(609) Violent Ideation in Physical Rehabilitation Patients

Authors: Daniel Bruns, Ramazzini Center; John Mark Disorbio, Private Practice Most of the literature on patients who are potentially dangerous has focused on patients in psychiatric facilities. Little is known about such tendencies in the physical rehabilitation setting. The relationship of violent ideation (VI) to other variables was explored using a community sample (n=1487) and a physical rehabilitation patient sample (n=777) gathered at 90 sites in 36 US states. Background information and BHI profiles were obtained from this sample. The results found that a significantly higher percentage of patients reported VI than did persons in the community ( P <.0001). VI and non‐VI groups were significantly different on 13 BHI scales ( P < .0001), with the Hostility scale showing the largest difference as hypothesized. Overall pain complaints were slightly higher in the VI group ( P <.05). VI was found to be associated with insurance system ( P <.001), type of rehabilitation program ( P <.05), litigation for the injury ( P <.001), a lower level of education ( P <.05), ethnicity ( P <.001), tobacco use ( P <.0001), having a traumatic brain injury ( P <.05), having a suicide plan ( P <.0001), and reports of surviving a childhood sexual assault ( P <.005). In contrast, patients reporting VI were not different with regard to gender, type of orthopedic injury, highest pain levels, chronicity, marital instability or vocational instability. A sobering statistic was that 20% of the sample of work hardening patients reported VI. As more is known about VI and aggressiveness in medical settings, there will be an increased opportunity to develop effective interventions. This may include managing the concerns of a hostile person with an injury, as well as designing health care delivery systems that do not unnecessarily antagonize patients.