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Previous research has shown good psychometric properties of the Staff Observation Aggression Scale-Revised (SOAS-R). However, it has never been investigated what proportion of aggressive incidents occurring in facilities is documented with the SOAS-R. Furthermore, if incidents are underreported, the consequences for the categorization of clients into aggressive and nonaggressive subgroups based on the SOAS-R are unknown. To examine this, in four inpatient psychiatric facilities for adults with mild intellectual disabilities, aggressive incidents were documented with the SOAS-R and two other indicators of aggressive incidents: the daily staff reports on clients'' behavior and reports on of the use of restraints. Less than half of the incidents documented with the staff and restraint reports were also documented with the SOAS-R. On the other way around, however, it was also found that a substantial proportion of incidents reported on SOAS-R forms were not documented in the daily staff reports, which points to a more general problem of underreporting aggressive behavior. Apart from that, categorization of clients into an aggressive and a nonaggressive subgroup with SOAS-R data collected during 1 month or longer corresponded largely with the categorization based on both other indicators. This study showed that underreporting of aggressive incidents is likely to occur with the SOAS-R, making the instrument less suitable to assess absolute aggression incidence in facilities. Still, the SOAS-R seems a good instrument to categorize clients into aggressive and nonaggressive subgroups. Ways to improve the “compliance” of the ward team to document all aggressive incidents are addressed in the Discussion section of this article. [Copyright &y& Elsevier]

The lack of single-bed rooms in psychiatric wards may reduce the possibility of patients getting sufficient rest and privacy and may increase their risk of being overstimulated. This study explored whether residing in single- versus multiple-bed rooms in a psychiatric ward was associated with psychiatric patients'' opinions about seclusion. More specifically, it was studied whether patients who had shared a room with other patients prior to seclusion rated seclusion more favorably. It was thought that they would rate seclusion more favorably due to the lack of rest they previously experienced in their regular room. For this, the Patient View-of-Seclusion Questionnaire of Hammill, McEvoy, Koral, and Schneider [Hammill, K., McEvoy, J., Koral, H., & Schneider, N. (1989). Hospitalized schizophrenic patient views about seclusion. Journal of Clinical Psychiatry, 50, 174–177] was completed by 54 secluded adult patients hospitalized in a locked ward of a Dutch psychiatric hospital. A significant association was found between residing in multiple-bed rooms prior to seclusion and a less negative view on seclusion. This finding suggests that the ward environment may have a rather large impact on how seclusion is perceived. The results underline the need for single-bed rooms in the treatment of psychiatric inpatients. [Copyright &y& Elsevier]