Prevalence and pattern of violent behavior among Psychiatric Patient admitted at Mathari Mental Hospital Nairobi Kenya.
Njuguna, K. S
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The study assessed the prevalence and pattern of aggressive behaviour among psychiatric inpatients. In Kenya, a similar study was done in 1991 by Nyaura S. reporting that incidents of aggressive behaviour were of trivial in nature. In Europe, similar studies have been done in Sweden (Palmstierna, et al, 1989). Methodological differences have been a limitation in assessing aggression. In this study, aggression was assessed using a staff observation scale (SOAS) that is widely used in Scandinavian studies (palmstierna et al 1987). This was a descriptive cross-sectional study. The study was conducted at Mathari Mental Hospital in Nairobi Kenya. Patients admitted to the general wards ofMathari Hospital between the months of May 2004 and July 2004 and met inclusion criteria were recruited for the study. Standardized psychiatric interview, sociodemographic and risk factors questionnaires were administered. Patients were observed for aggressive behaviour for a duration of three weeks by the nurses and rated using staff observation aggressive scale.The data collected was analysed using the SPSS version 10 computer package. A large proportion of patients were observed to be aggressive, ninty five out of one hundred and fifty seven subjects of study population (60.5%) with a male to female ratio of2:1. The severity of aggressive behavior was mild in nature occuring mainly in week one 117 Episodes (78%), while in week two and three only 33 episodes(22%) were observed.There was no significant difference in time of occurrence with 46% occurring in the afternoon and 54% occurring in the morning. Sociodemographic profiles had no significant correlation to aggression. Among the risks factor; previous history of violence, threat of physical violence and identified victims one month before admission positively correlated to aggression.The psychopathological factors found to have statistical significance were; agitation, elated/histrionic mood, depressive thought Content, delusion thought disorder and hallucinations. However psychiatric diagnosis did not have statistical correlation to aggression. Predictors of aggression as determined by binary logistic regression model were; elated histrionic mood,depressive thought Content, and physical violence toward other person or object.While on multiple regression analysis, only ideas of persecution were found to predict aggression in the first week of admission. Aggressive behaviour was proportionally high among admitted inpatient, mainly occurring with acute psychopathology and was mild in severity. Risks factors and sociodemographic profiles had a low predictive value of aggression among psychiatric inpatients. 1. Management of aggressive behaviour should be incorporated in the curriculum of all the mental health professionals. 2. Since only a small proportion exhibits severe aggression, public education to minimize the commonly held notion that mentally ill are dangerous should be enhanced, this will help destigmatize mental illnesses. 3. Design of outpatient clinics and wards should ensure security for the staff and patients.