Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2017-2022.

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in medical injury, human suffering, and dollar cost expense. International research through 2000-2017 documented the continued frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five-year period of 2017-2022. There were 39,034 assaults on 34,679 employee victims. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s and that nursing personnel continued to be at greater risk. Aggression management approaches, post-incident interventions, and an updated methodological inquiry are presented.

Public Works Employees and Posttruamatic Stress Disorder: an At-Risk Population.

Although not widely known, public works employees in the United States were designated as emergency providers during critical incidents in 2003 and have provided these public works services, when activated. These public works employees may be either employees of a specific government entity or, more recently, privately contracted employees who provide similar services for a government entity. First responders working critical incidents are at risk for psychological trauma and posttraumatic stress disorder (PTSD). It is less clear, however, whether government/contracted public works employees working the same critical incidents are subject to the same risk of onset. This paper reviewed 24 empirical studies assessing this possible association from 1980 to 2020. These studies included 94,302 government/contracted employees. Psychological trauma/PTSD was reported in all 24 manuscripts assessing PTSD. Three of these studies additionally reporting serious somatic health problems. Public works employees are at risk for onset and this is a worldwide issue. Study findings and treatment implications are presented.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022.

Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.

News Journalists and Postruamatic Stress Disorder: a Review of Literature, 2011-2020.

Research has demonstrated that first responders may develop psychological trauma/ posttraumatic stress disorder (PTSD) in the performance of their duties. Often overlooked in these studies of police, firefighters, and paramedics is an additional group of providers who also respond to these same events: news journalists and photo journalists. Although limited in scope, the research literature from 1980 to 2010 assessed an association between PTSD and some news journalists. The strength of these findings are limited due to serious methodological limitations. The present paper reviewed the journalist/PTSD literature from 2011 to 2020. There were 4558 subjects in 23 studies, which were world-wide in scope. There were 2633 male reporters (58%) and 1925 female journalists (42%). The average age of subjects was 34.37 years and the average length of experience was 10.68 years. Many reported either PTSD, PTSD symptoms, depression, and/or substance use. A detailed methodological critique is presented.

Psychological Trauma and the Trauma Surgeon.

Research has demonstrated that first responders may develop psychological trauma/ posttraumatic stress disorder (PTSD) in the performance of their duties. Often overlooked in these studies of police, firefighters, and paramedics is an additional group of providers in this health care delivery system: the trauma surgeons, who receive the victims transported by the first responders. Although limited in scope, the research literature does identify the presence of PTSD in trauma surgeons. These studies have repeatedly cited the need for further information about psychological trauma for trauma surgeons. This paper addresses that need with a brief overview of psychological trauma, where surgeons may encounter victims, and how to cope with its aftermath.

The Assaultive Staff Action Program (ASAP): Thirty Year Program Analysis.

The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program to address the psychological sequellae in staff victims of patient assaults. Its functions and service provisions have been reported in previous five-year intervals. ASAP has been associated with providing quality counseling services to employee victims of these patient assaults as well as declines in assaults facility-wide in some agencies after an ASAP team was fielded. The present paper presents a summary of both its most recent five-year interval (2015-2020) and an overview of its 30 years of service during which it has responded to 10,651 patient assaults on staff.

SUDEP and Grief: Overview and Current Issues.

The medical community and the general public are aware of sudden deaths in apparently healthy infants (SIDS) and in cases of cardiac arrest (SCD). However, there is a third, less-well known, form of sudden death that occurs in persons with epilepsy (SUDEP). This paper provides a detailed overview what is known about SUDEP, including the current important, unresolved issues being considered in the field (research, education, informed consent). This paper also includes an overview of the grieving process common to all three conditions. Again, the current issues being considered in the field of grieving are presented (major depression, posttraumatic stress disorder). It is written for physicians, including psychiatrists, and for the health community beyond neurologists and serves as a provider resource for persons with epilepsy, their families, and for the general public. This information about SUDEP and grief becomes also additionally important as national health care moves toward an interdisciplinary primary care model of service delivery.

Coroners and PTSD: Treatment Implications.

Experimental studies have documented the development of posttraumatic stress disorder (PTSD) in first responders. These studies have routinely included police, firefighters, and paramedics. However, there is another group of first responders that are at risk for PTSD but that has received less research attention. This group is comprised of coroners. This paper reviewed the published data concerning coroners and PTSD and outlined various treatments for addressing coronial PTSD. The findings, the differing treatments, and a detailed methodological inquiry are presented. The need for a conceptual framework for the various other professional groups responding to critical incidents and a crisis intervention approach to address the psychological needs of both family survivors and coronial personnel are noted.

International Review of Precipitants to Patient Assaults on Staff, 2013-2017.

In studying psychiatric patient assaults, assessing the person x event x environment interaction is important in enhancing safety and ensuring quality care. Precipitants to patient assaults have traditionally received less attention than the patient characteristics of such assaults. Reviews of inpatient precipitants from 1960 to 2012 noted acute psychosis, denial of services, and substance abuse as commonly occurring precipitants. The present study reviewed the literature on precipitants from 2013 to 2017. A variety of precipitants, including acute psychosis, substance abuse, and denial of services were observed. The literature in this review broke new ground in subjects, methodologies, and precipitants. These new findings and a detailed methodological inquiry are presented.

Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2013-2017.

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in human suffering and dollar cost expense. International research through 2012 documented the frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five year period of 2013-2017. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s, even with new policy initiatives in place meant to reduce such violence. Nursing personnel continued to be at greater risk. The findings by continents and an updated methodological inquiry are presented.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2013-2017.

