Aggression and violence towards healthcare workers in a psychiatric service in Italy. A retrospective questionnaire-based survey

Introduction Violence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy. Objectives or Aims The Bolzano psychiatric department adopted a de-escalation model developed by the Institut-fur-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers. Methods In 2015, health professionals were interviewed by using a ProDeMa ® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons. Results A total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation facility (REHAB). The one-year number of verbal aggressions (VA) was 9766, with INP (mean ± SD = 15.2 ± 29.6) vs. OUTP (mean ± SD = 6.2 ± 30.6) vs. REHAB (mean ± SD = 8.4 ± 26.1). The one-year number of physical aggressions (PA) was 1502, with INP (mean ± SD = 3.3 ± 12.2) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.7). The one-year number of injuries (IN) was 200, with INP (mean ± SD = 0.5 ± 1.9) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.2). ANOVA showed significant differences in terms of mean verbal/physical aggression and injuries among the three workplaces ( P -values = 0.000), with post-hoc Tukey test showing a significant difference of INP vs. REHAB and OUTP. The most frequent risk factors identified by the staff for precipitating aggression included rigid rules (15.1%) and inadequate communication (9.1%). Conclusions The three types of violence are common in all facilities of our Department.