Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry.

INTRODUCTION: Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML. METHODS AND ANALYSIS: We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups. ETHICS AND DISSEMINATION: The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.

Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor.

OBJECTIVES: In March 2020, France faced a health crisis due to the COVID-19 outbreak that, like previous infectious disease crises, involved high psychological and emotional stress, a series of factors that influenced the ongoing mental health crisis. METHODS: We recruited 384 respondents to complete an online questionnaire during the second month of isolation: 176 psychotherapy recipients (68 were currently attending psychiatric care) and 208 healthy controls. We measured demographic characteristics, impulsivity, aggression, hopelessness, suicidal risk, and the global level of anxiety and depression in order to estimate potential discrepancies in clinical measures across these populations. RESULTS: Our results indicate that the group currently undergoing psychiatric care was prone to loneliness and social isolation. Regarding clinical and nonclinical population, there were differences in suicidal risk, depression, anxiety, and hopelessness but mainly in aggression. Regression analysis also demonstrated that aggression surprisingly influenced anxiety levels. Patients undergoing therapy compared with patients who were not displayed differences only in suicidal risk, anxiety, and hopelessness, with those undergoing therapy having higher scores. The outpatient group undergoing therapy had a significantly lower level of impulsivity. Moreover, the regression to predict anxiety and depression levels from correlated factors highlighted the potentially heightened role of aggression in predicting anxiety in the clinical group. CONCLUSION: New research into stress reactions should assess other clinical signals, such as aggression, and examine preventive mental health interventions in times of crisis.

Violence Risk Assessment in the Emergency Department.

INTRODUCTION: Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. METHODS: Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. RESULTS: Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. DISCUSSION: The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.

Association between self-compassion and cyber aggression in the COVID-19 context: roles of attribution and public stigma.

Self-compassion is negatively associated with aggressive behaviors. However, the association between self-compassion and cyber aggression toward stigmatized people (e.g., people infected with COVID-19) has not been investigated in the COVID-19 context and the mechanism underlying this association remains underexplored. On the basis of emotion regulation theory and attribution theory, this study examined the indirect effects of self-compassion on cyber aggression toward people infected with COVID-19 through attribution and public stigma of COVID-19. Data were collected from 1162 Chinese college students (415 male, mean age = 21.61 years). Participants completed an online questionnaire including measurement of the key variables and basic demographic information. Results indicated that self-compassion was negatively associated with cyber aggression through the lower attribution of COVID-19 and lower public stigma of COVID-19. A sequential pathway from the attribution of COVID-19 to public stigma of COVID-19 was identified in the relationship between self-compassion and cyber aggression. Our findings are consistent with emotion regulation theory and attribution theory, which posit that emotion regulation strategies are associated with interpersonal mistreatment through cognitive pathways. These findings suggest that emotional self-regulation strategies can be used to reduce cyber aggression toward stigmatized people by reducing attribution and public stigma in the COVID-19 context. Self-compassion improvement could be target for the interventions aiming at alleviating public stigma and interpersonal mistreatment toward stigmatized people.

The effects of alcohol and marijuana co-use patterns on intimate partner aggression perpetration.

Alcohol and marijuana are two of the most widely used substances in the U.S, with rates of alcohol and marijuana co-use increasing in recent years. Despite this increase, little is known about the effects of alcohol and marijuana co-use patterns (e.g., simultaneous, concurrent) on intimate partner aggression (IPA) perpetration. The purpose of the current study was to examine differences in IPA among simultaneous and concurrent alcohol and marijuana use groups and an alcohol-only group. Participants were 496 individuals (57% identifying as a woman) recruited nationally in April 2020 via Qualtrics Research Services who reported being in a current relationship and recently consuming alcohol. Individuals completed an online survey that included demographics, measures of COVID-19 stress, alcohol and marijuana use, and physical and psychological IPA perpetration. Based on survey responses, individuals were categorized as belonging to the alcohol use only group (n = 300), the concurrent alcohol and marijuana use group (n = 129), or the regular simultaneous alcohol and marijuana use group (n = 67). Due to inclusion criteria, there was no marijuana use only group. Individuals with regular simultaneous or concurrent alcohol and marijuana co-use reported more frequent physical and psychological IPA perpetration compared to those who only used alcohol. Neither physical nor psychological IPA perpetration frequency differed between individuals who reported regular simultaneous versus concurrent alcohol and marijuana co-use. Results suggest that alcohol and marijuana co-use in general, and not the specific pattern of use, is associated with an increased likelihood of IPA perpetration.

