Introduction: Physical and verbal violence toward staff or other detained individuals is a reoccurring problem within correctional facilities. Screening for violence risk within the prison setting... Show moreIntroduction: Physical and verbal violence toward staff or other detained individuals is a reoccurring problem within correctional facilities. Screening for violence risk within the prison setting could provide a valuable first step in the prevention of institutional violence. The brief and compact Risk Screener Violence (RS-V) has shown to be an efficient new method for assessing concerns regarding post-release violent offending for incarcerated persons. This study aimed to find out whether the RS-V is also able to predict future violent and aggressive incidents during imprisonment.Methods: The predictive validity of the RS-V for future violent and aggressive incidents during a follow-up time of 4 months within prison was analyzed, using a file-based design. Violent incidents toward staff and other inmates (physical violence and violent threats), other aggressive incidents (aggression toward objects and verbal disruptive behavior), and both categories combined, were included as outcome measures based on disciplinary reports.Results: The RS-V showed medium to large predictive values for both violent and aggressive behavior during prison stay. In particular, good predictive values of the RS-V were found for violence toward prison staff.Discussion: This study shows that, besides post-release violent recidivism, the RS-V is able to accurately predict future violent and aggressive incidents during prison stay. By correctly differentiating between low concern and high concern individuals, the RS-V aims to contribute to more personalized interventions and risk management and, subsequently, to improved prison safety. Future studies using prospective prison practice data are needed to further support the validity of the RS-V regarding institutional violence. Show less
This thesis leads to empirical insights in the relationship between anger and aggression, on the one hand, and psychopathology, on the other hand, using robust study designs and a broad spectrum of... Show moreThis thesis leads to empirical insights in the relationship between anger and aggression, on the one hand, and psychopathology, on the other hand, using robust study designs and a broad spectrum of anger manifestations. It became clear that the occurrence of anger and aggression are common among both psychiatric outpatients, including individuals with depressive-, anxiety-, and bipolar disorders, and psychiatric inpatients, including individuals with psychotic- and personality disorders. Aggressive behaviour regularly leads to a referral to long-stay inpatient care. As supported by this thesis, the costs of aggression within long-stay wards are high. However, despite the increased awareness and efforts to reduce violence in clinical care among healthcare workers and policymakers, aggression incidents remain highly prevalent in psychiatric inpatient facilities. Research suggests diet to be a modifiable factor affecting mood and behaviour. Yet, the promising effects of nutritional supplementation on aggressive incidents found in previous studies were not replicated in psychiatric inpatients. These results strengthen the need for study of additional preventative and treatment options. Furthermore, our results underline the importance of including vulnerable populations, who are often underrepresented in RCTs, to provide evidence-based care for these groups. Show less
Background Aggression and violent incidents are a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents and rule violations in... Show moreBackground Aggression and violent incidents are a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents and rule violations in forensic populations and children with behavioural problems. Aims To assess whether multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation would reduce the number of aggressive incidents among long-stay psychiatric in-patients. Method The trial was a pragmatic, multicentre, randomised, double-blind placebo-controlled study. Data were collected from 25 July 2016 to 29 October 2019, at eight local sites for mental healthcare in The Netherlands and Belgium. Participants were randomised (1:1) to receive 6-month treatment with either three supplements containing multivitamins, minerals and n-3 polyunsaturated fatty acid, or placebo. The primary outcome was the number of aggressive incidents, determined by the Staff Observation Aggression Scale - Revised (SOAS-R). Secondary outcomes were patient quality of life, affective symptoms and adverse events. Results In total, 176 participants were randomised (supplements, n = 87; placebo, n = 89). Participants were on average 49.3 years old (s.d. 14.5) and 64.2% were male. Most patients had a psychotic disorder (60.8%). The primary outcome of SOAS-R incidents was similar in supplement (1.03 incidents per month, 95% CI 0.74-1.37) and placebo groups (0.90 incidents per month, 95% CI 0.65-1.19), with a rate ratio of 1.08 (95% CI 0.67-1.74, P = 0.75). Differential effects were not found in sensitivity analyses on the SOAS-R or on secondary outcomes. Conclusions Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric in-patients. Show less
