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Violent Behavior in Acute Psychiatric Inpatient Facilities: A National Survey in Italy

Biancosino, Bruno MD*; Delmonte, Sara MD; Grassi, Luigi MD*; Santone, Giovanni MD; Preti, Antonio MD§; Miglio, Rossella PhD; de Girolamo, Giovanni MDfor the PROGRES-Acute Group

The Journal of Nervous and Mental Disease: October 2009 - Volume 197 - Issue 10 - p 772-782
doi: 10.1097/NMD.0b013e3181bb0d6b
Original Article

Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members. Variables associated with violent behavior were: male gender, <24 years of age, unmarried status, receiving a disability pension, having a secondary school degree, compulsory admission, hostile attitude at admission, and a diagnosis of schizophrenia, bipolar disorder, personality disorder, mental retardation, organic brain disorder or substance/alcohol abuse. Violent behavior during hospitalization was a predictive factor for higher Brief Psychiatric Rating Scale scores and for lower Personal and Social Performance scale scores at discharge. Despite the low percentage of violent and hostile behavior observed in Italian acute inpatient units, this study shed light on a need for the careful assessment of clinical and treatment variables, and greater effort aimed at improving specific prevention and treatment programs of violent behavior.

*Section of Psychiatry, Department of Mental Health, University of Ferrara, Ferrara, Italy; †Villa Igea Psychiatric Clinic, Modena, Italy; ‡Psychiatric Clinic, United Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy; §Department of Psychology, University of Cagliari, Cagliari, Italy; ¶Department of Statistics, University of Bologna, Bologna, Italy; and ∥IRCCS Centro S. Giovanni di Dio-Fatebenefratellsi, Brescia, Italy.

Supported by funds from the Italian Ministry of Health.

This paper is dedicated to the memory of Pierluigi Morosini, MD, who was the Scientific Director of the National Mental Health Project, and enthusiastically supported and contributed to the development and conduct of this national research project.

Send reprint requests to Giovanni de Girolamo, MD, IRCCS Centro San Giovanni di Dio, Fatebenefratelli, Via Pilastroni, 20125 Brescia, Italy. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.