Socio-economic and psychosocial determinants of violent discipline among parents in Asia Pacific countries during COVID-19: Focus on disadvantaged populations.

BACKGROUND: Mobility restrictions and economic downfall as a result of the COVID-19 pandemic may increase the risk of child maltreatment, including increased risk for violent discipline use by parents. OBJECTIVE: We examined the socio-economic and psychosocial determinants of violent discipline among parents against children in Asia Pacific countries. PARTICIPANTS & SETTINGS: This secondary data analysis included 7765 parents with children 6-18 years old in eight Asia Pacific countries. METHODS: 24 potential determinants were identified, including household demographic factors, parents' psychosocial status, and livelihood changes. The dependent variable was parental use of violent discipline (physical, severe physical, psycho-social aggression, and any violent discipline). Univariate and multivariable logistic regression analysis was conducted. RESULTS: A total of 41 % of households reported violent discipline. Parental demographic characteristics that were positively related to use of violent discipline were living in rural areas, not being a household head, female sex, age younger than 35 years, and large family size. Poor parental mental health status, loss of job or reduced income due to COVID-19, lack of food at household level, parent engagement in petty trade, and owning a business also predicted violent discipline. Mandatory curfew and receiving pandemic-related education materials were also positive predictors. CONCLUSION: Some socio-demographic factors, economic hardship due to COVID-19, and poor mental health status of parents are associated with the use of violent discipline against children in the Asia Pacific region. These results highlight several potential target areas for child protection interventions by governmental and non-profit organizations, including economic, social, and mental health interventions.

A Study on the Relationship between Internet Overdependence and Anger Response among Young Adults during COVID-19 Pandemic: Moderating Effect on Negative Emotions.

The aim of this study is to examine how Internet dependence affects anger responses during the COVID-19 pandemic. Owing to social distancing policies, Internet dependence has intensified, and the prevalence of anger has significantly increased. To understand this phenomenon and draw some implications, the "frustration-aggression hypothesis" was utilized for the theoretical framework and anger response was categorized into functional and dysfunctional anger responses. An analysis shows that overdependence on the Internet has a positive effect on the dysfunctional anger response. At the same time, other negative emotions replace anger, reducing the possibility of a dysfunctional anger response. Accordingly, a need for a constant effort to understand the circumstances of the young generation living in the "new normal" is emphasized; moreover, this paper suggests some theoretical and practical implications.

Characterization of cases of violence against women in times of pandemic by Covid-19 in a municipality in the southwest of Paraná / Caracterização dos casos de violência contra a mulher em tempos de pandemia por Covid-19 em um município do sudoeste do Paraná / Caracterización de casos de violencia contra la mujer en tiempos de pandemia por Covid-19 en un municipio del sudoeste de Paraná

Introdução: A violência contra à mulher é caracterizada especialmente pela desigualdade de gênero, diferença hierárquica, subordinação e pela agressividade do parceiro ou ex-parceiro. Entre os principais subtipos, cita-se; a violência física, psicológica, sexual, patrimonial e moral. Com o surgimento da pandemia de coronavírus em 2020 na tentativa de contenção da doença, medidas protetivas como o isolamento social aumentaram o convívio familiar. Dessa forma, as vítimas de violência passaram a ficar ainda mais tempo expostas aos seus agressores e consequentemente com maiores dificuldades para denunciar os abusos sofridos, pois a prestação dos serviços públicos, instituições de segurança e judiciais também foram restringidas. Objetivo: Caracterizar os casos de violência contra a mulher em tempos de pandemia de coronavírus em um município do Sudoeste do Paraná. Materiais e métodos: Trata-se de um estudo descritivo, documental e transversal com abordagem quantitativa realizada em um município do Sudoeste do Paraná a partir da coleta de dados, por meio das fichas de notificação de violência contra a mulher entre 2019 e 2021. Resultados e discussão: O estudo demonstrou prevalência de notificações no ano de 2019 em mulheres com idade de 12 a 18 anos (27,2%), brancas (71,3%), com ensino médio (21,9%), sendo ainda estudantes (23,1%) ou desempregadas (17,2%), sem companheiro (52,4%), residentes da área urbana (74%), heterossexuais (50,6%), sem possuir algum tipo de deficiência (51,8%). Ao verificar a tipologia da agressão com maior incidência, observou-se a lesão autoprovocada (53,6%) por meio da intoxicação /envenenamento (41,4%). Quanto a violência interpessoal, notou-se que a maioria das agressões foram ocasionadas pelo próprio cônjuge da vítima (12,4%), utilizando da força física (29,3%), salienta-se que o álcool não estava presente na maior parte das agressões. Conclusão: Evidencia-se a prevalência de violência autoprovocada (53,6%), em adolescentes com ensino médio, brancas, sem companheiro, residentes da área urbana, agredidas em ambiente domiciliar, motivadas por conflitos geracionais, sendo as violências mais incidentes a física por meio de envenenamento/intoxicação. Diante do exposto é importante abordar o fato de que é necessário realizar capacitações com os profissionais de saúde referente a ficha de notificação e orientá-los da importância de preenchê-la de forma correta, para haja a tomada de providências de acordo com cada necessidade.

