Influence of sleep quality on aggressive behaviours: Predictive validity of the Brøset Violence Checklist-revised

• Published in: Sleep medicine Vol. 130; pp. 64 - 69
• Main Authors: Terzoni, Stefano, Opreni, Melissa, Lusignani, Maura, Ruta, Federico, Parozzi, Mauro, Bisesti, Alberto, D'Agostino, Armando, Ferrara, Paolo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2025
• Subjects: Adult; Aggression - psychology; Checklist; Female; Humans; Italy; Male; Middle Aged; Nursing; Predictive Value of Tests; Prospective Studies; Psychiatry; Psychometrics; Reproducibility of Results; Risk assessment; Risk Assessment - methods; Sleep; Sleep Quality; Violence; Violence - psychology; Violence - statistics & numerical data; Italy; Nursing; Sleep; Violence; Psychiatry; Risk assessment; Brøset Violence Checklist; sleep risk assessment; aggression
• ISSN: 1389-9457; 1878-5506; 1878-5506
• DOI: 10.1016/j.sleep.2025.03.018

Violent behaviours in acute psychiatric settings represent a critical issue within health systems. Prompt identification of patients at risk is a priority for nurses. The Brøset Violence Checklist (BVC), created to support nursing assessment, showed good psychometric skills; a new version of the instrument (BVCrev), including sleep alterations, seems to improve the predictivity of sleep compared to the original scale but is not available in Italian. To evaluate the psychometric properties of the Italian version of the Brøset Violence Checklist revised (BVCita-rev). This was a prospective, observational study. After back-translation and content validity assessment, the BVCita and BVCita-rev were used simultaneously for risk assessment on a sample of patients admitted to the psychiatric inpatient wards of two Italian hospitals. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated for both BVCita and BVCita-rev. 137 patients were enrolled, and 1117 evaluations were performed. Thirty-four subjects (24.82 %) engaged in aggressive actions during hospitalization, 24 of whom more than once. The predictivity of BVCita-rev was higher than that of BVCita (ROC = 0.9528 vs 0.8811). The S-CVI of the new version of the instrument was = 0.92. Including an item addressing sleep disturbances enhances the predictive capabilities of the BVCita-rev. This modified version of the BVC proves to be an effective tool for supporting nurses in the short-term assessment of violence risk within acute psychiatric inpatient settings. Keywords: Brøset Violence Checklist, violence, aggression, psychiatry, sleep, risk assessment. •Revised BVCita-rev shows higher predictive validity for violence in psychiatry (ROC 0.9528) vs. original BVCita (ROC 0.8811).•A low PPV of BVCita-rev highlights the importance of combining its findings with clinical expertise for effective risk management.•Adding sleep disturbances to BVCita-rev improved its predictive power, emphasizing sleep quality's role in assessing aggression risk.•The Italian BVCita-rev demonstrated strong psychometric properties (S-CVI = 0.92), proving to be a reliable tool for short-term violence risk in psychiatric settings.•The rate of aggressive events was 6.45 %, consistent with international data.