Criminal Thinking as a Risk Factor for Psychiatric Inpatient Aggression

Thinking styles that predispose offenders to antisocial behavior have been shown to predict violence and aggression among inmates. This study explored this relationship among civil psychiatric inpatients. Medical records of N = 74 discharged patients were reviewed for inpatient incidents using the Overt Aggression Scale (OAS), occurring subsequent to the administration of several measures including the Psychological Inventory of Criminal Thinking Styles (PICTS), and Brief Psychiatric Rating Scale (BPRS). Univariate negative binomial regression models demonstrated that a higher rate of aggressive incidents was predicted by higher PICTS Denial of Harm, higher BPRS Hostile Suspiciousness scores, and lower educational attainment. Violence (i.e., physical aggression towards others) was predicted by higher BPRS Hostile Suspiciousness, lower education, and younger age in univariate analyses. In multivariate negative binomial regression models using the above independent predictors, higher BPRS-Hostile Suspiciousness scores and lower educational attainment significantly predicted both outcomes. This study's results reinforce the importance of symptom-driven hostility to predicting inpatient aggression and violence, while highlighting the relatively minor role of specific criminal thinking styles in aggressive behavior among institutionalized psychiatric patients.