Article Figures & Data
Figures
- Figure 1.
Staff victims by role and location. Percent of assault incident reports where staff members were identified as victims in a psychiatric emergency room (n = 60 assaults) and two inpatient psychiatry units (n = 124 assaults). No medical students, nurse practitioners, or physician assistants were assaulted in the study time period.
- Figure 2.
Incidents by location and time of day. Percent of assault incident reports occurring in each time period in a psychiatric emergency room (n = 60 assaults) and two inpatient psychiatry units (n = 124 assaults).
- Figure 3.
Means of assault by location. Percent of incidents for each means of assault in a psychiatric emergency room (n = 60 assaults) and two inpatient psychiatry units (n = 124 assaults).
- Figure 4.
Interventions by location. Percent of incidents where each intervention was utilized in a psychiatric emergency room (n = 60 assaults) and two inpatient psychiatry units (n = 124 assaults). IM, intramuscular.
Tables
Themec Paradigmatic Examples Psychiatric Emergency Room, n (%) Inpatient Units, n (%) Psychosis 36 (60) 71 (57) Disorganization Incident is unprovoked and accompanied by other nonsensical behavior 25 (42) 56 (45) Paranoia Patient complains that a person is talking about him or her, then strikes that person 13 (22) 20 (16) Perceptual disturbance Patient has command auditory hallucinations to hurt others 4 (7) 10 (8) Conflicts with peers 8 (13) 34 (27) Taunting One patient calls another patient a derogatory name 3 (5) 17 (14) Dispute over limited resource Two patients want to use the same computer at the same time 0 (0) 7 (6) Annoyed by behavior on the unit A patient is talking loudly and constantly, which is bothering many on the floor and ultimately triggers an incident 1 (2) 7 (6) Dispute over personal space or property A patient enters the wrong room, or roommates disagree on whether the door should be open or closed 1 (2) 4 (3) Direct challenge to fight One patient challenges another patient to fight 2 (3) 2 (2) Retaliation Incident is a response to an argument that started the previous day 0 (0) 7 (6) Defending others Patient thinks someone else is about to be attacked 1 (2) 3 (2) Phenomenological escalation Patients are shadow boxing, then start real boxing 0 (0) 2 (2) Conflicts with staff 20 (33) 32 (26) Objection to unit rules or structure Patient is asked not to stand next to the door 4 (7) 18 (15) Admission or discharge dispute The patient wants immediate discharge 12 (20) 12 (10) Perceived needs are not being met Patient demands opioids for pain 4 (7) 4 (3) Other themes 16 (27) 37 (30) Accidental assault Person is flailing arms without targeting anyone in particular, or a staff member gets pushed while keeping two patients apart 1 (2) 3 (2) Dispute involving food Staff threw away food a patient was intending to eat 0 (0) 6 (5) Themes related to sexuality Patient feels a romantic connection with a staff member and touches the staff member inappropriately, or targets a perceived rival, or feels insulted on the basis of sexuality 3 (5) 11 (9) Family involvement Incident happens after a family visit 6 (10) 13 (10) Bodily integrity Patient thinks he or she is about to be attacked 2 (3) 4 (3) No identifiable narrative Patient is not described as disorganized, but no clear narrative is mentioned 4 (7) 1 (1) ↵a The full code book, with definitions for each code or theme, is available in the supplemental materials.
↵b There were n = 60 total incidents in the psychiatric emergency room and n = 124 incidents on the inpatient units.
↵c Category counts (e.g., psychosis) may differ from theme count sums (e.g., disorganization, paranoia, perceptual disturbance) because some incidents involved multiple themes within a category.