Introduction: Introduction: Violence against women is characterized especially by gender inequality, hierarchical difference, subordination and aggressiveness of the partner or ex partner. Among the main subtypes are physical, psychological, sexual, patrimonial and moral violence. With the emergence of the COVID-19 pandemic in 2020 in an attempt to contain the disease, protective measures such as social isolation increased family coexistence. As a result, the victims of violence have been exposed to their aggressors for even longer and consequently find it more difficult to report the abuse they have suffered, since the provision of public services, security and judicial institutions have also been restricted. Objective: To characterize the cases of violence against women during the COVID-19 pandemic in a municipality in the southwest of Paraná. Materals and methods: This is a descriptive, documentary, and cross-sectional study with a quantitative approach carried out in a municipality in the Southwest of Paraná from data collection performed through the notification forms of violence against women notified between 2019 and 2021. Results and discussion: The study showed a prevalence of notifications in the year 2019 in women aged 12 to 18 years (27.2%), white (71.3%), with high school education (21.9%), being still students (23.1%) or unemployed (17.2%), without a partner (52.4%), residents of the urban area (74%), more specifically the Padre Ulrico neighborhood (12.4%), heterosexual (50.6%), without having any type of disability (51.8%). When checking the type of aggression with the highest incidence, we observed self-harm (53.6%) through intoxication/ poisoning (41.4%). As for interpersonal violence, it was noted that most aggressions were caused by the victim's own spouse (12.4%), using physical force (29.3%), and alcohol was not present in most aggressions. Conclusion: The prevalence of self- inflicted violence (53.6%) is evident in adolescents with high school education, white, without a partner, urban residents, assaulted in the home environment, motivated by generational conflicts, with the most incident violence being physical violence through poisoning/intoxication. Given the above, it is important to address the fact that it is necessary to conduct training with health professionals regarding the notification form and guide them on the importance of filling it out correctly, so that there is taking action according to each need.

Introducción: La violencia contra las mujeres se caracteriza especialmente por la desigualdad de género, la diferencia jerárquica, la subordinación y la agresividad de la pareja o ex pareja. Entre los principales subtipos, se menciona; la violencia física, psicológica, sexual, patrimonial y moral. Con la aparición de la pandemia de coronavirus en 2020 en un intento de contener la enfermedad, las medidas de protección como el aislamiento social han aumentado la convivencia familiar. Así, las víctimas de la violencia han quedado aún más expuestas a sus agresores y, en consecuencia, tienen mayores dificultades para denunciar los abusos sufridos, ya que también se ha restringido la prestación de servicios públicos, de seguridad y de instituciones judiciales. Objetivo: Caracterizar los casos de violencia contra la mujer en tiempos de pandemia de coronavirus en un municipio del sudoeste de Paraná. Materiales y métodos: Se trata de un estudio descriptivo, documental y transversal con enfoque cuantitativo realizado en un municipio del suroeste de Paraná a partir de la recolección de datos a través de las formas de notificación de la violencia contra las mujeres entre 2019 y 2021. Resultados y discusión: El estudio mostró una prevalencia de notificaciones en 2019 en mujeres de 12 a 18 años (27,2%), de raza blanca (71,3%), con estudios secundarios (21,9%), siendo aún estudiantes (23,1%) o desempleadas (17,2%), sin pareja (52,4%), residentes en el área urbana (74%), heterosexuales (50,6%), sin tener algún tipo de discapacidad (51,8%). Al verificar el tipo de agresión con mayor incidencia, se observó la lesión autoinfligida (53,6%) a través de la intoxicación / envenenamiento (41,4%). En cuanto a la violencia interpersonal, se observó que la mayoría de las agresiones fueron causadas por el propio cónyuge de la víctima (12,4%), utilizando la fuerza física (29,3%), se destaca que el alcohol no estuvo presente en la mayoría de las agresiones. Conclusión: Se evidencia la prevalencia de la violencia autoprovocada (53,6%), en adolescentes con educación médica, brancas, sin compañía, residentes del área urbana, agredidos en ambiente domiciliario, motivados por conflictos geracionales, siendo las violencias más incidentes a la física por medio de envenenamiento/intoxicación. Dado lo anterior es importante abordar el hecho de que es necesario realizar una capacitación con los profesionales de la salud respecto a la ficha de notificación y orientarlos sobre la importancia de llenarla correctamente, para que exista la toma de acciones de acuerdo a cada necesidad.

