A study on prevalence and risk factors of aggression among psychiatric inpatients in a tertiary hospital in India

Abstract Background: The study was conducted with the background evidence that aggression is a psychiatric emergency, and prompt management requires understanding the predictors for such acts. There are minimal studies in South India, aimed at studying aggression in patients with any psychiatric diagnosis. Materials and Methods: A cross-sectional study was conducted in a tertiary care center of Kerala over a period of 2 years, among 175 inpatients of psychiatric ward. ICD-10 was used to diagnose the patients, and the Modified Overt Aggression Scale (MOAS) was used to determine the severity of aggression. The study also assessed the possible associations between sociodemographic factors, clinical variables, and aggression using the Chi-square test and multivariate logistic regression analysis. Results: The prevalence of aggressive behavior was 41.1% ( n = 72) among the psychiatric inpatients, with psychosis (45.8%), mood disorder (42.4%), and the personality disorders (66.7%) being the most common. The most significant risk factors were younger age of onset of illness (median age of onset was 22 [16, 30], recent history of aggression [odds ratio (OR) =19.03, 95% confidence interval (CI) =7.031, 51.51], history of aggression [OR = 16.01, 95% CI = 4.57, 56.04]), illicit drug use (90%), more number of previous admissions (64.7%), and psychotic symptoms (61.1%). Most of the aggressive patients required supported admission ( P = 0.004) and prolonged hospitalization ( P < 0.001). Conclusion: Examining and predicting the risk factors help the hospital categorize at-risk patients and prevent aggressive behaviors in the ward by guiding the staff and caregivers.