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World J Psychiatry. Jan 19, 2022; 12(1): 1-23
Published online Jan 19, 2022. doi: 10.5498/wjp.v12.i1.1
Prevalence and correlates of aggressive behavior in psychiatric inpatient populations
Hunor Girasek, Vanda Adél Nagy, Szabolcs Fekete, Gabor S Ungvari, Gábor Gazdag
Hunor Girasek, Vanda Adél Nagy, Gábor Gazdag, Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
Szabolcs Fekete, Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
Szabolcs Fekete, School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
Gabor S Ungvari, Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
Gabor S Ungvari, Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
Gábor Gazdag, Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
Author contributions: Gazdag G and Fekete S designed the project; Girasek H and Nagy VA performed the literature search and prepared the first draft of the manuscript; Gazdag G, Fekete S and Ungvari GS critically reviewed and corrected the manuscript; all authors approved the final version of the text.
Conflict-of-interest statement: Authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Gábor Gazdag, MD, PhD, Professor, Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Köves út 1, Budapest 1204, Hungary.
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: June 5, 2021
Revised: June 18, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: January 19, 2022

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.

Keywords: Aggression, Mental disorders, Inpatients, Prevalence, Risk factors, Risk assessment

Core Tip: The aim of this paper is to provide an overview of the prevalence of aggressive behavior of patients with various psychiatric disorders focusing mainly on inpatient populations. It also discusses the most commonly used measurement tools for aggressive behavior. As aggressive behavior endangers the safety of both patients and staff, predicting aggression is a key to its prevention. This review also highlights the importance of risk assessment and prevention of aggression in psychiatric patients.