# The Mental States of Aggressors: A Biopsychosocial Analysis of Workplace Violence Reports in Hospitals

## TL;DR

This study explores the mental states of aggressors in hospital workplace violence to improve prevention and support strategies.

## Contribution

The paper introduces a novel middle-range theory and mixed-methods approach to differentiate between involuntary and unremorseful aggression.

## Key findings

- WPV incidents increased by 212.4% from 2020 to 2021 and remained high afterward.
- Patient/visitor aggression accounted for 93% of incidents, with physical violence being most common.
- Differentiating aggression types offers actionable insights for de-escalation and support strategies.

## Abstract

Workplace violence (WPV) in hospitals worldwide has been on the rise for the last decade, marked by increased verbal and physical aggression. From a biopsychosocial perspective, we conceptualize aggressors' mental states as their control (or lack of) of an impulse across their life course. To contribute to violence prevention, our study synthesizes theoretical assumptions and organizational analysis.

An exploratory sequential mixed‐methods design analyzed 2634 WPV narratives from two hospitals in a large city in the Northeastern United States of America (2019–2023). Narratives were coded for “involuntary mental states” (e.g., dementia, delirium, lack of inhibition) and “unremorseful attitudes” (denial, minimization, justification without medical causation). Quantitative analysis identified patterns within these categories, types of violence, and safety responses.

WPV incidents increased by 212.4% from 2020 to 2021 and did not decrease in incidence in subsequent years. Patient/visitor workplace violence (Type 2) accounted for 93%. Physical violence was most prevalent (76%), followed by verbal (48%) and sexual (6%). “Involuntary mental states” comprised 28% of narratives, while “unremorseful attitudes” represented 29%. Workers often showed compassion, omitting emotional details for involuntary aggression, but reported significant distress from unremorseful acts.

Our novel middle‐range theory and mixed‐methods approach reveal the complexity of WPV beyond simple dichotomies. Differentiating between involuntary and unremorseful aggression provides actionable insights for tailoring prevention strategies, de‐escalation training, and aftermath support. Integrating mental health professionals and addressing the profound impact of remorseless acts is crucial for worker morale and retention.