Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital.

BACKGROUND: Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services. METHODS: We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression. RESULTS: One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness. CONCLUSIONS: The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.

The influence of changes in clinical factors on high-security forensic custody dispositions.

The demand for forensic psychiatric beds is increasing, while many individuals are "stuck" in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.

Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review.

OBJECTIVES: The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions. BACKGROUND: A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted. METHODS: We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet. RESULTS: From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises. CONCLUSIONS: This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations. RELEVANCE TO CLINICAL PRACTICE: This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study.

AIM: We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. BACKGROUND: Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. METHODS: We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. RESULTS: We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. CONCLUSION: Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

Using Graphs in Sexual Violence Risk Communication: Benefits May Depend on the Risk Metric.

Actuarial scales provide a relatively objective and reliable assessment of individuals' risk of recidivism. Recent research has explored how graphs can improve quantitative risk communication. We tested whether graphs can improve understanding and perception of sexual violence risk when matched with risk metric. Participants (N = 676) were recruited from Amazon's MTurk platform and read a brief description of a man convicted of a sexual offense, including results of a fictional sexual recidivism risk scale. In Study 1, absolute risk of recidivism enabled participants to distinguish between individuals with relatively high and low risk of sexual recidivism. In Study 2, this distinction was enhanced by adding a graph, especially when percentiles were communicated. Risk ratios increased perceived risk. Objective numeracy increased understanding and reduced perceived risk. We recommend that risk communication assumes limited statistical numeracy, and further research with practitioners to test the effect of graphs and risk metrics on forensic/judicial decisions.

Perceptions of Workplace Violence and Workplace Stress: A Mixed Methods Study of Trauma among Psychiatric Workers.

Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.

Mental health workers' experiences of support and help-seeking following workplace violence: A qualitative study.

The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.

Post-traumatic Stress Disorder, Depression, Anxiety Symptoms and Help Seeking in Psychiatric Staff: Trouble de stress post-traumatique, dépression, symptômes d'anxiété et recherche d'aide chez le personnel psychiatrique.

BACKGROUND AND METHODS: In this study, we surveyed 761 psychiatric hospital staff (69% women, 71% full-time, 56% nursing) regarding their exposure to trauma in the workplace; symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety; help seeking; and perceived barriers for help seeking. RESULTS: Significant proportions of staff met the screening cutoffs for probable PTSD (16%), depression (20%), and anxiety (16%). Comorbidity was high, with approximately half of those meeting the screening cutoff for PTSD also meeting the cutoffs for depression or anxiety. Only PTSD symptoms were uniquely associated with exposure to trauma in the workplace, but both PTSD and depression symptoms significantly predicted help seeking. Staff who met one or more screening cutoffs perceived more barriers to help seeking such as difficulty with accessing services. CONCLUSION: Implications for supporting psychiatric staff exposed to trauma are discussed.

Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health records compared with paper charts and verbal reports.

AIMS AND OBJECTIVES: To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. BACKGROUND: The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552) and considerable information missing (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker et al., 2008, J Clin Nurs, 17, 1122-1131). DESIGN: The project was a mixed-method, two-phase study that collected data from two sites. METHODS: In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. RESULTS: Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. CONCLUSIONS: We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. RELEVANCE TO CLINICAL PRACTICE: Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases.

Psychiatric Hospital Workers' Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms.

Background About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression. Objective We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic). Method Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL). Results All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced. Conclusion PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.

Communicating the risk of violent and offending behavior: review and introduction to this special issue.

