Psychiatry Trainees Subjected to High Levels of Abuse From Patients

More than 80% of psychiatric trainees have experienced some kind of verbal, physical, or sexual assault from patients, and approximately one third have been physically attacked multiple times, new survey results show.

Such incidents, said study investigator Victor Pereira-Sanchez, MD, Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, take a toll on the trainees' well-being and may ultimately affect the quality of patient care.

"The extent of violence against psychiatric trainees is alarming and calls for the implementation of effective training, prevention, and intervention measures," Pereira-Sanchez told Medscape Medical News.

The findings were presented at the European Psychiatric Association (EPA) 2020 Congress, which was virtual this year because of the COVID-19 pandemic.

Widespread Problem

Violence against healthcare professionals is widespread among clinicians in EDs with psychiatry trainees "more exposed and vulnerable," Pereira-Sanchez said during his presentation.

In 2017, the European Federation of Psychiatric Trainees established a group of researchers to describe "the extent and consequences of violence against psychiatric trainees in Europe and beyond," he said.

The group developed a 15-item questionnaire asking young clinicians about experiences of physical, sexual, and verbal assault at work. The survey was posted online by partner institutions via social media.

A total of 827 psychiatric trainees, the majority of whom were from France and the United Kingdom, completed the survey. Respondents had an average age of 31 years, and 68% were women. On average, respondents had completed 51.3% of their psychiatric training.

Results showed that 83.6% experienced some kind of assault at the hands of patients during their training, with 92.0% reporting verbal assaults, 44.1% physical assaults, and 9.3% sexual assaults.

In addition, 14.2% had been assaulted once, 51.9% had been assaulted two to five times, and 33.9% had been assaulted more than five times during their training.

Results also showed that assaults were more likely to occur on an inpatient ward (63.4%) or the ED (56.9%), although 37.2% occurred in an outpatient setting and 4.2% in community settings.

The majority of respondents (69.0%) did not report their assaults and 67.3% did not call police or security personnel.

The most common emotions experienced by trainees following an assault were fear, rage, and anxiety. Guilt, sadness, feeling unsupported, and self-doubt were also reported.

Pereira-Sanchez noted the low rate of reported assaults is likely because trainees view it as "part of the job to get insulted, it's part of the job to suffer minor physical violence."

Individuals who did reported assaults tended to be those who had been assaulted more than five times and those who felt more anxiety, rage, and fear.

"Basically, those who experience more emotional consequences and physical consequences tend to report more," he said.

In addition, trainees tended to report assaults if they worked in an institution that provided protocols and training in prevention and management of patient aggression.

However, he added, most respondents reported they were not aware of their center's protocols with respect to assaults and were not trained in the management or prevention of patient violence.

Management Tools Key

Commenting on the study for Medscape Medical News, Renee Binder, MD, professor of psychiatry at University of California, San Francisco, said the findings show that "when patients are out of control, they may act inappropriately, including verbal, physical, and sexual assaults."

Consequently, "clinicians should be prepared and have management tools," said Binder, who was not involved in the research.

She noted that derogatory statements and racial slurs were included among the verbal assaults, which is particularly common in inpatient units and EDs where "patients may be acutely psychotic or manic and out of control," she said.

However, Binder pointed out that the investigators did not separate mild and more severe forms of physical and sexual assault.

"If the authors had more finely separated out the types of physical and sexual assaults, they probably would have found that mild types of assaults are much more common than more severe assaults," she said.

Pereira-Sanchez ' s fellowship program is funded by Fundacion Alicia Koplowitz. He and Binder have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 2020 Congress: Abstract O0052. Presented July 5, 2020.

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