Dynamic Appraisal of Situational Aggression (DASA)

Introduction

The Dynamic Appraisal of Situational Aggression (DASA) is a tool developed by Ogloff & Daffern (2006) to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA is based on the Norwegian Brøset-Violence-Checklist (BVC).

DASA Items

  1. Irritability
  2. Impulsivity
  3. Unwillingness to follow instructions
  4. Sensitive to perceived provocation
  5. Easily angered when requests are denied
  6. Negative attitudes
  7. Verbal threats.

Scoring the DASA

Each of the items are scored 0 if absent or 1 if is present now or has been present in the last 24 hours. This means that if someone is not currently displaying easy anger upon denied requests, but was earlier, that item should be scored 1.

There is no typical cut-off score for the DASA, although Barry-Walsh et. al. (2009) note in their research that “for each increase in DASA total score, there was a 1.77 times increased likelihood that the patient would behave aggressively in the following 24 hours.”

In Ogloff & Daffern’s original 2006 study

  • 18% of aggressive patients scored 1 to 3
  • 15% of aggressive patients scored 4 or 5
  • 55% of aggressive patients scored 6 or 7

Kaunomäki (2013) used a cut-off score of 4 to identify high-risk individuals.

DASA Research

A study of the DASA by Griffith, Daffern & Godber (2013) the DASA allowed nurses to predict aggressive behaviour significantly better than unaided judgements. Lantta et. al. (2016) confirmed the same on mental health inpatient units.

Taylor & Large (2013) question the predictive validity of the DASA, noting that of 200+ patients identified as potentially becoming aggressive, only one actually will. (This “low base rate” problem is the same issue affecting violence risk assessment and suicide risk assessment.)

Daffern & Howells (2007) compared the DASA with the HCR-20 and noted moderate predictive validity.

Current Use

The DASA is currently used by a variety of mental hospitals around the world. Some DASA write-ups include:

Reference

Barry-Walsh, J., Daffern, M., Duncan, S., & Ogloff, J. (2009). The prediction of imminent aggression in patients with mental illness and/or intellectual disability using the Dynamic Appraisal of Situational Aggression instrument. Australasian Psychiatry, 17(6), 493-496. doi:10.1080/10398560903289975

Chan, O. (2014) The Assessment of Imminent Aggression in Forensic Setting A Validation Study of the Dynamic Appraisal of Situational Aggression (DASA) in Hong Kong. Non-Peer Reviewed. Retrieved on November 13, 2016 from http://www.hkcpsych.org.hk/index.php?option=com_docman&task=doc_view&gid=1338&Itemid=354&lang=en

Daffern, M., & Howells, K. (2007). The Prediction of Imminent Aggression and Self-Harm in Personality Disordered Patients of a High Security Hospital Using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression. International Journal Of Forensic Mental Health, 6(2), 137.

Griffith, J. J., Daffern, M., & Godber, T. (2013). Examination of the predictive validity of the Dynamic Appraisal of Situational Aggression in two mental health units. International Journal Of Mental Health Nursing, 22(6), 485-492. doi:10.1111/inm.12011

Kaunomäki, J. (2015) Patient interventions after the assessment of violence risk: Observational study in a Finnish psychiatric admission ward. Institute of Behavioral Sciences. Thesis. Retrieved on November 13, 2016 from https://helda.helsinki.fi/bitstream/handle/10138/156453/Pro%20Gradu%20Kaunomäki%202015.pdf?sequence=3

Lantta, T., Kontio, R., Daffern, M., Adams, C. E., & Välimäki, M. (2016). Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Preference & Adherence, 10691-701. doi:10.2147/PPA.S103840

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Taylor, L., & Large, M. (2013). Dynamic Appraisal of Situational Aggression lacks utility. International Journal Of Mental Health Nursing, 22(6), 579. doi:10.1111/inm.12019

Cite this article as: MacDonald, D.K., (2016), "Dynamic Appraisal of Situational Aggression (DASA)," retrieved on November 17, 2017 from http://dustinkmacdonald.com/dynamic-appraisal-situational-aggression-dasa/.

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