This thesis aimed to provide insight in the etiology, predictors, and outcomes of aggression and antisocial behavior in children and adolescents. The first part of this thesis focused on more... Show moreThis thesis aimed to provide insight in the etiology, predictors, and outcomes of aggression and antisocial behavior in children and adolescents. The first part of this thesis focused on more conventional prediction of outcomes and continuation of aggression and antisocial behavior on the basis of the following constructs: parental psychopathology (Chapter 2), anxiety and depression (Chapter 3), and Oppositional Defiant Disorder symptoms (Chapter 4). Next, the second part of this thesis focused on novel biological markers of aggression, consisting of a review on the genetics of aggression (Chapter 5) and an empirical study on the metabolomics of aggression (Chapter 6). Chapter 7 provides a summary and general discussion of the thesis' contents. Show less
Research on precursors of empathy, and on the association between empathy and aggression in early childhood is scarce and contradictory. It is likely that these contradictory results can be... Show moreResearch on precursors of empathy, and on the association between empathy and aggression in early childhood is scarce and contradictory. It is likely that these contradictory results can be explained by taking into account other factors that are related to empathy and aggression. Therefore, our main aim was to study early manifestations of empathy as a predictor of aggression during the first years of life, while taking into account the role of precursors of empathy and possible moderators of the association between empathy and aggression. Early manifestations of empathy could be predicted from emotional responses in infancy, as infants who were more emotionally reactive themselves were also more sensitive to emotions of others during toddlerhood. In addition, impaired empathy already was a risk factor of aggression from the age of 20 months. High levels of aggression were associated with low levels of affective empathy, but not cognitive empathy. The negative association between empathy and aggression was stronger for girls, children with high levels of inhibition, and children with low levels of social attention. It is important to take these factors into account in further research and intervention programs that target empathy and its association with aggression in early childhood. Show less
Background Levels of aggression are high in residential settings for juveniles with Mild Intellectual Disability (MID). As a result, treatment is less effective, aggression causes injury, traumatic... Show moreBackground Levels of aggression are high in residential settings for juveniles with Mild Intellectual Disability (MID). As a result, treatment is less effective, aggression causes injury, traumatic experiences and longer inhabitation for juveniles. Additionally, inpatient aggression has been linked to burnout and stress among group workers, which has negative consequences such as less job satisfaction or poorer work performance Objective Therefore, it is crucial to diminish aggressive incidents in these settings and to find a way for staff how to respond to aggression properly. Methods As there is no intervention method which tackles all of the referred problems efficiently, a new method Non-violent Resistance for MID was introduced into three residential settings for juveniles with MID, in a quasi-experimental stepped wedge design. Reports of aggressive incidents were assessed seven times before, during and after the training in NVR-MID on group level. Multilevel analyses were carried out in order to assess the development of the aggressive incidents over time. Results Aggressive incidents decreased significantly in time during and after training in NVR-MID, this decrease is seen in all three institutions. Thus, regardless of resident's age, gender or IQ, NVR-MID seemed successful in diminishing aggressive incidents. Furthermore, a significant interaction effect was found between institution and time, indicating that regardless if incidents of aggression were relatively high at baseline, decrease in incidents was similar to institutions where incidents were relatively low on baseline. Conclusions Implementing NVR-MID into residential settings for juveniles with MID and comorbid behavioral problems might help to decrease aggressive incidents. Show less
Objective Aggressive behaviour is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression... Show moreObjective Aggressive behaviour is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. Methods A random sampling procedure was conducted at long-term psychiatric inpatient care facilities. Nurses were asked to recall all incidents (i.e., verbal, physical towards objects, self, or others) of their shift. For the time spent on each type of incident, staff were monitored in real-time. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to material-related costs. Results Incidence rates were 90 incidents per patient year. The average time spent per incident was 125 min but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was euro78; extrapolated per patient year, the total costs were approximately euro7000. Conclusions The current study found a high rate of aggression incidents in closed long-stay psychiatric wards. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs. Show less
