Aggression in psychiatry: impact of family history, substance use, psychiatric history, and dual diagnosis

Aims and objectives: Association has been reported between aggression and person(s) with mental illness. This study aimed to assess patterns of aggression, extent to which patients’ characteristics (psychiatric history and substance use behaviour) and parental characteristics (substance use and psychiatric disorder in family) predict violent behaviour. Method: For a period of 12 months, data were collected from the indoor patients. Aggressive incidents and their types were noted. Forms of aggression and their severity were assessed based on questions of the Overt Aggression Scale-Modified (OAS-M). The characteristics of those patients involved in aggressive incidents were compared with those of others who had not been aggressive. Patterns of aggression and their severity were assessed based on questions of OAS-M. Results: Total 472 patients were included in the study. The prevalence rate of aggression in the study population was 55.7% (n=263). Among the aggressive patients, 53.6% (n=253) exhibited verbal aggression, 36.4% (n=172) exhibited aggression towards objects, 32.2% (n=152) exhibited aggression towards others, and 16.1% (n=76) exhibited aggression towards self (more than one form of aggressive behaviour is noted). There were high correlations of one form of aggression in presence of other forms. Family history of substance abuse, family history of mental illness, substance abuse, psychiatric history, and dual diagnosis were found as major risk factors for the aggressive behaviour. Conclusions: Present study revealed that patients’ characteristics (psychiatric history and substance use behaviour) and parental characteristics (substance use and psychiatric disorder in family) predict violent behaviour. The utility of these factors to identify patients who subsequently will exhibit violent behaviour may provide an empirically substantiated basis for efficient psychiatric population screening for violence prevention.