited by 28
Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients
Krüger, C., & Rosema, D. (2011) · African Journal of Psychiatry · doi:10.4314/ajpsy.v13i5.63102 · Cited by 27
Staff and Patient Views of the Reasons for Aggressive Incidents: A Prospective, Incident-Based Study
Nolan, K. A., Shope, C. B., Citrome, L., et al. (2009) · Psychiatric Quarterly · doi:10.1007/s11126-009-9104-8 · Cited by 27
Violence and self-harm in severe mental illness: inpatient study of associations with ethnicity, cannabis and alcohol
Dharmawardene, V., & Menkes, D. B. (2016) · Australasian Psychiatry · doi:10.1177/1039856216671650 · Cited by 26
Prevalence and Risk Factors ofWorkplace Violence towardMental Health Staff Departments in Jordanian Hospitals
AlAzzam, M., Tawalbeh, L. I., Sulaiman, M., et al. (2017) · Issues in Mental Health Nursing · doi:10.1080/01612840.2016.1268225 · Cited by 26
Conflict and containment events in inpatient psychiatric units
Ross, J., Bowers, L., & Stewart, D. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2012.04073.x · Cited by 25
Correlation Between Levels of Conflict and Containment on Acute Psychiatric Wards: The City-128 Study
Bowers, L., Stewart, D., Papadopoulos, C., et al. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200328 · Cited by 25
Risk Factors for Aggressive Behavior Among Psychiatric Inpatients
Chang, J., & Lee, C. (2004) · Psychiatric Services · doi:10.1176/appi.ps.55.11.1305 · Cited by 25
Environmental and nursing-staff factors contributing to aggressive and violent behaviour of patients in mental health facilities
Wijk, E. V., Traut, A., & Julie, H. (2014) · Curationis · doi:10.4102/curationis.v37i1.1122 · Cited by 24
Prediction of Violence on a Psychiatric Intensive Care Unit
Eaton, S., Ghannam, M., & Hunt, N. (2000) · Medicine Science and the Law · doi:10.1177/002580240004000210 · Cited by 24
Assaults and Nonpatient-Induced Injuries Among Psychiatric Nursing Staff in Bahrain
Hamadeh, R. R., Alaiwat, B. A., & Ansari, A. A. (2003) · Issues in Mental Health Nursing · doi:10.1080/01612840305314 · Cited by 24
The Effects of Cannabis on Inpatient Agitation, Aggression, and Length of Stay
Johnson, J. M., Wu, C. Y., Winder, G. S., Casher, M. I., Marshall, V. D., & Bostwick, J. R. (2016) · Journal of Dual Diagnosis · doi:10.1080/15504263.2016.1245457 · Cited by 24
Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey
Mi, W., Zhang, S., Liu, Q., et al. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.02.065 · Cited by 24
DAY-NIGHT VARIATION IN AGGRESSIVE BEHAVIOR AMONG PSYCHIATRIC INPATIENTS
Manfredini, R., Vanni, A., Peron, L., la Cecilia, O., Smolensky, M. H., & Grassi, L. G. (2001) · Chronobiology International · doi:10.1081/cbi-100103972 · Cited by 23
Overcrowding in Psychiatric Wards is Associated With Increased Risk of Adverse Incidents
Teitelbaum, A., Lahad, A., Calfon, N., et al. (2016) · Medical Care · doi:10.1097/mlr.0000000000000501 · Cited by 23
Positive symptoms, substance use, and psychopathic traits as predictors of aggression in persons with a schizophrenia disorder
van Dongen, J. D. M., Buck, N. M. L., & Marle, H. J. C. V. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.01.068 · Cited by 23
Aggressive behavior during the first 24 hours of psychiatric admission
Calegaro, V. C., Dotto, A. B., Freitas, D., et al. (2014) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2014-0016 · Cited by 22
Inpatient aggression in community hospitals
Szabo, K. A., White, C. L., Cummings, S. E., Wang, R. S., & Quanbeck, C. (2015) · CNS Spectrums · doi:10.1017/s1092852914000820 · Cited by 22
Work Stress and Satisfaction with Leadership Among Nurses Encountering Patient Aggression in Psychiatric Care: A Cross-Sectional Survey Study
Pekurinen, V., Valimaki, M. A., Virtanen, M., Mika Kivimaki, B., & Vahtera, J. (2019) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-018-00919-6 · Cited by 22
A survey of verbal and physical assaults towards psychiatrists in Turkey
Altınbaş, K., Altınbaş, G., Türkcan, A., Oral, E., & Walters, J. (2010) · International Journal of Social Psychiatry · doi:10.1177/0020764010382364 · Cited by 21
Delusional distress partly explains the relation between persecutory ideations and inpatient aggression on the ward
van Dongen, J. D. M., Buck, N. M. L., & Marle, H. J. C. V. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.05.016 · Cited by 21
Characteristics of assaultive psychiatric inpatients: Updated review of findings, 1995-2000
Flannery, R. B. (2001) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/153331750101600305 · Cited by 19
Aggressive behaviour and mental illness: a study of in-patients at Aro Neuropsychiatric Hospital, Abeokuta.