Gink, K. van; Domburgh, L. van; Jansen, L.; Goddard, N.; Ottenbros, R.; Stegen, B. van der; ... ; Vermeiren, R. 2020
Non-violent Resistance (NVR) is a method to manage child and adolescent aggressive behavior and to decrease parental helplessness. Although developed for a family setting, this paper describes the... Show moreNon-violent Resistance (NVR) is a method to manage child and adolescent aggressive behavior and to decrease parental helplessness. Although developed for a family setting, this paper describes the adaptation of NVR for child and adolescent residential settings, reports on the possible hampering and facilitating elements of implementing NVR in four different institutions and finally presents seclusion and restraint rates before and after implementation. Retrospective analysis of the different implementation processes suggested the following dements to facilitate implementation: awareness that NVR is not a quick fix, a considerable amount of time and financial investment, a team-wide perspective, support from all levels in an organization and influential team members committed to NVR to decrease the risk of falling back into more familiar patterns. Seclusion and restraint figures pre-post point in the direction that the implementation of an adapted version of NVR in residential settings could result in decreased seclusion and restraint. Furthermore, this decrease was most pronounced in sites with a successful implementation process. This observational study provides a starting point for an empirical basis for the use of NVR within child and adolescent residential settings. Further research on successful implementation processes for multi-level, milieu-based interventions, such as NVR, is required. Show less
This thesis examined the extent to which relationships between emotional experiences and aggressive behaviours in adolescents are affected by culture. While existing studies often compare... Show moreThis thesis examined the extent to which relationships between emotional experiences and aggressive behaviours in adolescents are affected by culture. While existing studies often compare individuals from different countries to study cultural influences, this thesis also took a between-country approach by comparing Dutch and Malaysian adolescents; groups that reflect individualistic and collectivistic cultures, respectively. Also, the effect of individualistic and collectivistic values at an individual level was examined. First, the outcomes show that many relationships were culturally universal. Regardless of country or cultural orientation, adolescents who had more problems with anger control tended to be more aggressive; and those who experienced intense anger, fear and shame were more often bullied. Also, guilt was related to less aggressive behaviours in both Malaysian and Dutch samples. Yet, this thesis also revealed country/cultural specific relationships. Whereas shame was related to more aggression in Dutch adolescents, the opposite was true for Malaysian adolescents.Remarkably, this thesis found that the traditional classification between individualistic Western countries and collectivistic Eastern countries was not fully supported when cultural values were assessed at individual levels. For example, while higher levels of shame were related to less aggressive behaviours in individualistic-oriented adolescents, the opposite was true for collectivistic-oriented adolescents. Show less
Experiencing shame and guilt is painful but these emotions have an important social function. They prevent socially inappropriate behaviors as they make us aware of norms and values that are... Show moreExperiencing shame and guilt is painful but these emotions have an important social function. They prevent socially inappropriate behaviors as they make us aware of norms and values that are necessary for creating and maintaining social harmony. Participation in the social world is crucial for the development of shame and guilt, and less access to the social world could therefore be detrimental to this development. In this thesis, the influence of access to the social world on the development of self-conscious emotions is examined in two groups with less access to the social world: adolescents with an autism spectrum disorder (ASD) and adolescents with hearing loss. In addition, this thesis aimed to unravel the longitudinal contributions of shame and guilt on the development of adolescent aggression. Adolescents with diminished access to the social world reported lower levels of shame and guilt. The longitudinal relationships applied to both adolescent with diminished access and typically developing adolescents. It was demonstrated that shame is a risk factor for the development of reactive aggression, and that guilt is an inhibiting force on the development of bullying and proactive aggression Show less
Steen, J.T. van der; Smaling, H.J.A.; Wouden, J.C. van der; Bruinsma, M.S.; Scholten, R.J.P.M.; Vink, A.C. 2018