The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Team for Total Worker Health® Approach in a Hospital.

The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, workplace violence (WV) is often considered as part of HCW's job, leading to a general underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a pediatric hospital. According to a specific protocol, each aggressive act was analyzed by a multidisciplinary team using the "Modified Overt Aggression Scale" (MOAS), the "General Health Questionnaire-12" (GHQ-12), and the "Short Form-36 Health Survey" (SF-36) to build a report addressing improvement measures. A three-domain model of WV was also developed considering: (1) assaulted HCWs, (2) attacker-related issues, and (3) environmental context. Contributing factors to overt aggression were outlined and tested using univariate analyses. Statistically significant factors were then included in a multiple linear regression model. A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used, and emotion intensity were significantly associated with overt aggression (p < 0.05), as well as the attacker's role in the hospital (p < 0.05). The multiple regression analysis confirmed these findings (p < 0.001). Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment, individual workers' health, and organizational well-being.

Asian American nursing students' experiences of racial microaggressions amid the COVID-19 pandemic: Focus group discussions.

AIM: This study aimed to explore the thoughts and feelings of Asian American nursing students regarding Anti-Asian racism that they might anticipate or experience during their clinical training. BACKGROUND: Asian Americans have long been viewed as perpetual foreigners and coronavirus disease 2019 has reinforced that negative view. Asian American nursing students may anticipate and experience racial discrimination during their clinical training, which could negatively affect their mental health. DESIGN: This is a qualitative research study using focus group discussions. METHOD: Focus group discussions were conducted over Zoom and audiotaped. The audiotapes were transcribed and validated for accuracy. A thematic analysis was performed using NVivo10. Emerging themes and subthemes were compared and discussed until agreements were made. RESULTS: Nineteen students participated in four focus group meetings, of which, 13 (68 %) had clinical training and six (32 %) were preclinical students. Four major themes emerged: (a) looking forward to hands-on learning opportunities, (b) enduring racial microaggressions, (c) maintaining professionalism in the face of racial microaggressions and (d) standing up for oneself and other Asian American healthcare workers. Preclinical students were anxiously waiting for clinical training so that they could have hands-on learning experiences. They anticipated that anti-Asian racism in clinical settings would be similar to what they had experienced on the streets and therefore, they were not afraid of it. Students who had clinical training reported experiencing a variety of racial microaggressions that varied from "side-eyes" to "verbal assault" and occurred at three levels: patients, nurses and clinical instructors. They reported that most of the microaggressions were familiar to them, but some, especially coming from their clinical instructors, were unique to clinical settings. CONCLUSION: Asian American nursing students experienced racial microaggressions during their clinical training which came from patients, nurses on the unit and their clinical instructors. Nevertheless, the students strove to maintain professionalism and stand up for themselves and other Asian healthcare workers as they gained confidence in clinical knowledge and skills.

COVID Stress, socioeconomic deprivation, and intimate partner aggression during the COVID-19 pandemic.