Amoo, G., & Fatoye, F. O. (2010) · PubMed · Cited by 18
Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards
Bowers, L., Jeffery, D., Simpson, A., et al. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.04101.x · Cited by 18
Crowding and Violent Behaviour: The Influence of Patient Density on Violent and Self-Harming Behaviour at a Medium Secure Unit
Hardie, T. (1999) · Medicine Science and the Law · doi:10.1177/002580249903900211 · Cited by 18
Exploration of Aggression/Violence Among Adult Patients Admitted for Short-term, Acute-care Mental Health Services
Giarelli, E., Nocera, R., Jobes, M., Boylan, C., Lopez, J., & Knerr, J. (2017) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2017.11.004 · Cited by 17
Iranian Nurses’ Experiences of Aggression in Psychiatric Wards: A Qualitative Study
Moghadam, M. F., Pazargadi, M., & Fallahi‐Khoshknab, M. (2013) · Issues in Mental Health Nursing · doi:10.3109/01612840.2012.737893 · Cited by 16
Psychiatric Patient Assault and Staff Victim Gender: Fifteen-year Analysis of the Assaulted Staff Action Program (ASAP)
Flannery, R. B., Marks, L., Laudani, L., et al. (2007) · Psychiatric Quarterly · doi:10.1007/s11126-006-9029-4 · Cited by 14
Characteristics of aggression among psychiatric inpatients by ward type in Japan: Using the Staff Observation Aggression Scale – Revised (SOAS‐R)
Sato, M., Noda, T., Sugiyama, N., Yoshihama, F., Miyake, M., & Ito, H. (2016) · International Journal of Mental Health Nursing · doi:10.1111/inm.12228 · Cited by 14
Creatine kinase (CK) and its association with aggressive behavior in patients with schizophrenia
Meng, X., Cao, X., Li, T., & Li, J.-P. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.02.025 · Cited by 13
Pattern and correlates of agitation in an acute psychiatry in-patient setting in a teaching hospital
George, C., Jacob, T. R., & Kumar, A. (2015) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2015.11.010 · Cited by 12
Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups
Bilici, R., Sercan, M., & İzci, F. (2016) · Issues in Mental Health Nursing · doi:10.3109/01612840.2016.1162883 · Cited by 12
Substance use and violence among psychiatric inpatients
Stewart, D., & Bowers, L. (2014) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12144 · Cited by 11
Characteristics of Aggressive Behavior among Male Inpatients with Schizophrenia.
Zhu, X., Li, W., & Wang, X. (2016) · PubMed · doi:10.11919/j.issn.1002-0829.216052 · Cited by 11
The developmental and social history of repetitively aggressive mental health patients
Grenyer, B. F. S., Lewis, K. L., Ilkiw‐Lavalle, O., Deane, R., Milicevic, D., & Pai, N. B. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412474106 · Cited by 10
Aggressive incidents on a psychiatric intensive care unit
Cohen, D. P., Akhtar, M. S., Siddiqui, A. A., Shelley, C., Larkin, C., Kinsella, A., O’Callaghan, E., & Lane, A. (2008) · Psychiatric Bulletin · doi:10.1192/pb.bp.107.015412 · Cited by 10
Aggression in Acute Inpatient Psychiatric Care: A Survey of Staff Attitudes
Ezeobele, I. E., McBride, R., Engstrom, A., & Lane, S. D. (2019) · Canadian Journal of Nursing Research · doi:10.1177/0844562118823591 · Cited by 10
Sex differences in aggressive incidents towards staff in secure services
Knowles, S. F., Coyne, S. M., & Brown, S. L. (2008) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789940801962130 · Cited by 9
Relationship of akathisia to aggressive and self-injurious behaviour: A prevalence study in a UK tertiary referral centre
Stubbs, J. H., Hutchins, D. A., & Mountjoy, C. Q. (2000) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651500050517894 · Cited by 9
The Incidence and Risk Factors of Workplace Violence towards Female Nurses Reported via Internet in an Acute Psychiatric Hospital
Chen, W.-C., Huang, C.-J., Chen, C.-C., & Wang, J. (2011) · Archives of Environmental & Occupational Health · doi:10.1080/19338244.2010.511310 · Cited by 8
Violence in a general hospital psychiatry unit for men
Abeyasinghe, R., & Jayasekera, R. (2011) · Ceylon Medical Journal · doi:10.4038/cmj.v48i2.3369 · Cited by 8
Prevalence and predictors of verbal aggression in a secure mental health service: Use of the HCR ‐20
Gunenc, C., O’Shea, L. E., & Dickens, G. L. (2015) · International Journal of Mental Health Nursing · doi:10.1111/inm.12130 · Cited by 8
Staff members’ evaluation of inpatients’ motivation for aggression – the roles of staff restrictions and aggression severity
Winje, M., van Mastrigt, S. B., Gjestad, R., et al. (2017) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2017.1410563 · Cited by 8
Age structure at diagnosis affects aggression in a psychiatric inpatient population: Age structure affecting inpatient aggression
Cho, U. J., Lee, J. Y., Kim, H., et al. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.09.022 · Cited by 6
Violent typologies among women inpatients with severe mental illness
Schaefer, R. J., Broadbent, M. T. M., & Bruce, M. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1280-x · Cited by 6
High en intensive care in de psychiatrie
van Melle, L., & Voskes, Y. (2021) · TVZ - Verpleegkunde in praktijk en wetenschap · doi:10.1007/s41184-021-1040-6 · Cited by 5
Involuntary hospitalization and violent behaviors: medical act or social control? A 3-Year Retrospective Analysis.