How to communicate risk of recidivism in correctional and forensic contexts has been a subject of scholarly discussion for two decades. This emerging literature, however, is sparse compared with studies on the assessment of risk for violent and offending behavior. In this special issue of Behavioral Sciences and the Law, we have gathered together empirical and review papers exemplifying promising directions and methodologies. We begin with a review of the state of the field, and lessons that can be drawn from research into medical risk assessment and risk communication, finding that many of the same principles apply to the forensic context. How risks are framed, and how numerate assessors are, affects how risk information is understood and applied. We discuss the existing research bearing on these issues, as well as the conceptual, practical, empirical, and legal implications of communicating risk using numerical or categorical risk terms. Along with the seven articles in this volume, we suggest directions for future research on measuring and communicating change, understanding and managing the statistical literacy of those who use and communicate risk assessments, and developing a theoretical framework for forensic risk communication research. We hope this volume will help integrate and invigorate research into forensic risk communication.

Evidence for risk estimate precision: implications for individual risk communication.

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

Coercive control in a national U.S. self-report survey: Prediction of repeated intimate partner violence.

Coercive, controlling behavior toward intimate partners correlates with physical intimate partner violence (IPV). We examined whether it also predicts subsequent IPV or other aggression. We conducted a secondary analysis of self-reports by 1,039 women and 509 men who participated in the first two waves of the Interpersonal Conflict and Resolution Study (Mumford et al., 2019). We defined coercive control as any reported perpetration at Wave 1 of threat to physically harm, threat to use information to control, or put down or disrespect their partner. The participants also reported perpetration of verbal abuse and physical or sexual aggression against intimate partners. We tested correlations of these behaviors with similar acts toward nonintimates (friends or unfamiliar persons) in Wave 1 and the prediction of physical violence in Wave 2, approximately 5 months later. Coercive control (14% of men, 26% of women) was correlated with physical or sexual IPV (8% of men, 15% of women) in both women and men and with physical violence and coercive control to nonintimates. In logistic regressions entering Wave 1 physical IPV on the first step, Wave 1 coercive control was a significant independent predictor of Wave 2 physical IPV overall, and for men but not women. Coercive control did not independently predict nonintimate physical violence. Coercive control toward an intimate partner is a unique predictor of physical IPV among men. Future research should use improved measures of coercive control and further examine coercive control as an indicator of general antisociality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Biopsychosocial risk factors for intimate partner violence perpetration and victimization in adolescents and adults reported after the COVID-19 pandemic onset: a scoping review protocol.

OBJECTIVE: This scoping review aims to provide a comprehensive summary of the biological, psychological, and sociological risk factors for intimate partner violence (IPV) victimization and perpetration reported after the onset of the COVID-19 pandemic. INTRODUCTION: IPV is a significant public health concern, characterized by various forms of violence inflicted by intimate partners. The onset of the COVID-19 pandemic significantly increased the global prevalence of IPV. While prior research has identified factors linked to IPV, the risk factors reported in the literature during this period have not been systematically mapped. Additionally, the similarities and differences in risk factors between perpetration and victimization have not been well delineated. INCLUSION CRITERIA: This review will focus on individuals aged 12 years or older involved in dyadic romantic relationships. Primary studies and systematic reviews published from the year 2020 will be included. Full-text papers, preprints, theses, and dissertations published in English will be included. Studies focusing on factors unrelated to IPV risk will be excluded. Non-systematic reviews, opinion pieces, and protocols will also be excluded. METHODS: Following the JBI methodology for scoping reviews, systematic searches will be conducted for both peer-reviewed and gray literature. Independent reviewers will screen records, select eligible studies, and extract data using a standardized form. Key risk factors will be mapped to explore their interplay. REVIEW REGISTRATION: Open Science Framework https://osf.io/c2hkm.

Psychiatric inpatient services in Ontario, 2019-2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods.

BACKGROUND: The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period. METHODS: We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum). RESULTS: A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively. INTERPRETATION: Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.

Coping Strategies in Women and Children Living with Domestic Violence: Staying Alive.

Purpose: Children exposed to domestic violence are at risk of adverse short- and long-term psychosocial effects and of being abused themselves. However, mothers and children face systemic gaps when seeking safety from domestic violence services and police. Safety planning typically focuses on women, overlooking their multiple social identities and excluding their children. We explored safety strategies used by mothers and children coping together with severe domestic violence. Method: Interviews with 30 mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood were qualitatively analyzed using thematic analysis, revealing five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence. Results: Interpreting participants' experiences in terms of the mother-child dyad, we found that mothers and their children worked together to reassure each other, keep each other safe, and make plans to leave their abuser. Conclusions: Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage.

