Revision of the Staff Observation Aggression Scale (SOAS): comment on Hallsteinsen et al.

We would like to make some comments on the extended Staff Observation Aggression Scale (SOAS-E) presented by Hallsteinsen et al. (1). The Staff observation Aggression Scale (SOAS) was originally presented and evaluated in 1987 (2). For some years now, the further development, psychometric properties and clinical use of the SOAS have been a major focus of our research (e.g. 3-7). According to Hallsteinsen et al. (l), the SOAS-E was developed because ‘the original SOAS form appeared to be inadequate for characterization of aggressive incidents’ (1; p.424). Unfortunately, the nature of these inadequacies is not discussed further in the paper. Surprisingly, the SOAS-E emphasizes even more than the the original SOAS inadequate factors. In their attempt to characterize aggressive behaviour more accurately the authors add another item (column) to the SOAS, in which behavioural changes taking place in the hour before the aggressive incident are recorded. In our view, this procedure adds inadequate information to the characterization of the single episode of aggression. The fact that the original SOAS collects data on triggering factors related to aggressive behaviour differentiates this scale (among other things) from other observer aggression scales. The specific registration of aggression-provoking factors may increase the staffs awareness of risk factors, and thus it may constitute an aggression-reducing intervention by itself (5) . Adding a column to the SOAS, in which warning signals not immediately associated with the aggressive act are scored (l), may indeed further increase this awareness of aggressionprovoking risk factors. However, the SOAS was originally designed to characterize aggressive incidents, rather than to record associated changes in the psychiatric condition of the patient prior to aggression. The addition of warning signals such as those described by Hallsteinsen et al. (1) in a separate column of the SOAS may reduce the general applicability of the scale to special patient settings and selections. Moreover, it is questionable whether the warning signals described, such as ‘verbal expression of anger’ and ‘bodily expression of anger’ (1; p.426), can be distinguished from the original item ‘means’, which includes assessment of actual verbal and physical aggression, i.e the warning signal should not be recorded as a warning signal but rather as an aggressive act per se. Hallsteinsen et al. (1) also state that the SOAS, unlike other rating scales, cannot be used to record the location of aggressive incidents. However, the attachment of a ward map to the SOAS has been used in several previous research studies. Such a procedure is described in detail in, for example, the ApriVJune 1997 issue of the European Journal ojPsychiatry (6). In this paper the inter-reporter reliability of the SOAS is presented, information which is not provided in the presentation of the SOAS-E (1). Our own research has led to the development of a revised version of the SOAS, namely the SOAS-R (7). In the construction of the SOAS-R, seventy scores from the original SOAS were validated by comparing these scores with severity judgements of staff members concerning 556 aggressive incidents recorded on six closed wards of