Menculini, G., Verdolini, N., Lanzi, R., et al. (2018) · PubMed · Cited by 4
Werkboek High en Intensive Care
van Mierlo, T., Bovenberg, F., Voskes, Y., et al. (2013) · Pure Amsterdam UMC · Cited by 4
Incidence and risk factors of workplace violence on psychiatric staff
Ridenour, M. L., Lanza, M. L., Hendricks, S. A., et al. (2013) · PsycEXTRA Dataset · doi:10.1037/e577572014-558 · Cited by 4
The Relationship of Perceived Family Criticism and Other Risk Factors to Violence Among Patients with Schizophrenia
Sehlo, M. G., Youssef, U. M., Hussein, R., et al. (2015) · European Psychiatry · doi:10.1016/s0924-9338(15)31339-0 · Cited by 3
An audit of patient aggression in an adult psychiatric unit: 2013–2014
Ewing, C., Phillipou, A., & Castle, D. J. (2017) · Australasian Psychiatry · doi:10.1177/1039856217726222 · Cited by 2

Flagged first, then by citations

Research works printed but not linked: 2

Merriam Webster Dictionary, 2008, Merriam Webster US
JM Johnson, 2015, The effects of cannabis on inpatient agitation, aggression, and length-of-stay in patients with schizophrenia, schizoaffective disorder, and bipolar disorder, Journal of Pharmacy Practice, 28, 329

Sorted by citations

Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention
Caruso, R., Toffanin, T., Folesani, F., Biancosino, B., Romagnolo, F., Riba, M. B., McFarland, D. C., Palagini, L., Murri, M. B., Zerbinati, L., et al. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01398-1 · Cited by 125
Development of a methodological quality criteria list for observational studies: The observational study quality evaluation
Drukker, M., Weltens, I., van Hooijdonk, C. F. M., Vandenberk, E., & Bak, M. (2021) · Frontiers in Research Metrics and Analytics · doi:10.3389/frma.2021.675071 · Cited by 75
Self-citation
Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis
Haig, S., & Hallett, N. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13065 · Cited by 43
Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross‐sectional survey
Newman, C., Roche, M. A., & Elliott, D. (2023) · Journal of Advanced Nursing · doi:10.1111/jan.15885 · Cited by 29
Barriers and enablers to the implementation of Safewards and the alignment to the i‐PARIHS framework – A qualitative systematic review
Björkdahl, A., Johansson, U. E., Kjellin, L., & Pelto‐Piri, V. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13222 · Cited by 23
“Violent and aggressive patient behaviour, unengaged or uncaring staff approaches, and the use of coercive measures are frequently reported, adding to a negative spiral of physical and psychological trauma and injury to both patients and staff (Weltens et al., 2021).”
Background
Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic
Janoušková, M., Pekara, J., Kučera, M., Kearns, P. B., Šeblová, J., Wolfová, K., Kuklová, M., & Šeblová, D. (2024) · Scientific Reports · doi:10.1038/s41598-024-59700-5 · Cited by 22
‘I Think the First Priority is Physically Safe First, Before You Can Actually Get Psychologically Safe’: Staff Perspectives on Psychological Safety in Inpatient Mental Health Settings
Vogt, K. S., Baker, J. A., Morys‐Edge, M., Kendal, S., Mizen, E., & Johnson, J. (2024) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13101 · Cited by 20
“Healthcare staff working in these settings, especially nurses and support workers, thus face a unique work environment of supporting individuals in crisis who often cannot keep themselves (or others) safe, while being at high-risk of exposure to, and experience of, violence (Weltens et al. 2021).”
The Predictive Value of Monocyte/High-Density Lipoprotein Ratio (MHR) and Positive Symptom Scores for Aggression in Patients with Schizophrenia
Cheng, N., Ma, H., Zhang, K., Zhang, C., & Geng, D. (2023) · Medicina · doi:10.3390/medicina59030503 · Cited by 17
Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers
Valimaki, M. A., Lantta, T., Lam, J. Y. T., Cheung, T. C. C., Cheng, P. Y. I., Ng, T., Ip, G., & Bressington, D. T. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03974-4 · Cited by 21
“Current explanation of reasons for aggression is a combination of factors embodied in patients, staff and the ward environment [7].”
BackgroundMethodInfluential
Aggression in Women with Schizophrenia Is Associated with Lower HDL Cholesterol Levels
Herceg, D., Mimica, N., Herceg, M., & Puljić, K. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms231911858 · Cited by 16
“In line with our results, aggression was associated with psychotic disorders, and higher scores on the PANSS were related to aggression [17].”
BackgroundResultInfluential
Predicting coercion during the course of psychiatric hospitalizations
Müller, M., Brackmann, N., Jäger, M., Theodoridou, A., Vetter, S., Seifritz, E., & Hotzy, F. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2023.3 · Cited by 16
“Waiting times on the ward, not being allowed to leave and rigid ward rules can overstrain the capacity to adapt and then lead to aggression [45].”
Background
Nutritional factors associated with aggression
Choy, O. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1176061 · Cited by 19
“Another review of 53 studies internationally showed that 23% of patients in psychiatric units exhibited aggression or agitation (2).”
Background
Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study
Valimaki, M. A., Lam, J. Y. T., Hipp, K., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106032 · Cited by 15
“[24] who found that patient aggressive events increased during ward rounds when nurses and doctors were occupied.”
BackgroundResult
Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed‐methods study
Maddineshat, M., Khodaveisi, M., Kamyari, N., Razavi, M., Pourmoradi, F., & Sadeghian, E. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12983 · Cited by 16
An analysis of Chinese nursing electronic medical records to predict violence in psychiatric inpatients using text mining and machine learning techniques
Hu, Y., Hung, J., Hu, L., Huang, S., & Shen, C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286347 · Cited by 15
“The factors considered to be most associated with patient aggression/violence are the existence of previous episodes, the victim and aggressor being of the same sex, being hostile and impulsive, having experienced involuntary admission, and having longer hospitalization [9, 21, 22].”
Background
Utilization and effects of security technologies in mental health: A scoping review
Anastasi, G., & Bambi, S. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13193 · Cited by 12
Aggressive behavior and its associated factors among persons with mental illness: An observational study
Kurian, L. P., Rentala, S., Chellappan, X. B., Srinivasan, P., & Thimmajja, S. G. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_195_23 · Cited by 13
“Aggression in an acute psychiatric care setting is generally explained as multifactorial including environmental factors such as ward design, privacy, doors, ambiance, noise, and stimulation; system‐related factors such as hospital, ward, and regional policies, attitude toward patients and cultural factors; patient‐re…”
BackgroundInfluential
Role of turnover, downsizing, overtime and night shifts on workplace violence against healthcare workers: a seven-year ecological study
Giusti, E. M., Veronesi, G., Forrest, H., Ghelli, M., Persechino, B., Borchini, R., Magnavita, N., & Ferrario, M. (2024) · BMC Public Health · doi:10.1186/s12889-024-20898-8 · Cited by 14
“…studies, and comparisons are complicated by differing denominators, such as fewer visitors, patients, and healthcare workers during night shifts, previous research has shown that the number of WPV episodes in psychiatric wards is relatively evenly distributed between day and night shifts [40].”
