Anger Predictors of Aggressive Behavior on an Acute Inpatient Psychiatric Unit

Background: Violent behavior by patients on psychiatric units is a topic that has received considerable attention, particularly with regard to its consequences for nursing staff. While studies have sought to identify predictors of violence by inpatients, there is a dearth of research on dynamic risk factors, particularly anger. Aims: The present study investigates the viability of assessing anger among patients on an acute civil commitment psychiatric hospital unit and to examine its association with aggressive behavior. Methods: We evaluated the psychometric properties of several patient-rated anger assessment instruments and tested whether anger was predictive of subsequent patient-rated and nurse-rated aggressive behavior during the hospital stay of 42 patients. A brief, semi-structured diagnostic interview and measures of depression, early trauma, and coping were also used. Results: Patients’ self-ratings of anger, across all the psychometric scales, had high internal consistency and high concurrent validity, along with convergent and discriminant validity. Patient-rated anger was associated with patient-reported physical and verbal aggression and was prospectively predictive of aggressive behavior observed by psychiatric nurses, controlling for age, gender, and depression. Conclusions: Patients on an acute psychiatric unit can self-report anger that bears on their risk for short-term aggressive behavior. The value of nurse involvement in monitoring patients’ anger on inpatient psychiatric units is discussed, along with nurse-supported anger treatment programs.