Predicting falls among psychiatric inpatients: a case-control study at a state psychiatric facility.

OBJECTIVE: The purpose of the study was to add to the research on risk of falling in an understudied population of psychiatric inpatients in an acute setting. METHODS: Five years of fall data in an inpatient psychiatric facility, where falls were frequent but benign, were examined for patient and treatment characteristics that might be associated with falls. This was a retrospective analysis, which matched 1:1 the medical records of fallers and nonfallers on primary psychiatric diagnoses. The total sample consisted of 148 patients. Statistical analysis was conducted on patient demographic characteristics, summed medical history items reported, summed physical complaints on the day of the fall, the number and types of medications taken within a 24-hour period of the fall, and the patient's vital signs. Multivariate logistic regression was used to identify the most salient associations with faller status. RESULTS: Univariate analyses revealed that fallers were prescribed significantly more medications and complained of more physical symptoms on the day of their fall. Fallers were more likely to have a current acute medical condition and to be currently prescribed clonazepam or antihypertensive medication. Multivariate logistic regression analysis revealed that current physical complaints and current clonazepam treatment had significant associations with faller status. CONCLUSIONS: Risk factors identified in this study should be assessed in replication studies. Psychiatric clinicians can use such risk factors to create evidence-based fall prevention programs.

Assessing behavioral coping preferences of psychiatric inpatients: a pilot study.

BACKGROUND: Recently there has been increased concern about excessive restraint and seclusion on inpatient psychiatric units and the resulting injuries and deaths. Individual crisis management strategies may be one way to reduce restraint and seclusion, which may include active engagement of inpatients in behavioral coping plans. METHOD: We developed a 5-question Coping Agreement Questionnaire (CAQ) asking inpatients for their preferences on how to prevent loss of control if they become agitated. Nurses completed the CAQ with each patient to find alternatives to restraint and seclusion. A total of 264 admissions were reviewed, with the following diagnoses: mood disorders (n = 111 [42%]), schizophrenia or other psychotic disorders (n = 69 [26%]), or substance use disorders (n = 58 [22%]). One hundred thirty-seven patients (52%) were male. RESULTS: Many CAQ answers differed by diagnosis, sex, age, and ethnicity. For example, when asked how staff could help if they were about to lose control, all groups rated "talk with me" highly, although substance abusers preferred to "sit by self in room." Adolescent patients were more often upset by not having visitors, whereas elderly patients reported being upset by having visitors. Overall, white patients gave more answers to CAQ questions than did black or Hispanic patients. CONCLUSIONS: The findings have implications for practice on 3 levels. First, overall implications for the milieu were suggested by patients' preferences. Second, responses that differed by group suggested that optimal case management strategies may vary according to population characteristics. Third, patients may be engaged on the basis of individual preferences as active partners in managing their behavior during inpatient hospitalization.

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks.

A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.