The contribution of dynamic risk factors in predicting aggression: A systematic review including inpatient forensic and non-forensic mental health services

Aggression in inpatient mental health services is more likely when dynamic risk factors escalate, but there has been no systematic review of individual factors and their relevance in different inpatient settings. This systematic review identifies: i) which dynamic risk factors are associated with inpatient aggression, ii) their temporal relationship with aggression, iii) their overlap with aggression outcomes, and iv) differences between forensic and non-forensic mental health services. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases were searched in November 2019. Twenty-five primary studies were included, reporting 74 statistically significant dynamic risk factors. Thirty-five percent were significantly associated with aggression in at least two studies, and 94% with more than one aggressive outcome. Statistically significant risk factors overlapped greatly between forensic and non-forensic services (82%), and included individual cognitive, affective, behavioural, and situational factors which may be amenable to rehabilitative support. Studies were evaluated for methodological rigour, with few studies in non-forensic services of high methodological quality. Future research should include assess risk factors closer in-time to aggressive outcomes, employ prospective designs, and incorporate service users' perspectives.