Predictors of violent incidents amongst patients in psychiatric intensive care units: A review of global evidence

Aim: The objective is to identify key predictors of violent behaviour amongst patients admitted to PICUs. Methods: A literature search was carried out in five online databases using a predefined strategy with terms relevant to the setting and population. Articles were screened based on the inclusion criteria and quality assessed using the Hawker critical appraisal tool. A thematic matrix was prepared from the final articles to highlight the pivotal predictors for violent behaviour in PICUs. Results: Initial search without duplicates retrieved 152 articles, of which 120 were excluded after screening their title and abstract. The full-text of 32 articles was read of which a total of 10 studies with 4733 participants were included in the literature review. These studies had good designs and methodological quality. The key predictors of violent incidents were a longer duration of in-patient stay, higher readmission rate, non-voluntary admission to PICUs, previous history of violence and substance misuse, permanent staff absences, being a single young male, having low level of education and having schizophrenia. Conclusion: The findings suggest that a variety of different factors contribute to violent incidents in PICUs. Our results may assist in the development of community and hospital-based interventions including situation management regular staff training, promoting a friendly environment and post-incident debriefs that can prevent future violent incidents in PICUs