BACKGROUND: Intimate partner aggression (IPA) is a prevalent public health concern that is associated with multiple negative consequences. Rates of IPA in the U.S. have increased since the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, likely due to stress associated with the pandemic. Socioeconomic deprivation is associated with COVID-19 outcomes as well as IPA. However, whether socioeconomic deprivation interacts with COVID-19 stress in predicting IPA remains unclear. METHODS: Using a sample of 510 individuals recruited via Qualtrics Research Services in April 2020, the present study tested whether socioeconomic deprivation moderates the association between COVID-19 stress and IPA perpetration and victimization. Participants completed a questionnaire battery that included measures of COVID-19 stressors and physical and psychological IPA perpetration and victimization. In addition, participants reported their residential zip codes, which were subsequently matched with scores on the Social Deprivation Index, a composite measure of seven demographic variables from the 5-year American Community Survey. RESULTS: Sequential generalized linear models in Mplus Version 8.7 showed that the effects of COVID-19 stress on physical IPA perpetration and psychological IPA victimization can be best understood through its interactive effects with socioeconomic deprivation. Higher COVID-19 stress was associated with higher levels of physical IPA perpetration and psychological IPA victimization when socioeconomic deprivation was low but not when socioeconomic deprivation was high. Importantly, however, overall rates of IPA were higher among individuals with higher socioeconomic deprivation than among individuals with lower socioeconomic deprivation, regardless of the amount of COVID-19 stress they experienced. CONCLUSIONS: The present analyses implicate COVID-19 stress as a critical correlate of IPA and show that the association between this stress and physical IPA perpetration and psychological IPA victimization may be particularly salient among individuals who live in areas of lower socioeconomic deprivation. Furthermore, our results clearly pinpoint the detrimental effects of socioeconomic deprivation more broadly, showing that individuals who live in more deprived areas tend to have high levels of IPA regardless of their level of COVID-19 stress. These findings call for public health policies at the community and societal level that target not only COVID-related stress but also the impacts of socioeconomic inequality.

Internet Gaming Disorder and Aggression among Students on School Closure during COVID-19 Pandemic.

BACKGROUND: The Corona Virus Disease (COVID-19) pandemic has significantly disrupted the regular school-going activities of the students, predominantly increasing internet gaming activities to endure significant stress. Excessive involvement in internet gaming brings deviant behaviour, especially aggression among the students. Hence, this study aimed to assess the internet gaming disorder and aggression among the students on school closure during COVID-19 pandemic in Chitwan, Nepal. METHODS: A web-based cross-sectional survey was conducted among 417 students from secondary and higher secondary level who studied in two private schools of Chitwan district. Sample were selected using simple random sampling technique and structured questionnaire, i.e. Internet gaming disorder scale- short form (IGDS9-SF) and Aggression questionnaire (Buss and Perry, 1992) were used to collect the data via web-based through Google Form. Obtained data were analysed using descriptive and inferential statistics. RESULTS: Out of 417 students, the mean age was 17 (±1.411) years, 278 (66.7%) were male and 150 (36.0%) were studying in twelve standard. Majority of students 405 (97.1%) were non-disordered gamers whereas only 12 (2.9%) students were disordered gamers. Students' overall aggression score was 57.79% where the verbal aggression score was higher (66.33%) followed by hostility (61.41%) and anger (56.80%). Further significant positive relationship was found between scores on online gaming disorders and aggression (r=0.239). CONCLUSIONS: Internet gaming disorder and aggression are common among the students during COVID-19 pandemic. Therefore, educational institutions and concern authorities need to organize awareness programs and effective psychosocial intervention approaches for students to enhance the knowledge regarding harmful use of internet game, IGD, to cope with stress and aggression as well as to enhance the adoptive behaviour.

The relationship between internet addiction and aggressive behavior among adolescents during the COVID-19 pandemic: Anxiety as a mediator.

The COVID-19 pandemic has brought unprecedented challenges for adolescents, who tended to experience more emotional instability, impulsivity, and aggressive behavior driven by the fear of infection and the uncertainty of network information. In the present study, we investigated the relationship between Internet addiction and aggressive behavior, and the mediating effects of depression and anxiety. There were differences in Internete addiction and aggressive behavior in gender, thus the moderating role of gender between them were explored. A total of 1148 middle school students were invited to complete the Buss Perry Aggression Questionnaire, the Internet Addition Scale, the Self-rating Depression Scale (SDS), and the Self-rating Anxiety Scale (SAS) separately. The results suggested that 1) there was a significant positive correlation between Internet addiction and aggressive behavior; 2) anxiety, but not depression, mediated the effect of Internet addiction on aggressive behavior; 3) gender did not moderate the effect of Internet addiction on aggressive behavior. The practical implication of the current findings on boosting adolescents' mental health was discussed and further suggestions were provided.

The Influence of Sociodemographic Factors on Symptoms of Anxiety, the Level of Aggression and Alcohol Consumption in the Time of the COVID-19 Pandemic among Polish Respondents.

The COVID-19 pandemic has had a significant impact on the mental health of most of the world's population. The authors of this study decided to identify differences in the intensity of anxiety, aggression and alcohol consumption within the study population. The study was conducted via an Internet survey. It uses Polish adaptations of international scales to assess anxiety (GAD-7), aggression (Buss and Perry Aggression Scale) and alcohol consumption (AUDIT test). A total of 538 people were examined. The surveyed group of respondents does not reflect the structure of Polish society. The group of surveyed women scored higher than men in terms of anxiety, as well as anger and hostility. The examined men were characterized by higher results of alcohol consumption and physical aggression. People between 18 and 49 years of age consumed significantly more alcohol than people aged 50 and over. People aged 18-29 obtained statistically significantly higher scores in generalized aggression and hostility. The relationships between the studied parameters do not differ significantly from those presented in other studies. People under the age of 50 are the group most exposed to the harmful effects of alcohol. Women between the ages of 30 and 49 are most vulnerable to the negative mental health effects of the COVID-19 pandemic. There is a need for further research studies in which the studied group will obtain a greater degree of compliance with the structure of Polish society.

Investigating the association between patient verbal aggression and emotional exhaustion among Italian health care professionals during the COVID-19 pandemic.

AIMS: To analyze whether patient verbal aggression would be related to emotional exhaustion and whether this relationship would be mediated by work-family conflict and moderated by dehumanization and resilience. BACKGROUND: Although patient verbal aggression has been identified as one of the most experienced forms of aggression, its effects on Italian health care providers during the pandemic are still poorly known. METHODS: A total of 197 Italian health care professionals completed paper-and-pencil questionnaires. Descriptive statistics and moderated mediation analyses were performed. RESULTS: Patient verbal aggression was positively related to health care professionals' emotional exhaustion, both directly and indirectly, as mediated by work-family conflict. Health care providers were more likely to become emotionally exhausted when they had low resilience and, simultaneously, tended to ascribe patients non-uniquely human traits. CONCLUSIONS: Patient verbal aggression may spill over onto health care professionals' family lives. Dehumanization represents an ineffective coping strategy that exacerbates the effects of aggression on work-family conflict, whereas resilience represents a protective resource against emotional exhaustion. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital organisations could benefit from providing their staff with stress management interventions, aggression management, psychological support and psychological resilience training programmes. These programmes should incorporate coping skills on establishing work-home boundaries and balancing empathy with cognitive problem-solving abilities.

Establishing best practice in violence risk assessment and violence prevention education for nurses working in mental health units.

OBJECTIVES: To explore and evaluate extant and potential methods used in risk assessment and aggression prevention training. This study was also designed to consider the most appropriate method for educating nurses in use of a novel risk assessment instrument linked to a structured nursing intervention protocol (the electronic application of the Dynamic Appraisal of Situational Aggression and Aggression Prevention Protocol). BACKGROUND: Organisational and personal concerns have led to the development of training programs designed to prevent and manage aggression in mental health units. DESIGN: This descriptive qualitative study explored experts' opinions about effective training approaches. METHODS: Data were collected via focus groups (a total of four discrete groups), with each of the four focus groups repeated after four weeks. A semi-structured guide was used to guide the focus group discussions. RESULTS: Seventeen experts with experience coordinating and facilitating training in prevention and management of aggression in mental health units in New Zealand and Australia participated in this study. Three themes emerged from the data 1) existing training can be "like pulling teeth without anaesthetic" 2) the need to "breathe life" into the training and 3) a vision of the "gold standard" for practice and training. CONCLUSIONS: Training is optimal when it is place-based, responsive to local needs and inclusive of relevant clinical, cultural, consumer/carer and contextual factors. Training may benefit from a focus on the application of the knowledge, skills and attitudes learnt and there is a need for ongoing reinforcement of training in the clinical setting, beyond initial introduction and provision of information and orientation to relevant skills.

Co-occurrence of adult abuse and child abuse: analysis of the phenomenon.