Psychiatric nurses’ experiences of patient violence on acute psychiatric units in Turkey: a qualitative study
Ayhan, C. H., Aktaş, M. C., & Karan, E. (2025) · BMC Nursing · doi:10.1186/s12912-025-03030-y · Cited by 13
Inpatient violence in a psychiatric hospital in the middle of the pandemic: clinical and community health aspects
Bellman, V., Thai, D., Chinthalapally, A., Russell, N., & Saleem, S. (2022) · AIMS Public Health · doi:10.3934/publichealth.2022024 · Cited by 14
“Most incidents of aggression occurred on acute admission or locked units, with a prevalence ranging from 44% to 62% on chronic units, and 30% in the outpatient department [15].”
BackgroundInfluential
Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables
Aguglia, A., Corsini, G. P., Berardelli, I., Berti, A., Conio, B., Garbarino, N., Gnecco, G. B., Magni, C., Venturini, E., Costanza, A., et al. (2023) · Medicina · doi:10.3390/medicina59101847 · Cited by 13
“In a systematic review, the weighted mean prevalence of aggressive behaviors was 54% (ranging from 7.5% to 75.9% between studies) [42].”
BackgroundInfluential
Staff and ward factors associated with aggression development on an acute closed psychiatric ward: an experience sampling method study
Weltens, I., Drukker, M., van Amelsvoort, T., & Bak, M. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-067943 · Cited by 12
Self-citation
Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence
Gong, M., Yao, L., Ge, X., Liu, Z., Zhang, C., Yang, Y., Amdanee, N., Wang, C., & Zhang, X. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160357 · Cited by 11
“The aggressive behaviors of hospitalized individuals typically manifest in the form of verbal aggression but can also occur as physical aggression in extreme circumstances (7, 18, 19).”
Background
Nurses’, patients’, and informal caregivers’ attitudes toward aggression in psychiatric hospitals: A comparative survey study
Valimaki, M. A., Lam, J. Y. T., Bressington, D. T., Cheung, T. C. C., Wong, W. K., Cheng, P. Y. I., Ng, C., Ng, T., Yam, C. P., Ip, G., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274536 · Cited by 15
“Although differences in attitudes toward aggression may not be a problem per-se, it is important to be aware of these variations and to better understand the factors that account for different opinions [16].”
Background
Do improved structural surroundings reduce restrictive practices in psychiatry?
Harpøth, A. J., Kennedy, H. G., Terkildsen, M. D., Nørremark, B., Carlsen, A. H., & Sørensen, L. U. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00562-7 · Cited by 10
“Thus, the new UH was designed to reduce crowding, provide private space, and promote well-being by using natural light, all of which have been suggested as instrumental when reducing violence in psychiatric wards [34, 35].”
Background
Burn-out and relationship with the learning environment among psychiatry residents: a longitudinal study
Chew, Q. H., Cleland, J., & Sim, K. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060148 · Cited by 10
Aggressive behaviour of psychiatric patients with mild and borderline intellectual disabilities in general mental health care
Nieuwenhuis, J. G., Lepping, P., Mulder, C. L., Nijman, H. L. I., & Noorthoorn, E. O. (2022) · PLoS ONE · doi:10.1371/journal.pone.0272502 · Cited by 10
Restrictive interventions on a psychiatric admission ward before and after COVID-19
Feeney, L., Bonner, N., & McAndrew, J. (2022) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2022.9 · Cited by 10
Space and Well-Being in High Security Environments
Roß, T., Bulla, J., & Fontao, M. I. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.894520 · Cited by 8
“Referring to this, in the subsection on bed occupancy, the authors state that “the evidence for overcrowding as a factor contributing to the occurrence of aggression is contradictory, but there is some evidence that overcrowding is associated with the occurrence of aggression” [(22), p.”
Background
Incidents related to safety in mental health facilities in Kenya
Kwobah, E. K., Kiptoo, R., Jaguga, F., Wangechi, F., Saina, C., Ogaro, F., & Aruasa, W. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09074-7 · Cited by 8
Unveiling Hidden Trauma: A Cross‐Sectional Study of Violence Exposure and Its Impacts on Entrapment, Self‐Stigma and Empathic Care Among Psychiatric Nurses
Atta, M. H. R., Eweida, R. S., Albzia, A., El‐Monshed, A. H., & Barakat, M. M. (2025) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13160 · Cited by 9
The Association Between Nurse Staffing and Conflict and Containment in Acute Mental Health Care: A Systematic Review
Woodnutt, S., Hall, S., Libberton, P., Ball, J., Dall’Ora, C., & Griffiths, P. (2025) · International Journal of Mental Health Nursing · doi:10.1111/inm.70039 · Cited by 8
“In contrast, Weltens et al. (2021) found greater experience was associated with more aggression reporting (OR = 3.5, CI = 1.32–8.26, p < 0.05), though the sample was small and the duration of the study short.”
Influential
De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas
Jones, N., Decker, V. B., & Houston, A. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230221-02 · Cited by 8
A highly scalable deep learning language model for common risks prediction among psychiatric inpatients
Zhu, E., Wang, J., Zhou, G., Li, C., Chen, F., Ju, K., Chen, L., Yin, Y., Chen, Y., Zhang, Y., et al. (2025) · BMC Medicine · doi:10.1186/s12916-025-04150-7 · Cited by 9
“Additionally, laboratory biomarkers also serve as risk predictors, possibly due to their association with metabolic dysregulation, inflammation, organ dysfunction, and medication side effects [73–76].”
Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards
Doedens, P., Vermeulen, J. M., ter Riet, G., Boyette, L., Latour, C. H. M., & de Haan, L. (2022) · Perspectives In Psychiatric Care · doi:10.1111/ppc.13099 · Cited by 7
“Several meta‐analyses investigated which patient characteristics influence the incidence of aggressive behavior, such as male sex, young age, and/or involuntary admission (Iozzino et al., 2015; Weltens et al., 2021).”
BackgroundResult
Staff support for workplace trauma: a freedom of information act request survey for NHS trusts providing mental health care in England
Berry, K., Allsopp, K., Gaskin, F., et al. (2023) · Journal of Mental Health · doi:10.1080/09638237.2023.2278094 · Cited by 7
“These in turn may result in poor patient care and consequent rises inpatient aggression, self-harm and suicide (Weltens et al., 2021).”
Antecedents and Consequences of Violence in Homeless Shelters: Perspectives and Experiences of Service Users and Shelter Staff
Kerman, N., Kidd, S. A., Voronov, J., et al. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241265419 · Cited by 7
“…a systematic review of contributory factors to aggression on psychiatric inpatient units found that overcrowding patients not feeling heard when raising concerns, lack of privacy, poor staff communication, and noisier environments were each linked to greater aggression (Weltens et al., 2021).”
Solving the shortage of psychiatric – mental health nurses in acute inpatient care settings
Frawley, T., & Culhane, A. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12964 · Cited by 6
A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high‐risk patient behaviours
Velmans, S. R., Joseph, C., Wood, L., & Billings, J. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12987 · Cited by 6
‘A ward full of emotional, aggressive people’: Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder
Rodwell, D., & Frith, H. (2024) · International Journal of Mental Health Nursing · doi:10.1111/inm.13308 · Cited by 6
Relationship between antipsychotic medication and aggressive events in patients with a psychotic disorder hospitalized for treatment
Tseligkaridou, G., Egger, S., Spiller, T. R., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04692-1 · Cited by 6
“Not only because they pose a risk for injury (and even traumatization) for the victims but also because they have adverse effects on the perpetrators, including the use of force for involuntary medication, isolation or restraint [8].”
Background
Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry
Sikstrom, L., Maslej, M. M., Findlay, Z., Strudwick, G., Hui, K., Zaheer, J., Hill, S., & Buchman, D. Z. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069255 · Cited by 7
Risk factors for involuntary admission in a Romanian patient sample
Paun, R., Pavel, A. N., Matei, V. P., & Tudose, C. (2023) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2023.101938 · Cited by 7
Experiences of preventing violence in two high-risk sectors: A qualitative study of front-line workers
Andersen, D. R., Karlsen, I., Jaspers, S. Ø., Pedersen, A. H. M., Andersen, L. P., & Aust, B. (2023) · Work · doi:10.3233/wor-220151 · Cited by 6
Aggression in Psychiatry: State of the Art
Chaika, Y. A., & Леонидович, Б. М. (2025) · Psikhiatriya · doi:10.30629/2618-6667-2025-23-1-98-112 · Cited by 5
Risk factors for suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders: An analysis using the Japanese Adverse Drug Event Report database
Uwai, Y., & Nabekura, T. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.07.005 · Cited by 5
Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care
Dharma, C., Bondy, S. J., Sikstrom, L., Muirhead, P. S., Zaheer, J., & Maslej, M. M. (2024) · Psychiatric Services · doi:10.1176/appi.ps.20240108 · Cited by 5
Associations between violence, self‐harm and acute psychiatric service use: Implications for inpatient care
McIvor, L., Payne‐Gill, J., & Beck, A. (2022) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12872 · Cited by 5
Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa
Thandavhathu, T. G., Maluleke, M., Raliphaswa, N. S., et al. (2024) · Health SA Gesondheid · doi:10.4102/hsag.v29i0.2158 · Cited by 5
“The verbal aggression that nurses experienced in this study is well recorded in several studies of a similar nature (Hahn 2020; Fritz et al. 2020; Maluleke & Van Wyk 2017; Michael 2021; Stephens & Zile 2017; Weltens et al. 2021).”
Result
Exploring Nurses’ and Nursing Students’ Attitudes Toward Coercive and Technological Measures in Mental Health: A Conceptual Framework and Study Protocol
Anastasi, G., Latina, R., Longobucco, Y., Stievano, A., & Bambi, S. (2024) · Nursing Reports · doi:10.3390/nursrep14040301 · Cited by 5
“Violence remains a critical issue, with a significant number of psychiatric inpatients exhibiting violent behavior [7], engaging in self-harm, or revealing suicidal ten-dencies [8].”
Violence Risk Assessment Tools Used in Forensic and Acute Psychiatry in North America: A Scoping Review
Rosca, M. A., Charité-Harbec, O. L., Allard, J.-M., Pagé, S. B., & Hudon, A. (2025) · Psychiatry International · doi:10.3390/psychiatryint6010008 · Cited by 4
Sexual Violence Against Mental Health Nurses in Inpatient Psychiatric Settings: A Systematic Review of Prevalence, Outcomes, and Risk Factors
Anastasi, G., Monaco, M. L., Figura, M., D’Amico, D., Amodio, E., Stievano, A., Notarnicola, I., & Latina, R. (2026) · Nursing Reports · doi:10.3390/nursrep16020059 · Cited by 4
Patient Perspectives on Open-Door Policies in Psychiatry: Mixed Methods Study
Liwinski, T., Davidson, R., Sarlon, J., Gaupp, R., Imfeld, L., Brühl, A. B., Vogel, M., Huber, C. G., & Lang, U. E. (2025) · Journal of Medical Internet Research · doi:10.2196/73610 · Cited by 6
“Despite the central role that patient experiences play in shaping psychiatric care, empirical research capturing their perspectives remains scarce [32,33].”
