Prevalence of Discharge against Medical Advice in Psychiatric Patients and Associated Factors

Background and purpose: Leaving the hospital against physician advice is associated with negative consequences. The aim of this study was to investigate the prevalence of discharge against medical advice in a psychiatric hospital and factors associated with this decision. The study was conducted using the records of 1112 patients admitted to Sari Zere Hospital, Iran between April 2014 and March 2015. The cases were selected using census. They were asked about the reasons for discharge against medical advice on telephone calls. Data analysis was done in SPSS V24 applying Chi-square test. Among the patients 150 were discharged against medical advice. Main diagnosis of these patients was bipolar mood disorder (22.7%) accompanied by psychotic features and borderline personality disorder. The onset of disease was during youth in 57.3% of the patients. Among the subjects, 60% were admitted for the first time. At the second time of discharge against medical advice, frequency of patients with substance abuse was higher. The most common causes of discharge against medical advice were family pressure (44%), patients will for early discharge (33%), dissatisfaction from medical staff (11%), and costs associated with hospitalization and family problems (11%), respectively. The findings suggest providing patients and their families with appropriate training and information on the consequences of discharge against medical advice.