Since the 1960s, empirical research has worked toward a better understanding of the characteristics of assaultive psychiatric patients. International research through 2012 indicated that male and female patients with schizophrenia and other diagnoses presented the greatest risk for assault. This present review of studies that presented raw assault sought to assess the latest research findings on assaultive patients for the most recent 5 year period, 2013-2017. It was hypothesized that male patients with schizophrenia would present the greatest risk. The findings indicated a sharp increase in the total number of reported assault incidents over the proceeding decade. These assaults were committed largely by male patients with a diagnosis of schizophrenia. Explanations for these findings and an updated methodological inquiry are presented.

The Assaultive Staff Action Program (ASAP): 25 Year Program Analysis.

The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program to address the psychological sequelae in staff victims of patient assaults. It has been associated with cost-effective, quality support services to staff victims of patient assaults and declines in assaults facility-wide in several facilities, after an ASAP was fielded. ASAP's functions and service provisions have been reported in previous 5-year intervals. The present paper reports on its most recent 5-year interval as ASAP complete its 25th year of service. The 5-year summary and the basic strengths and limitations of the program over this 25 year period are examined.

Treating psychological trauma in first responders: a multi-modal paradigm.

Responding to critical incidents may result in 5.9-22% of first responders developing psychological trauma and posttraumatic stress disorder. These impacts may be physical, mental, and/or behavioral. This population remains at risk, given the daily occurrence of critical incidents. Current treatments, primarily focused on combat and rape victims, have included single and double interventions, which have proven helpful to some but not all victims and one standard of care has remained elusive. However, even though the need is established, research on the treatment interventions of first responders has been limited. Given the multiplicity of impacts from psychological trauma and the inadequacies of responder treatment intervention research thus far, this paper proposes a paradigmatic shift from single/double treatment interventions to a multi-modal approach to first responder victim needs. A conceptual framework based on psychological trauma is presented and possible multi-modal interventions selected from the limited, extant first responder research are utilized to illustrate how the approach would work and to encourage clinical and experimental research into first responder treatment needs.

International precipitants to psychiatric patient assaults in community settings: review of published findings, 2000-2012.

In studying psychiatric patient assaults, assessing the person × event × environment interaction is important in enhancing safety and ensuring quality care. Precipitants to patient assaults have traditionally received less attention than the characteristics of such assaults. A recent review of inpatient precipitants noted acute psychosis, denial of services, and substance abuse as common precipitants in these settings. Even though health care systems are moving toward community-based services, no community studies were included in this inpatient review. The present study reviewed the precipitants reported in community studies internationally from 2000-2012. A variety of community precipitants, including acute psychosis and substance abuse, were obtained. How these community precipitants differ from the inpatient preciptiants and a detailed methodological inquiry are presented.

Characteristics of international staff victims of psychiatric patient assaults: review of published findings, 2000-2012.

Psychiatric patient assaults on staff are a worldwide occupational hazard that results in human suffering and dollar cost expense. International research in the 1990s documented the frequent occurrence of these assaults. This present paper reviewed the published, international literature on staff victim assaults during the first decade of the new century. The findings indicate assaults on staff remain a serious worldwide issue as it was in the 1990s, even with new policy initiatives in place meant to reduce such violence. The findings by continents and a detailed methodological inquiry are presented.

Characteristics of international assaultive psychiatric patients: review of published findings, 2000-2012.

In international reviews of psychiatric inpatient violence, one study of all types of patient violence found hostility, involuntary admission, and longer hospital stays associated with violence. A second study of comparison-group papers of patient assaults found younger males with schizophrenia, past violence, and substance abuse assaultive. The present review of raw assault data studies assessed characteristics of assaultive patients worldwide. It was hypothesized that patients with schizophrenia would present greatest assault risk. There were three analyses: International/no American studies (reviewed earlier), European studies, and merged International/American studies. Results revealed that male and female patients with schizophrenia, affective disorders, personality disorders, and other diagnoses presented greatest worldwide risk. Results partially support earlier findings. Given that individual institutional studies in this review reported significant assailant characteristics, a second finding is the absence of most of these institutional characteristics in this international review. Possible explanations for findings and a detailed methodological review are presented.

Characteristics of American assaultive psychiatric patients: review of published findings, 2000-2012.

Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.

Safety and the violent person: guidelines for emergency services.

Emergency service providers (EMS), police, health-care providers, counselors, and other helping professionals are at times called upon to provide services to violent or potentially violent individuals. Providing these services safely can be enhanced with six general guidelines that can be implemented to reduce the risk of violence or contain what violence may have already erupted. Thinking about medical/ psychiatric illnesses, call log information, scene surveillance, old brain stem functioning, early warning signs of loss of control, and the theories of violence may provide strategies to enhance both the safety and quality ofservices provided in these difficult situations.

Just show up: the importance of caring attachments in emergency services.

Caring attachments to others are important for health, well-being, and longevity. This is no less true when EMS are providing needed medical services to victims at a vulnerable moment in the victims' lives. This article reviews the recent medical and behavioral science findings of the psychological and physiological benefits of caring attachments. Special attention is paid to the societal state of anomie and individuals' differing levels of optimal stimulation. The review then focuses on how attachments can be utilized by EMS as they provide services to victims and how these same health benefits may accrue to their colleagues onsite as well.

The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program.

Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.