The neurophysiology of aggressiveness: From adaptive behavior to pathology and deep brain stimulation
Santin, M. D. N. (2025) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2025.103090 · Cited by 5
Dissociating prefrontal contribution to reactive and proactive aggression: a transcranial direct current stimulation study
Gramegna, C., Barbieri, B., & Bolognini, N. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-025-02087-9 · Cited by 4
Difficulties in providing nursing care to children with neurodevelopmental disorders admitted to child and adolescent psychiatric units for aggressive behavior
Kato, Y., Kawahara, T., Endo, Y., & Yamazaki, A. (2025) · Japan Journal of Nursing Science · doi:10.1111/jjns.70001 · Cited by 3
“About 25% – 80% of nurses experience physical violence within psychiatric health-care facilities (Weltens et al., 2021).”
Expanding the Five Urgent Recommendations: Advancing Workplace Safety in Healthcare Settings
Schimmels, J., Beeber, L. S., Delaney, K. R., Hauenstein, E. J., Iennaco, J. D., Sharp, D. L., & Shattell, M. M. (2025) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903251348948 · Cited by 5
“But as Weltens et al. (2021) point out, the patient-related risk factor offers the fewest possibilities in WPV prevention efforts.”
Exploring the nature and prevalence of targeted violence perpetrated by persons found not criminally responsible on account of mental disorder
Almond, M. F. E., Nicholls, T. L., Petersen, K. L., et al. (2023) · Behavioral Sciences & the Law · doi:10.1002/bsl.2626 · Cited by 4
Development of a Pediatric Behavioral Early Warning Scale (Pedi-BEWS) for Children
Eisenstein, M., Chung, J., Domaleski, V., et al. (2023) · Journal of Nursing Measurement · doi:10.1891/jnm-2021-0068 · Cited by 4
Optimizing Patient Safety and Security Management in Zambian Mental Health Facility: A PDSA Quality Improvement Study
Tsarkov, A., Fernandez, A. F. D. A., Ribeiro, M. L., & Petlovanyi, P. (2024) · European Journal of Medical and Health Sciences · doi:10.24018/ejmed.2024.6.3.2112 · Cited by 3
“The potential for harm to themselves or others can pose significant security risks [11]–[13].”
Background
Prevalence of aggression and associated factors among inpatients with mental illness at tertiary hospitals in Southwestern Uganda
Kayongo, B., Rukundo, G. Z., Favina, A., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06865-6 · Cited by 3
“The findings of our study showed that verbal aggression was the commonest form of aggression and the findings are similar to other previous studies conducted in Europe and in Sub-Saharan Africa reporting a prevalence of more than 50% [11, 21, 22].”
Facilitators and barriers to the deprescribing of benzodiazepines and Z-drug hypnotics in patients under 65 on adult mental health wards
Filmer, S., & Maidment, I. (2025) · Scientific Reports · doi:10.1038/s41598-025-25261-4 · Cited by 4
Aggression, violence and threatening behaviour during critical illness
Northcott, M. H., Johnston, G., Presneill, J., et al. (2023) · Critical Care and Resuscitation · doi:10.1016/j.ccrj.2023.05.002 · Cited by 3
“22,23 Interestingly, patients who had a Code Grey event in ICU had lesser APACHE III 24 severity of illness scores when compared to patients who did not have a Code Grey event.”
Background
Individual Variance in Human Aggression: A Combined Effect of Polygenic Score and Social/Lifestyle Factors
Kazantseva, A. V., Davydova, Y. D., Enikeeva, R. F., Yakovleva, D. V., Mustafin, R. N., Lobaskova, M. M., Malykh, S. B., & Хуснутдинова, Э. К. (2023) · Russian Journal of Genetics · doi:10.1134/s1022795423140065 · Cited by 3
“While occasional smoking can help to overcome exaggerated stress, nicotine addiction causes worsening of aggressive behavior [25].”
Intervening factors between risk of violence and aggressive behaviours among forensic inpatients: a scoping review
Badruddin, N. A., Roseliza-Murni, A., Kamaluddin, M. R., Badayai, A. R. A., & Munusamy, S. (2024) · BMC Psychology · doi:10.1186/s40359-024-01649-1 · Cited by 4
“At the same time, it creates a climate for victimisation [22], reduces positive group climate [23], and increases staff burnout [24].”
Background
Exploring the Consequences of Aggressive Experiences on Psychiatric Nurses: A Real‐Time Assessment Study
Weltens, I., Drukker, M., van Amelsvoort, T., Domen, P. A. E., & Bak, M. (2024) · Perspectives In Psychiatric Care · doi:10.1155/2024/1952005 · Cited by 3
Self-citation
Measurement and Prevalence of Aggression
Iennaco, J. D., Molle, E., Lauvrud, C., et al. (2024) · Springer eBooks · doi:10.1007/978-3-031-61224-4_5 · Cited by 3
Examining Gender Differences in Aggression as a Predictor of Anxiety, Depression, and Suicide in a Cross‐Sectional French Sample
Martin, S. S. (2025) · Health Science Reports · doi:10.1002/hsr2.70359 · Cited by 3
“These results look aligning with the recent literature where gender did not appeared to play a role in patient's aggression [42] even if presented in 22 articles hypothetizing the dominance of male aggression.”
Who is Navigating this Ship? A Qualitative Interview Study of Nursing Staff’s Experiences of Implementing Safewards in a Forensic Mental Health Clinic
Karlsson, J., Anttonen, S., Kjellin, L., et al. (2025) · International Journal of Forensic Mental Health · doi:10.1177/14999013251332954 · Cited by 3
“In inpatient mental health settings, incidents of aggression, violence, and the use of coercive interventions, such as seclusion and restraint, often create a stressful and unsafe environment for both patients and staff (Weltens et al., 2021).”