Nonreciprocal action of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increases susceptibility to emotional and behavioral problems in children exposed to adversity. Little is... Show moreNonreciprocal action of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increases susceptibility to emotional and behavioral problems in children exposed to adversity. Little is known about the PNS and SNS in interaction with early adversity during infancy. Yet this is when the physiological systems involved in emotion regulation are emerging and presumably most responsive to environmental influences. We examined whether parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) response and recovery at six months, moderate the association between cumulative prenatal risk and physical aggression at 20 months (N = 113). Prenatal risk predicted physical aggression, but only in infants exhibiting coactivation of PNS and SNS (i.e., increase in RSA and decrease in PEP) in response to stress. These findings indicate that coactivation of the PNS and SNS in combination with prenatal risk is a biological marker for the development of aggression. Show less
Kinderen met een oppositioneel opstandige gedragsstoornis (ODD) of antisociale gedragsstoornis (CD) hebben een verhoogd risico op toekomstig probleemgedrag zoals delinquentie, werkeloosheid en... Show moreKinderen met een oppositioneel opstandige gedragsstoornis (ODD) of antisociale gedragsstoornis (CD) hebben een verhoogd risico op toekomstig probleemgedrag zoals delinquentie, werkeloosheid en psychiatrische problemen. Om beter te begrijpen waarom kinderen agressief en antisociaal gedrag vertonen en dit gedrag positief te kunnen beïnvloeden is het nuttig om naar de onderliggende cognitieve en neurobiologische processen te kijken, welke onderliggend zijn aan (probleem)gedrag. Eén van die mechanismen is zelfregulatie: het vermogen om controle uit te kunnen oefenen over onze gedachten, emoties en gedrag. In dit onderzoek hebben we zelfregulatie onderzocht door vier aspecten van zelfregulatie te onderzoeken: neurobiologie (ANS, HPA-as), emotieregulatie; executieve functies en gedrag. We onderzochten 65 jongens met ODD/CD en 38 normaal ontwikkelende controle jongens in de leeftijd van 8-12 jaar in rust en in een stressvolle situatie. We ontdekten dat jongens met ODD/CD een heterogene groep vormen zowel op gedragsniveau als neurobiologisch niveau. Daarnaast zagen we dat er specifieke relaties zijn tussen neurobiologische factoren en verschillende gedragsproblemen en dat de neurobiologie voorspellend is voor het verloop van agressie over een jaar tijd. Deze informatie is belangrijk omdat het laat zien dat interventies moeten aansluiten op het individu, passend bij het mechanisme dat onderliggend is aan het probleemgedrag en verstoord is. Show less
Het terugdringen van agressie is in de afgelopen jaren in toenemende mate een maatschappelijke prioriteit geworden. Agressie in de vroege kindertijd vergroot de kans op latere agressieproblemen en... Show moreHet terugdringen van agressie is in de afgelopen jaren in toenemende mate een maatschappelijke prioriteit geworden. Agressie in de vroege kindertijd vergroot de kans op latere agressieproblemen en antisociaal gedrag. In de peutertijd is er al een groep hoog-agressieve kinderen te identificeren die later in de ontwikkeling meer persistente, ernstigere vormen van agressie laat zien. Belangrijk is om veranderbare factoren te identificeren die samenhangen met het ontstaan en/of de instandhouding van het probleemgedrag. Het ouderlijk reflectief functioneren (RF) is in dat kader een interessant concept, aangezien deze vaardigheid te trainen is. In dit proefschrift is de invloed van het RF-vermogen van moeder op de ontwikkeling van (voorlopers van) gedragsproblemen in de vroege kindertijd, in het bijzonder fysieke agressie, bekeken. Geconcludeerd kan worden dat het RF-vermogen van de moeder een belangrijke rol speelt bij het ontwikkelen van (voorlopers van) gedragsproblemen. Over het algemeen genomen lijkt een beter prenataal RF-vermogen van de moeder samen te hangen met een kleinere kans op het ontwikkelen van vroege fysieke agressie. De bevindingen suggereren dat het bij de preventie en aanpak van vroege gedragsproblemen belangrijk is om te investeren in het verbeteren van het ouderlijk RF, bij voorkeur al tijdens de zwangerschap. Show less
Smaling, H.J.A.; Huijbregts, S.C.J.; Heijden, K.B. van der; Hay, D.F.; Goozen, S.H.M. van; Swaab, H. 2017
Dit proefschrift beschrijft studies over prosociaal en antisociaal gedrag bij kinderen en de hieraan gerelateerde situationele en dispositionele factoren. De resultaten beschreven in dit... Show moreDit proefschrift beschrijft studies over prosociaal en antisociaal gedrag bij kinderen en de hieraan gerelateerde situationele en dispositionele factoren. De resultaten beschreven in dit proefschrift laten zien dat, ondanks de hoge kosten en lage baten, een substantieel deel van de kinderen uit de diverse studies zich prosociaal gedroeg richting een kind in nood of tijdens sociale uitsluiting van een ander. Uit het onderzoek blijkt daarnaast dat specifieke kenmerken van de situatie ten grondslag liggen aan zowel prosociaal als antisociaal gedrag. Kinderen doneren bijvoorbeeld meer geld aan een goed doel wanneer zij dit een ander kind ook zien doen. Maar er is ook een verband gevonden tussen dispositionele factoren en prosociaal en antisociaal gedrag. Hoeveel geld kinderen doneren hangt bijvoorbeeld samen met de anatomie van hun hersenen en kinderen die volgens hun ouders hoge niveaus van agressie laten zien, vertonen ook in een andere situatie (op school) meer antisociaal gedrag. Dit proefschrift laat bovendien zien dat dispositionele factoren zoals angst en autistische trekken een kind meer of juist minder gevoelig kunnen maken voor situationele factoren. Show less
