- Strategies to De-escalate Aggressive Behavior (DAB) in Psychiatric Patients
- This small systematic review addresses interventions to prevent or de-escalate aggressive behavior and to reduce use of seclusion and restraint for aggressive behaviors. We focus on studies in acute health care settings, as to our knowledge no such review has been done using data from such settings.
- Authors of Report
- Methodology description
- Data Sources: We searched MEDLINE®, Embase®, the Cochrane Library, Academic Search Premier, PsycINFO, and CINAHL from January 1, 1991, through February 3, 2016. We manually searched reference lists of pertinent reviews, included trials, and background articles to identify relevant citations that our searches might have missed. Eligible studies included randomized controlled trials (RCTs), cluster randomized trials (CRTs), and observational and noncontrolled studies with sample sizes greater than 100. Eligible studies were limited to acute care settings and adult patients with psychiatric disorders or severe psychiatric symptomatology (excluding dementia); they had to report on aggression or seclusion and restraint outcomes.
Review Methods: Two investigators independently selected, extracted data from, and rated risk of bias of studies. Risk of bias and strength of evidence (SOE) were assessed only for controlled studies. Twenty-nine primary studies (from 31 articles) met inclusion criteria. Of these, 11 were controlled trials that provided eligible data for SOE grades. Only 4 of these trials took place in the United States. We grouped studies as follows: (1) staff training interventions, (2) risk assessment interventions, (3) multimodal interventions, (4) environmental interventions (including group psychotherapeutic options), and (5) medication protocols versus other medication protocols or alternative strategies. We organized results by three Key Questions; these covered benefits, harms, and potential modifying characteristics of these strategies.
- All of the report's study data were entered retrospectively to SRDR, via direct file uploading as four Word documents: 1) Appendix E (detailed characteristics for all included studies, regardless of design); 2) Primary benefits (KQ 1) and harms (KQ 2) outcome results data for all controlled studies; 3) Appendix C (detailed risk of bias ratings for all controlled studies); and 4) Appendix F (Primary benefits and harms results data for all single-group pre/post studies).
For both Key Questions 1 and 2, the uploaded data include all four Word documents described above. No studies provided information relevant to Key Question 3.
Publication of the final report and PMID are pending.
- Funding Source