Triggers of Agitation in Psychiatric Hospitalization Ward According to Professional Experience Questionnaire
Ortiz-Sandoval, I., Martínez-Quiles, M. D., López-Pérez, J., & Simonelli‐Muñoz, A. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042014 · Cited by 3
Negative Acts as Risk Factor for Work-Related Violence and Threats from Clients towards Employees: A Follow-Up Study
Andersen, L. P., Biering, K., & Conway, P. M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043358 · Cited by 3
“A review found that the development of aggression in patients was related to employee dissatisfaction with the leadership and poor collaboration between nurses [36], while a study among 228 employees in six residential homes for mentally retarded patients found that a poor social climate (e.”
Exploring the Psychosocial and Wellbeing Needs of Staff Accessing Trauma Support in Forensic Mental Health Services in the UK: Relations with Demographic, Occupational and Trauma Event Characteristics
Morris, D. J., Webb, E. L., Worsfold, J., & Greenwood, A. (2023) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2023.2183530 · Cited by 3
“Alternatively, they may be at increased risk for physical assaults, including racially motivated aggression, regardless of professional role (Weltens et al., 2021).”
Background
Incidence, Severity and Characteristics of Patients’ Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey
Čelofiga, A., Koprivšek, J., Kumperščak, H. G., & Plesničar, B. K. (2023) · Slovenian Journal of Public Health · doi:10.2478/sjph-2023-0027 · Cited by 3
“Although the frequency of aggressive behaviour in acute psychiatric settings in developed countries varies greatly (3, 4), on average the data are comparable to our national data.”
BackgroundResultInfluential
Møte med aggresjonsproblematikk i psykisk helsevern – instruktørers erfaringer med selvregulering
Lilledrange, S., Lockertsen, Ø., & Beyene, L. S. (2024) · Tidsskrift for psykisk helsearbeid · doi:10.18261/tph.21.1.4 · Cited by 3
Handling conflict situations in psychosis inpatient care: Nursing staff experiences of the Interactive Approach model
Arturén, H., Zetherström, J., Sjöström, N., Abrams, D., & Johansson, L. (2024) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13066 · Cited by 3
Year one review: Staff perception on the implementation of the chair restraint on an adolescent psychiatric inpatient unit
Seney, V., & Safford, J. (2023) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12414 · Cited by 3
The risk assessment of imminent inpatient aggression: A cross‐cultural validation study of the dynamic appraisal of situational aggression in Estonia
Lenk‐Adusoo, M., Kangro, R., & Haring, L. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13010 · Cited by 2
Aggression in psychiatry: a bibliometric analysis
Bulut, M., & Yıldırım, N. (2024) · Middle East Current Psychiatry · doi:10.1186/s43045-024-00476-9 · Cited by 2
“Prevalence rates of aggression in psychiatric wards range from 8 to 76% [3].”
Association between behavioral parameters of men in psychiatric emergency department video recording and subsequent violence in the psychiatric ward
Raad, R., Hirschmann, S., Bloemhof‐Bris, E., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06248-3 · Cited by 2
The relationship between moral, cultural, and spiritual competences with aggression of psychiatric nurses: a descriptive correlational study
Nazari, A. M., & Mousavizadeh, S. N. (2025) · BMC Psychology · doi:10.1186/s40359-025-03259-x · Cited by 2
“The occurrence of workplace violence in healthcare settings can lead to significant disruptions in nurse-patient communication, thereby endangering patient safety and negatively affecting the psychological well-being of the nursing staff, ultimately impacting the quality of care provided [8–10].”
Economic data on interventions for reducing aggression and restrictive interventions in inpatient mental health: a systematic review
Luigi, M., Imbeault, A., Crocker, A. G., & Latimer, E. A. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-025-00692-8 · Cited by 2
“According to an international review, 54% of psychiatric nurses experience verbal or physical aggression over the course of their career, whereas 23% of patients display aggressive behavior during hospitalization [3].”
Therapists and ward staff experiences of virtual reality-assisted aggression treatment in a maximum-security forensic psychiatric clinic
Andersson, Y. A., Bengtsson, M. L. K., & Moraga, F. R. G. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07866-9 · Cited by 3
“Within forensic psychiatry, aggressive incidents are among the most harmful and challenging, as they can result in serious physical or psychological harm to both fellow patients and staff members [26].”
The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders
Yirmiya, K., Constantinou, M., Simes, E., BATEMAN, A. W., Wason, J. M. S., Yakeley, J., McMurran, M., Crawford, M., Frater, A. P., Moran, P., et al. (2024) · Psychological Medicine · doi:10.1017/s003329172400062x · Cited by 4
“…mental health difficulties, particularly severe personality disorders and comorbidity, to increased aggression (Girasek, Nagy, Fekete, Ungvari, & Gazdag, 2022; Weltens et al., 2021; Whiting & Fazel, 2020) our model did not identify a significant link between p factor and aggressive behavior.”
Background
Violence Risk Assessment
Mistler, L. A., Almvik, R., Fluttert, F., Lockertsen, Ø., Hassiotis, A., Manton, M., & Pekara, J. (2024) · Springer eBooks · doi:10.1007/978-3-031-61224-4_6 · Cited by 2
Antecedents to aggression and the use of coercive measures in inpatient mental health settings: a scoping review protocol
Sterri, N. H. E., Lockertsen, Ø., Husum, T. L., Lockertsen, V., Siqveland, J., & Senneseth, M. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092632 · Cited by 2
“21 This ambiguity, combined with the fragmented nature of the literature on antecedents to both aggression and coercive measures, remains a challenge.”
Influential
The Association of Cortisol and Testosterone Interaction With Inpatient Violence: Examining the Dual‐Hormone Hypothesis in a Psychiatric Setting
Zerroug, Y., Imbeault, A., Giguère, C., Marin, M., & Geoffrion, S. (2025) · Aggressive Behavior · doi:10.1002/ab.70027 · Cited by 2
“Each domain encompasses numerous sub ‐ factors, such as institutional climate, staff qualification, level of privacy in the setting, patient's impulsivity, and patient's hormonal levels (Weltens et al. 2021; Cutcliffe et al. 2013; Das et al. 2018; Steinert and Whittington 2013).”