Recent Developments in Islet Biology: A Review With Patient Perspectives.

Navigating the coronavirus disease-2019 (COVID-19, now COVID) pandemic has required resilience and creativity worldwide. Despite early challenges to productivity, more than 2,000 peer-reviewed articles on islet biology were published in 2021. Herein, we highlight noteworthy advances in islet research between January 2021 and April 2022, focussing on 5 areas. First, we discuss new insights into the role of glucokinase, mitogen-activated protein kinase-kinase/extracellular signal-regulated kinase and mitochondrial function on insulin secretion from the pancreatic ß cell, provided by new genetically modified mouse models and live imaging. We then discuss a new connection between lipid handling and improved insulin secretion in the context of glucotoxicity, focussing on fatty acid-binding protein 4 and fetuin-A. Advances in high-throughput "omic" analysis evolved to where one can generate more finely tuned genetic and molecular profiles within broad classifications of type 1 diabetes and type 2 diabetes. Next, we highlight breakthroughs in diabetes treatment using stem cell-derived ß cells and innovative strategies to improve islet survival posttransplantation. Last, we update our understanding of the impact of severe acute respiratory syndrome-coronavirus-2 infection on pancreatic islet function and discuss current evidence regarding proposed links between COVID and new-onset diabetes. We address these breakthroughs in 2 settings: one for a scientific audience and the other for the public, particularly those living with or affected by diabetes. Bridging biomedical research in diabetes to the community living with or affected by diabetes, our partners living with type 1 diabetes or type 2 diabetes also provide their perspectives on these latest advances in islet biology.

The relation of childhood adversity and antisociality to suicide attempts in men admitted to forensic psychiatric hospital.

Suicide is a leading cause of death in custody. Although previous studies with prison inmates suggest a strong relation between childhood adversity and suicidal behavior, as well as between childhood adversity and antisociality, this has not been explored in the forensic psychiatric system. We compared 211 men admitted to a forensic hospital having a lifetime history of suicide attempts with 275 men with no suicide history in the same institution. Data were retrospectively coded from information gathered during their assessment and medical records. We examined associations of adverse childhood events and antisociality with suicide attempt history in a series of regression analyses. Childhood adversity was present in majority of individuals and significantly more common for individuals with a history of suicide attempts (76.8%) than those with no suicide attempts (63.3%). The suicide attempt group also experienced a greater number of adverse childhood events. Physical abuse, parental separation, and parental psychiatric history during childhood were associated with suicide attempts. Men with a suicide attempt history had higher antisociality scores than the comparison group and adult antisocial behavior partially mediated the relationship between adverse childhood experiences and suicide attempts. Men in forensic hospital who have suffered multiple experiences of childhood adversity are at increased risk for exhibiting antisocial behavior and engaging in suicidal attempts. Early interventions targeted toward antisociality and trauma-informed care in the forensic hospital are needed to support the mental health of the forensic population.

Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout.

Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.

Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice.

WHAT IS KNOWN ON THE SUBJECT?: Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics. We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provide training in risk assessment and violence prevention to psychiatric nurses. Offer mental health support to those exposed to violence, especially with cumulative exposure. ABSTRACT: Introduction Psychiatric nurses are at risk of workplace violence and post-traumatic stress disorder (PTSD). There is limited understanding of pre-trauma and post-trauma risk factors. Aim Our aim was to review factors associated with workplace PTSD in psychiatric nurses. Method We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full-text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best-fit framework synthesis, we identified workplace violence, pre-trauma and post-trauma risk factors. Results Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study ("promising": severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others ("suggestive": gender, poor training, any physical aggression exposure, compassion fatigue). Discussion Pre-trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research. Implications for Practice Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals.