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The risk assessment of imminent inpatient aggression: A cross-cultural validation study of the dynamic appraisal of situational aggression in Estonia

J Psychiatr Ment Health Nurs. 2023 Dec 14. doi: 10.1111/jpm.13010. Online ahead of print.


INTRODUCTION: The reason for this study was void of a data-driven imminent risk assessment instrument for aggression in psychiatry clinics in Estonia. The predictive accuracy of the observer-rated Dynamic Assessment of Situational Aggression (DASA) has been repeatedly demonstrated. However, the research gap remains regarding a deeper conceptual understanding of the underlying latent structure of the DASA.

AIM: Comprehensively evaluate the psychometric properties of the Estonian DASA version for cross-cultural clinical use.

METHOD: We used a prospective repeated measure design and collected 6097 risk evaluations from 381 adult inpatients, 151 of whom committed 1013 aggressive incidents during the study.

RESULTS: The Estonian DASA version has acceptable inter-rater reliability (Kendall’s τ = 0.74) and is a useful instrument with excellent predictive validity (AUC = 0.86) for identifying potentially aggressive inpatients. In our sample, the DASA has a bi-factorial structure which explains 83% of the total variance.

DISCUSSION: The adapted DASA has acceptable validity and reliability indices for measuring imminent aggression risk in adult inpatient units.

IMPLICATIONS FOR PRACTICE: Evidence-based risk assessment of aggression in psychiatric clinics enhances recognition of the signs of potentially aggressive behaviour in order to apply preventive actions and reduce aggression, thereby improving the quality of the care provided.

PMID:38095026 | DOI:10.1111/jpm.13010

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