Psychiatric ward design can reduce aggressive behavior
Journal article, 2018

The article describes a conceptual model proposing that aggression in psychiatric facilities may be reduced by designing the physical environment with ten evidence-grounded stress-reducing features. The model was tested in a newer hospital in Sweden having wards with nine of the ten features. Data on two clinical markers of aggressive behavior, compulsory injections and physical restraints, were compared with data from an older facility (replaced by the newer hospital) that had only one stress-reducing feature. Another hospital with one feature, which did not change during the study period, served as a control. The proportion of patients requiring injections declined (p < 0.0027) in the new hospital compared to the old facility but did not change in the control hospital. Among patients who received injections, the average number of injections declined marginally in the new hospital compared to the old facility, but increased in the control hospital by 19%. The average number of physical restraints (among patients who received at least one) decreased 50% in the new hospital compared to the old. These findings suggest that designing better psychiatric buildings using reasoned theory and the best available evidence can reduce the major patient and staff safety threat posed by aggressive behavior.


Aggressive behavior

Evidence-based design

Psychiatric patients

Psychiatric hospital


Roger Ulrich

Chalmers, Architecture and Civil Engineering, Building Design

Lennart Bogren

Linköping University

Sahlgrenska University Hospital

Stuart K. Gardiner

Legacy Health

Stefan Lundin

Chalmers, Architecture and Civil Engineering

Journal of Environmental Psychology

0272-4944 (ISSN) 1522-9610 (eISSN)

Vol. 57 53-66

Subject Categories


Health Care Service and Management, Health Policy and Services and Health Economy




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