Introduction

In a meta-analysis of international studies, 17% of admitted patients in psychiatric hospitals had exhibited violent behavior toward others. Reported data from studies in Germany were considerably lower until recent years. However, studies examining only single hospitals, as well as the quality of the data itself, have raised questions as to the validity of these findings. Indeed, a debate currently exists as to whether there has, in fact, been an increase of violent incidents in German mental institutions.

Methods

In a group of 10 hospitals serving about half the population of the Federal State of Baden-Wuerttemberg with 11 million inhabitants, the Staff Observation Aggression Scale–Revised (SOAS-R) was introduced into patients’ electronic charts as part of routine documentation. Data recording was strongly supported by staff councils and unions. A completed data set is now available for the year 2019. For one hospital, data are available since 2006. Due to some doubts with respect to fully covering self-directed aggression, we restricted the analysis to aggression toward others and toward objects.

Results

In 2019, 17,599 aggressive incidents were recorded in 64,367 admissions (1,660 staying forensic psychiatric inpatients included). 5,084 (7.90%) of the admitted cases showed aggressive behavior toward others. Variation between hospitals was low to modest (SD = 1.50). The mean SOAS-R score was 11.8 (SD between hospitals 1.20%). 23% of the incidents resulted in bodily harm. The percentage of patients showing violent behavior was highest among patients with organic disorders (ICD-10 F0) and lowest among patients with addictive or affective disorders (F1, F3, F4). Forensic psychiatry had the highest proportion of cases with aggressive behavior (20.54%), but the number of incidents per bed was lower than in general adult psychiatry and child and adolescent psychiatry (indicating a lower risk for staff). In the hospital with longer-term recordings available, an increase could be observed since 2010, with considerable variation between years.

Conclusions

This is the most robust estimate of the frequency of violent incidents in German psychiatric hospitals thus far. The incidence is about half of what has been reported internationally, probably due to sample selection bias in previous studies and a relatively high number of hospital beds in Germany. Available data suggest an increase of violent incidents over the last ten years; however, it is unclear to which extent this is due to increased reporting.

中文翻译：

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德国精神病医院的侵略事件：有增加吗？

介绍

在一项国际研究的荟萃分析中，精神病医院中17％的入院患者表现出对他人的暴力行为。直到最近几年，来自德国的研究报告的数据都相当低。但是，仅检查单个医院的研究以及数据本身的质量就这些发现的有效性提出了疑问。确实，目前存在关于实际上是否在德国精神病院中发生暴力事件的人数增加的争论。

方法

在服务于巴登-符腾堡州联邦州人口约一半，人口为1100万的10家医院中，作为常规记录的一部分，已将经修订的员工观察攻击量表（SOAS-R）引入患者的电子病历中。数据记录得到了员工理事会和工会的大力支持。现在可以获取2019年的完整数据集。对于一家医院，该数据自2006年以来可用。由于对完全涵盖自我导向的侵略性存有疑问，我们将分析范围限制为对他人和对象的侵略性。

结果

2019年，在64,367名患者中记录了17,599起侵略性事件（包括1,660名在法医住院的患者）。5,084（7.90％）的入院案例显示出对他人的攻击行为。医院之间的差异很小至中等（SD = 1.50）。SOAS-R平均得分为11.8（医院之间的标准差为1.20％）。23％的事件造成了人身伤害。表现为暴力行为的患者百分比在器质性疾病（ICD-10 F0）中最高，而在成瘾性或情感性疾病（F1，F3，F4）中最低。法医精神病学具有侵略性行为的病例比例最高（20.54％），但每张床的事件数量低于普通成人精神病学和儿童及青少年精神病学的发生率（表明工作人员的风险较低）。

结论

到目前为止，这是对德国精神病医院暴力事件发生频率的最有力估计。该发病率约为国际报道的一半，可能是由于先前研究中的样本选择偏见以及德国相对较高的病床数量。现有数据表明，过去十年来暴力事件有所增加；但是，尚不清楚这在多大程度上归因于报告的增加。