A model of aggression in psychiatric hospitals.

Objective: Research of the determinants of inpatient aggression indicates that certain environmental hospital variables play a role in triggering aggression in psychiatric hospitals. Yet, how patient, staff and ward variables interact in eliciting aggression is not well understood.

Method: On the basis of earlier findings, a model was proposed in which psychopathology and distorted cognitions of the patient are combined with environmental and communicational stressors that are specific for psychiatric wards.

Results: The proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence.

Conclusion: Although tentative, the model may shed light on the mechanisms that lead to (repeated) violence.