BACKGROUND: The purpose of this study was to analyze the co-occurrence of adult and child abuse based on the reports collected from the Polish police and social welfare institutions. METHODS: The study involved data concerning 468 households in Szczecin (Poland) inhabited by children where acts of violence between adults took place. The presented data refer to the years 2012-2103. The data came from so called Blue Card files, i.e. documents issued by the police and social workers in cases of domestic abuse, providing information about its forms, perpetrators, and victims. RESULTS: Domestic violence usually occurs between spouses and cohabitees (78%). The perpetrator was usually a man (88%). Violence usually lasted from 1 up to 3 years (30.0%). The most common forms of physical abuse against adults and children included pushing (79.5% of adults, 22.4% of children) and hitting (64.7% of adults, 16.6% of children), and psychologically abusive behaviors were mostly insults (91.9% of adults, 27.5% of children) and criticism (79.1% of adults, 21.5% of children). This work has shown that the longer the psychological abuse between adults lasts, the greater probability is that it will also be used against children. Child abuse is also associated with putting up resistance to the police by perpetrators. CONCLUSIONS: Summing up, in households where violence between adults is observed, actions should be taken to prevent violence against children.

Workplace Bullying and Patient Aggression Related to COVID-19 and its Association with Psychological Distress among Health Care Professionals during the COVID-19 Pandemic in Japan.

The novel coronavirus disease (COVID-19) pandemic has spread throughout the world. Poor mental health has been reported among healthcare professionals responding to COVID-19. However, no study has examined the impact of COVID-19-related workplace bullying or patient aggression on the mental health of healthcare professionals during the COVID-19 outbreak. This study examined the prevalence of COVID-19-related workplace bullying and patient aggression and its association with psychological distress among healthcare professionals during the COVID-19 outbreak in Japan. This was a cross-sectional study conducted from May 22 to 26, 2020, inviting participants (n = 1,421) from an online survey of full-time employees. We limited the sample to healthcare professionals for further analyses. Using an online self-report questionnaire, workplace bullying and patient aggression related to COVID-19 was measured using nine items with dichotomous response options. Psychological distress was measured using the Japanese version of Brief Job Stress Questionnaire. Among 1,032 participants (72.6%) who completed the survey, 111 healthcare professionals were identified. Among them, 19 participants (17.1%) had experienced any COVID-19-related workplace bullying or patient aggression: 11 participants (9.9%) had experienced any workplace bullying and 12 participants (10.8%) had experienced any patient aggression. Multiple linear regression analysis showed that any bullying or patient aggression related to COVID-19 significantly correlated with psychological distress. It was suggested that a non-negligible proportion of participants experienced workplace bullying or patient aggression related to COVID-19. Preventing and reducing workplace bullying and patient aggression may be effective in improving mental health of healthcare professionals during the COVID-19 outbreak.

Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series.

BACKGROUND: People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. OBJECTIVE: To evaluate the feasibility (acceptance and safety) of VR experience. METHODS: A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions). RESULTS: The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. CONCLUSION: This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.

PPAR-α Hypermethylation in the Hippocampus of Mice Exposed to Social Isolation Stress Is Associated with Enhanced Neuroinflammation and Aggressive Behavior.

Social behavioral changes, including social isolation or loneliness, increase the risk for stress-related disorders, such as major depressive disorder, posttraumatic stress disorder (PTSD), and suicide, which share a strong neuroinflammatory etiopathogenetic component. The peroxisome-proliferator activated receptor (PPAR)-α, a newly discovered target involved in emotional behavior regulation, is a ligand-activated nuclear receptor and a transcription factor that, following stimulation by endogenous or synthetic ligands, may induce neuroprotective effects by modulating neuroinflammation, and improve anxiety and depression-like behaviors by enhancing neurosteroid biosynthesis. How stress affects epigenetic mechanisms with downstream effects on inflammation and emotional behavior remains poorly understood. We studied the effects of 4-week social isolation, using a mouse model of PTSD/suicide-like behavior, on hippocampal PPAR-α epigenetic modification. Decreased PPAR-α expression in the hippocampus of socially isolated mice was associated with increased levels of methylated cytosines of PPAR-α gene CpG-rich fragments and deficient neurosteroid biosynthesis. This effect was associated with increased histone deacetylases (HDAC)1, methyl-cytosine binding protein (MeCP)2 and decreased ten-eleven translocator (TET)2 expression, which favor hypermethylation. These alterations were associated with increased TLR-4 and pro-inflammatory markers (e.g., TNF-α,), mediated by NF-κB signaling in the hippocampus of aggressive mice. This study contributes the first evidence of stress-induced brain PPAR-α epigenetic regulation. Social isolation stress may constitute a risk factor for inflammatory-based psychiatric disorders associated with neurosteroid deficits, and targeting epigenetic marks linked to PPAR-α downregulation may offer a valid therapeutic approach.