Correlates of partner and non-partner aggression among patients with substance use disorders in an urban ED

Analysis of patient related violence in a regional emergency department in Victoria, Australia

BACKGROUND

Emergency Departments (ED) have been identified as high-risk areas for patient related violence (PRV). The aim of the present study was to analyse recorded events of violence in a regional Victorian hospital ED, and examine the association these events had with substance abuse.

METHODS

A retrospective cohort study was undertaken to establish the incidence of PRV. Data were obtained from the hospital's incident management system, RiskMan, over a five and a half year period for all violent events categorised as Code Grey (CG) and Code Black (CB). The Haddon Matrix attached to the individual incident record was also reviewed.

RESULTS

A total of 548 violent events were analysed. The incident rate was 3.4 per 1000 ED presentations. Intoxication was the primary reason for violent escalations. There was no association between the frequency of CG events and the day of the week, month of admission, or shift of the day. Intoxicated men (110, 64.3%) were more likely to be the instigator of a violent event compared with intoxicated females (61, 35.7%) (OR 1.5, 95% CI: 1.19-2.02, p<0.001). A form of restraint, chemical, physical or both, was used in the majority of violent events (376, 68.6%).

CONCLUSION

This study demonstrated an increasing frequency of violent events in the regional ED. Rates of PRV were comparable to those reported in metropolitan hospitals. Intoxication was the most frequently observed underlying factor for PRV. Regional hospitals are in need of additional resources to instigate policies and procedures that will maximise patient and staff safety.

Coping and violence perpetration in a residential substance use disorder treatment sample

Background: Individuals in substance use disorder treatment report high rates of violence against partners and non-partners. There is growing interest in integrated coping-oriented treatment approaches for violence and substance use concerns, yet little is known about the relationship between specific coping responses and perpetration of partner and non-partner violence. Objective: This cross-sectional study evaluated relationships between coping responses and partner and non-partner physical assault perpetration in a substance use disorder treatment sample. Methods: Participants included 343 men (76%) and women (24%) who completed self-report survey measures of coping responses, violence perpetration, and substance use as part of screening for a randomized trial. Negative binomial regression was used to examine relationships between coping strategies and partner and non-partner violence perpetration, when accounting for substance use and demographic factors. Results: About one-third of participants reported partner violence perpetration (30%) and non-partner violence perpetration (34%). Frequency of partner violence and non-partner violence were both associated with more use of avoidant and emotion-focused strategies and less use of problem-focused coping in adjusted models. Discussion: Continued research is warranted to determine whether coping-oriented interventions decrease violence among people in substance use disorder treatment.

Associations between PTSD and intimate partner and non-partner aggression among substance using veterans in specialty mental health

BACKGROUND

Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration.

METHODS

Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM), probable PTSD (PCL-C), and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment.

RESULTS

In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ²=11.46, p=0.001, φ=0.12; non-partner physical, χ²=50.64, p<0.001, φ=0.25; partner injury, χ²=6.41, p=0.011, φ=0.09; non-partner injury, χ²=42.71, p<0.001, φ=0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics, probable PTSD was independently associated with non-partner physical (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.97-4.05) and injury aggression (OR, 3.96; CI, 2.56-6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively.

CONCLUSIONS

The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.

Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study

The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.