The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients

Authors

  • James R. P. Ogloff J.D., Ph.D., F.A.P.S,

    Corresponding author
    • Monash University, Thomas Embling Hospital, Locked Bag 10, Fairfield, Victoria 3078, Australia.
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    • Centre for Forensic Behavioural Science, Monash University and Victorian Institute of Forensic Mental Health, Australia.

  • Michael Daffern Ph.D.

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    • Centre for Forensic Behavioural Science, Monash University and Victorian Institute of Forensic Mental Health, Australia.


  • The authors are grateful to Trish Martin for her insight and comments on the development of the DASA and work relating to inpatient aggression. We thank Roger Almvik, Phil Woods, and Christopher Webster for graciously allowing us to incorporate items from their measures into the DASA. We also thank staff at the Thomas Embling Hospital for their diligence in completing the measures used in this study. We are also grateful to Stuart Thomas and Simon Moss for their advice and assistance with the statistical analyses employed in this work.

Abstract

Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression. Copyright © 2006 John Wiley & Sons, Ltd.

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