- Table 2
Demographic and Clinical Characteristics That Are Significantly Different across Patients Groups
Psychiatric Emergency Room Patients with Incident Reports Inpatients with Incident Reports Psychiatric Emergency Room Patients with No Incident Reports Test Statistic (df) P Psychiatric Emergency Room Patients with Incident Reports versus Inpatients with Incident Reports Psychiatric Emergency Room Patients with Incident Reports versus Psychiatric Emergency Room Patients with No Incident Reports Test Statistic (df) P Test Statistic (df) P Age, y 37.5 ± 14.3 33.2 ± 12.5 41.4 ± 15.1 F(2,262) = 6.38a .0020 t(153) = 1.88b .062 t(163) = 3.51b .0006 Categorical variablesc Employed 9 (17.0) 12 (12.0) 30 (28.9) χ2(2) = 9.44 .009 χ2(1) = 0.73 0.39 χ2(1) = 2.65 .104 Prior arrests 31 (58.5) 59 (60.2) 46 (43.0) χ2(2) = 6.97 .031 χ2(1) = 0.042 .84 χ2(1) = 3.41 .065 Current AOT 6 (11.1) 5 (5.1) 2 (1.8) χ2(2) = 6.59 .037 χ2(1) = 1.92 .17 χ2(1) = 6.66 .010 History of violence 38 (70.4) 63 (65.6) 41 (39.8) χ2(2) = 19.11 <.001 χ2(1) = 0.35 .56 χ2(1) = 13.24 <.001 Presented with thoughts to harm others 27 (49.1) 50 (50.5) 14 (12.7) χ2(2) = 39.50 <.001 χ2(1) = 0.028 .87 χ2(1) = 25.96 <.001 Recent cannabinoid use 25 (45.5) 39 (39.0) 29 (26.4) χ2(2) = 6.94 .031 χ2(2) = 0.61 .44 χ2(2) = 6.07 .014 Recent cocaine use 14 (25.5) 14 (14.0) 33 (30.0) χ2(2) = 7.80 .020 χ2(2) = 3.15 .076 χ2(2) = 0.37 .54 Schizophrenia, schizoaffective, or bipolar disorder χ2(4) = 38.09 <.001 χ2(2) = 1.50 .47 χ2(2) = 31.62 <.001 None 6 (10.9) 14 (14.0) 37 (33.6) Yes, without manic symptoms 22 (40.0) 47 (47.0) 61 (55.5) Yes, with manic symptoms 27 (49.1) 39 (39.0) 12 (10.9) Unipolar depression 1 (1.8) 6 (6.0) 17 (15.5) χ2(2) = 10.10 .006 χ2(2) = 1.44 .23 χ2(2) = 7.02 .008 Intellectual disability 5 (9.1) 11 (11.0) 1 (0.9) χ2(2) = 9.71 .008 χ2(2) = 0.14 .71 χ2(2) = 7.00 .008 Antisocial personality disorder or traits 7 (12.7) 3 (3.0) 5 (4.6) χ2(2) = 6.73 .035 χ2(2) = 5.56 .018 χ2(2) = 3.64 .056 Psychiatric emergency room patients with incident reports: n = 55; inpatients with incident reports: n = 100; psychiatric emergency room patients with no incident reports: n = 110. Data are presented as mean ± SD or n (%). The full analysis with all demographic and clinical variables is available in the supplemental materials.
↵a Analysis of variance for parametric continuous variables.
↵b Post hoc analyses without adjustment.
↵c χ2 test for categorical variables.
df, degrees of freedom; AOT, assisted outpatient treatment.
- Table 3
Conditional Logistic Regression of Factors Associated with Having an Assault Incident Report among Psychiatric Emergency Room Patients
Crude Odds Ratio (95% CI) P Adjusted Odds Ratio (95% CI) P Age 0.96 (0.94–0.99) .002 0.93 (0.86–0.999) .048 Gender Male 1.00a 1.00a Female 0.73 (0.35–1.51) .397 0.15 (0.007–2.68) .194 Employment Employed 1.00a 1.00a Unemployed 2.04 (0.88–4.67) .094 2.35 (0.38–14.41) .356 Prior arrest No 1.00a 1.00a Yes 1.88 (0.94–3.79) .075 0.53 (0.075–3.74) .525 Current AOT No 1.00a 1.00a Yes 12.96 (1.44–99.67) .021 0 (0–infinity) .995 History of violence No 1.00a 1.00a Yes 3.69 (1.71–7.97) .001 4.08 (0.48–35.01) .200 Presented with thoughts to harm others No 1.00a 1.00a Yes 7.13 (2.91–17.50) <.001 10.94 (1.01–118.94) .049 Recent cannabinoid useb No 1.00a 1.00a Yes 2.29 (1.15–4.54) .018 0.33 (0.028–3.75) .370 Schizophrenia, schizoaffective, or bipolar disorder None 1.00a 1.00a Yes, without mania 2.30 (0.79–6.69) .128 1.10 (0.11–11.14) .939 Yes, with mania 19.39 (5.05–74.52) < .001 27.86 (1.18–656.85) .039 Unipolar depression No 1.00a 1.00a Yes 0.12 (0.02–0.88) .038 0.56 (0.02–12.57) .712 Intellectual disability No 1.00a 1.00a Yes 10.00 (1.17–85.59) .036 0 (0–infinity) .994 Antisocial personality disorder No 1.00a 1.00a Yes 2.80 (0.89–8.82) .079 1.61 (0.11–23.34) .729
