Factors associated with violent behavior among hospitalized adolescents with affective disorders: a two-center cross-sectional study

Abstract

Objective Violent behavior among hospitalized adolescents with affective disorders poses substantial challenges to psychiatric care and ward safety. This study aimed to examine demographic, clinical, behavioral, family-related, and personality-related factors associated with violent behavior among hospitalized adolescents with affective disorders. Methods A two-center cross-sectional study was conducted among 202 adolescents with affective disorders admitted to two psychiatric hospitals in China. Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS), with a total score of ≥4 indicating the presence of violent behavior. Non-suicidal self-injury (NSSI), anxiety and depressive symptoms, and personality traits were assessed using standardized instruments. Variables for the multivariable logistic regression analysis were selected based on previous evidence, clinical relevance, the conceptual framework of the study, and the available number of violent events. Study center, age, sex, diagnostic category, single-parent family status, NSSI score, GAD-7 score, neuroticism, and conscientiousness were entered simultaneously into the adjusted model. Results Among the 202 participants, 74 (36.6%) met the criterion for violent behavior. After adjustment for the other variables in the model, single-parent family status was associated with higher odds of violent behavior (OR = 3.709, 95% CI: 1.535–8.965), as was bipolar disorder compared with major depressive disorder (OR = 2.879, 95% CI: 1.030–8.046). Male participants had higher odds of violent behavior than female participants (OR = 3.009, 95% CI: 1.321–6.855). Higher NSSI scores (OR = 1.073, 95% CI: 1.033–1.116) and higher neuroticism scores (OR = 1.322, 95% CI: 1.047–1.670) were associated with higher odds of violent behavior, whereas higher conscientiousness scores were associated with lower odds of violent behavior (OR = 0.695, 95% CI: 0.552–0.875). Conclusions Violent behavior was common in this sample of hospitalized adolescents with affective disorders. Sex, family structure, diagnostic category, NSSI, neuroticism, and conscientiousness were independently associated with concurrent violent behavior. These findings provide a multidimensional understanding of the characteristics associated with violent behavior in adolescent psychiatric inpatient settings. Because of the cross-sectional design, the findings should not be interpreted as evidence of causal relationships or prospective predictive validity.