Rate and risk factors for aggressive behavior in young people presenting with first-episode psychosis in Hong Kong: a three-year follow-up study

Abstract

Accumulating evidence has indicated that early psychosis patients have an elevated risk of violence, but the prevalence and risk factors varied across studies. The present study aimed to examine the rate and predictors of aggressive behavior in a large representative Chinese young people with first-episode psychosis (FEP) in Hong Kong. Seven hundred patients aged 15–25 years consecutively enrolled in a territory-wide specialized early intervention service for FEP from July 2001 to August 2003 were studied. Socio-demographics, pre-treatment characteristics, baseline and three-year follow-up variables were collected via systematic medical file review. Of the 700 patients, 73 (10.4%) exhibited aggressive behavior during three-year treatment period, and 23 (2.4%) engaged in more than one attempt. Occurrence of aggressive behavior was associated with male sex (p < 0.001), lower educational level (p < 0.001), pre-treatment violence (p < 0.01), history of substance abuse (p < 0.05) and smoking (p < 0.05), and baseline unemployment status (p < 0.05). Multivariate regression analysis controlling for length of service revealed that male sex (p = 0.01), educational attainment (p < 0.01) and pre-treatment violence (p < 0.001) independently predicted aggressive behavior during three-year follow-up. In a large cohort of Chinese FEP patients, one in ten displayed aggressive behavior in the initial three years of treatment. Our findings confirmed predictive role of male sex, past aggressive behavior and lower educational attainment for heightened violence risk at follow-up. Frequent clinical monitoring, comprehensive risk assessment and more intensive case management should be provided to those patients with identified violence risk factors so as to minimize later aggressive behavior.