Demystifying aggression in response to smoking bans in psychiatry

Objective: To investigate the aggressive behaviors of patients in a psychiatric hospital adhering to the anti-smoking law and to identify their associated factors. Materials and method: This cross-sectional epidemiological study analyzed the medical records of 573 discharged patients from a Brazilian psychiatric hospital. The response variables included verbal aggression, physical aggression, physical restraint, and mechanical restraint. Multiple Poisson regression models were applied for analysis. Results: Approximately 48% of the patients were smokers. Aggression was found to be 121% higher among younger patients (aged 19-35), 73% higher among those with longer hospital stays, 55% higher among individuals hospitalized involuntarily, and 89% higher among those prescribed five or more psychotropic drugs, independent of other variables. Additionally, individuals hospitalized after the implementation of the smoking ban exhibited 55% fewer aggressive behaviors compared to those hospitalized prior to the ban. Conclusions: The study revealed that the associations between smoking and aggression, as well as the duration of hospitalization relative to the smoking ban, were influenced by personal and clinical variables. Cultural beliefs about the perceived benefits of smoking may be perpetuated among individuals with mental disorders, while older nursing professionals might influence younger colleagues’perspectives on permitting smoking in mental health settings as a means of mitigating aggression. Breaking this cycle of misinformation requires generating new knowledge and insights, which represents a significant contribution of this study.