Understanding Risk Factors for Physical Assault in a Large Inpatient Behavioral Health System

Psychiatr Serv. 2025 May 21:appips20250075. doi: 10.1176/appi.ps.20250075. Online ahead of print.

ABSTRACT

OBJECTIVE: To enhance understanding of the risk for violence in inpatient psychiatric environments, the authors studied assaultive behavior in a large health care system to explore the demographic, clinical, and other factors associated with the likelihood of patients’ committing a physical assault.

METHODS: In this retrospective chart review study, 3 years of data were collected from a single-state health care system spanning >330 inpatient psychiatric beds across six separate hospitals. The system’s risk management database was queried for all physical assaults during the study period (2021-2023), and these assaults were cross-matched with patients’ electronic medical record data. Descriptive and inferential statistical analyses were conducted to investigate differences between patients who had committed an assault during the study period and those who had not.

RESULTS: A total of 15,186 unique inpatients were evaluated, and 556 physical assaults committed by 359 (2.4%) patients during the study period were identified. Patients who committed an assault were significantly more likely to be male, be younger, identify as Black or African American, have a psychotic disorder, be subject to conservatorship, have been admitted involuntarily, and have a known history of assault. Patients with a comorbid substance use disorder were significantly less likely to engage in assault.

CONCLUSIONS: This study represents one of the largest investigations into rates of assault by patients in U.S. inpatient psychiatric hospitals. By attaining a greater understanding of risk factors for inpatient assault, this study may contribute to the development of risk assessment and management methodologies.

PMID:40395080 | DOI:10.1176/appi.ps.20250075