Aggressive behaviour and associated factors among patients with severe mental illness attending a tertiary hospital in Northwest Ethiopia: an institution-based cross-sectional study
Zemene Yiglet, Goshu Nenko Dukele, Seblewongel Tinsea, Daniel Ayelegne Gebeyehu, Dawed Ali, Selam Koye, Tadele Amare Zeleke, Hilina Tadesse, Digafe Demelash, Yeneneh Workie, Mulualem Admasu Kelebie, Tesfaw GetachewObjective
To determine the prevalence and patterns of aggressive behaviour and identify factors associated with aggressive behaviour among patients with severe mental illness (SMI) attending a tertiary hospital in Northwest Ethiopia in 2025.
Design
Institution-based cross-sectional study.
Setting
University of Gondar Comprehensive Specialised Hospital, Northwest Ethiopia, conducted from 1 to 30 March 2025.
Participants
A total of 423 patients with SMI were selected using a systematic random sampling technique.
Outcome measures
Data were collected using interviewer-administered questionnaires and medical record review. Aggressive behaviour was assessed using the Modified Overt Aggression Scale (MOAS). Sociodemographic, clinical, substance use, medication adherence and psychosocial characteristics were assessed using standardised instruments and medical records. Adjusted ORs (AORs) with 95% CIs were estimated, and statistical significance was declared at p<0.05.
Results
The prevalence of aggressive behaviour was 32.2% (95% CI 28.0% to 36.9%). Verbal aggression was the most common subtype (25.5%), whereas auto-aggression was the least common (12.4%). Poor medication adherence (AOR = 3.31; 95% CI 1.24 to 8.86), current substance use (AOR = 7.31; 95% CI 2.41 to 22.10), previous history of aggression (AOR = 2.82; 95% CI 1.03 to 7.74), moderate illness severity (AOR = 2.59; 95% CI 1.19 to 5.66) and severe illness severity (AOR = 4.71; 95% CI 1.12 to 19.78) were independently associated with aggressive behaviour.
Conclusion
One-third of patients with SMI exhibited aggressive behaviour. Poor medication adherence, current substance use, previous history of aggression and severe illness severity were independently associated with aggressive behaviour. Routine assessment of aggression risk and interventions targeting medication adherence, substance use and illness severity may help reduce aggressive behaviour among patients with SMI.