The mediating role of neuroception of psychological safety in the relationship between traumatic experiences and aggressive behaviors among inpatients with mental disorders.

BACKGROUND: Patient safety is a central concern in the field of mental health. Violent and aggressive behaviors occur frequently in psychiatric wards and often lead to serious consequences. Existing management strategies predominantly focus on physical interventions and symptom treatment, as well as risk assessment, emergency response planning, and coercive measures, while paying insufficient attention to patients' psychological perceptions and traumatic experiences. The Polyvagal Theory distinguishes neuroception from conscious psychological safety. Neuroception refers to a subconscious process involved in detecting safety and threat, which may provide a theoretical perspective for understanding the association between trauma and defensive behaviors, including aggression. However, current assessment tools in China, such as the Security Questionnaire developed by Cong Zhong et al., mainly assess conscious psychological safety do not capture this preconscious bodily dimension. The Chinese version of the Neuroception of Psychological Safety Scale (NPSS), culturally adapted and validated by our research team, may address this gap. To date, the potential relationships among traumatic experiences, neuroception of psychological safety, and aggressive behavior among hospitalized patients with mental disorders in China remain insufficiently understood.

METHODS: This was a cross-sectional study. 216 inpatients were randomly sampled (2023.7-10). Scales including NPSS, CTQ and MOAS were used for data collection. SPSS 26.0 and AMOS 23.0 were applied for statistical analysis and structural equation modeling, with bootstrap testing of indirect effects.

RESULTS: Neuroception of psychological safety score was 3.80 ± 0.56 (highest somatic perception, lower social engagement/compassion); 90.3% had treatment-related trauma. Seven factors were independently associated with neuroception of psychological safety (all p < 0.05, adjusted R2  = 0.581). Traumas correlated positively with aggression and negatively with neuroception of psychological safety, which correlated negatively with aggression (all p < 0.01). Significant indirect associations through neuroception of psychological safety were observed in both trauma-aggression relationships, accounting for 24.2 and 20.4% of the total associations, respectively.

CONCLUSION: Inpatients with mental disorders exhibited relatively lower scores on the dimensions of social engagement and compassion. Neuroception of psychological safety may partially account for the observed association between trauma and aggression. Its potential role as a clinically relevant factor warrants further investigation in longitudinal and interventional studies.