Suicidal risk in patients with aggression in schizophrenia: a systematic review
Bravve, L. V., Kaydan, M. A., & Kostyuk, G. P. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1560699 · Cited by 2
Responding to Escalating Behaviors on a Child Inpatient Unit: Five Elements Often Missing in De-escalation Dialogs
Delaney, K. R. (2025) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903251341557 · Cited by 2
“Child/adolescent investigators should examine these issues and conduct research that maps milieu situations preceding escalating situations and how they build into an aggressive incident (Weltens et al., 2021).”
Post-incident debriefing for people with schizophrenia after coercive measures
Valimaki, M. A., Varpula, J., & Lantta, T. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014487.pub2 · Cited by 2
Documenting Stigma: A Descriptive Qualitative Study of Psychiatric Emergency Notes of Aggressive Incidents
Imbeault, A., Billé, V., Lessard, G., et al. (2025) · Issues in Mental Health Nursing · doi:10.1080/01612840.2025.2512896 · Cited by 2
“These rules are frequently documented as contributing factors to aggressive incidents, where people receiving care contest or violate institutional regulations, leading to coercive practices aimed at securing compliance (Bowers et al. 2014; Weltens et al. 2021).”
“Bad news, bad behavior: The communication of bad news and aggressive behavior in healthcare. A multicenter retrospective italian study”
Marrone, M., Pititto, F., Paladini, E., et al. (2025) · Journal of Patient Safety and Risk Management · doi:10.1177/25160435251366614 · Cited by 2
“24,25 The way healthcare professionals communicate bad news signi ﬁ cantly in ﬂ uences how patients and their families receive, interpret, and cope with it.”
Fairness analysis of machine learning predictions of aggression in acute psychiatric care
Wang, Y., Sikstrom, L., Xiao, R., Findlay, Z., Zaheer, J., Hill, S., & Maslej, M. M. (2026) · npj Mental Health Research · doi:10.1038/s44184-026-00194-6 · Cited by 4
“Most outcomes were expected to occur on the ﬁ rst three days that a patient was receiving acute care 24 .”
Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward
Chang, P.-Y., Chen, J., Cheng, H.-W., & Wang, Y.-C. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s403388 · Cited by 2
“A previous study reported high scores on the Positive and Negative Syndrome Scale (PANSS) or BPRS that appear to increase risk of aggression.(21) Another study also found that persistent physical aggression before and during hospitalization was associated with higher overall BPRS scores.”
Person-in-Situation Framework of Aggression Among Persons with Severe Mental Illness: A Case Series
Gopika, G. G., Antony, S., Jayakumar, C., Moirangthem, S., Joseph, E., Gowda, G. S., & Reddi, V. S. K. (2023) · Indian Journal of Psychological Medicine · doi:10.1177/02537176231196289 · Cited by 1
How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique
Vogt, K. S., Baker, J. A., Coleman, R., Kendal, S., Griffin, B. L., Taha, A., Ashley, K. L., Archer, B. L., Berry, K., Feldman, R., et al. (2024) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzae086 · Cited by 3
Ward Culture and Atmosphere
Hallett, N., Duxbury, J. A., Björkdahl, A., et al. (2024) · Springer eBooks · doi:10.1007/978-3-031-61224-4_12 · Cited by 1
Ward Design, Coercion and Aggression in Psychiatric (Intensive) Care
van der Kruijff, E. N., van der Schaaf, P., Doedens, P., et al. (2024) · Springer eBooks · doi:10.1007/978-3-031-61224-4_10 · Cited by 1
Influence of sleep quality on aggressive behaviours: Predictive validity of the Brøset Violence Checklist-revised
Terzoni, S., Opreni, M., Lusignani, M., et al. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.03.018 · Cited by 1
Exploring the Utility of the Model for Understanding Inpatient Aggression for General Mental Health Settings
Maguire, T., Dunn, C., Furness, T., Carroll, A., & Daffern, M. (2025) · International Journal of Mental Health Nursing · doi:10.1111/inm.70045 · Cited by 1
“…(2017) and an interrupted time series analysis by Robson et al. (2019) found no link between a comprehensive smoke free policy and an increase in physical or verbal violence, which is contradicted by Weltens et al. (2021) who found that nicotine withdrawal symptoms are associated with aggression.”
Influential
Contributing factors to aggressive incidents in correctional and forensic psychiatric care: a rapid evidence assessment
Melunovic, I., Ireland, C. A., & Ireland, J. L. (2025) · Journal of Forensic Practice · doi:10.1108/jfp-02-2025-0017 · Cited by 1

Authors: Weltens, I., Bak, M., Verhagen, S., Vandenberk, E., Domen, P., van Amelsvoort, T., & Drukker, M.
Affiliations: Maastricht University (NL)
Corresponding author: Weltens, Irene
ORCID: Weltens, Irene
Bak, Maarten
Verhagen, Simone
Domen, Patrick
Drukker, Marjan
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2021-10-08
Volume: 16
Issue: 10
Pages: e0258346
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0258346
PMC: PMC8500453
OpenAlex: W3203779517
Semantic Scholar: e846fd8ddba3c076abcd3b2b177f0227618486b2
Cited by: 200
References: 181
Citations by year: 2026: 53 · 2025: 58 · 2024: 29 · 2023: 40 · 2022: 18 · 2021: 2
FWCI: 4.27
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
DSpace (Open University in the Netherlands) (publishedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
DSpace (Open University in the Netherlands) (submittedVersion, other-oa)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics: Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Workplace Violence and Bullying
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Keywords: aggression, psychiatric ward, prevalence, risk factors, patient factors, ward environment, psychosis, bipolar disorder, substance abuse, job strain, staff-patient interaction, aggression prevention
MeSH terms: Aggression, Bed Occupancy, Female, Health Personnel, Humans, Male, Mental Health, Psychiatric Department, Hospital, Risk Factors, Time Factors, Violence, Prevalence, Substance-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks