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Objective: Inpatient treatment in psychiatric practice is an important component of treatment both in our country and all over the world. The termination of inpatient treatment despite of medical recommendations is a common problem in psychiatric wards. That problem causes labor loss and it triggers disappointment on the side of mental health professionals. This issue has addressed broadly in English literature under the term, which is called “Discharge against Medical Advice (DAMA)”. DAMA rate ranged from 36% to 6% for psychiatric inpatient treatment. Rate of discharge against medical advice among psychiatric inpatients has increased due to the relative increase in patients’ autonomy in making decisions for treatment processes. We did not find any studies conducted in this field for our country. In this study, we aimed to examine DAMA data of our clinic, and review the literature on the subject.
Method: This study has been carried out in A1 clinic (an open ward psychiatric unit) of the Erenkoy Research and Training Hospital. Two hundred and eighty-six female patients who were accepted inpatient treatment with their own request, between January-December 2013, were enrolled. Patients who were enrolled in the study were divided into two groups according to whether they were DAMA or not. The age of the patient, length of the hospitalization and data related to the diagnosis according to DSM 5 were examined.
Results: Rate of DAMA patients was 27.9% (n=80), rest of the patients (n=206, 72.1%) were discharged according to cooperation of medical stuff and patient’s will. The average age DAMA group was 37.3±12.1, the difference between two groups was statistically insignificant (p=0.24). There were no significant differences between the groups with respect to the DSM-5 diagnosis (p=0.221). However, obsessive compulsive disorder had has predictive feature for being in the DAMA group (p=0.32 among all data. The average time for the length of hospitalization for the DAMA group it was 10.7±11.5 days, and for the normally discharged group it was 25.9±15.1 days, and the difference between two groups was statistically significant (p: 0.00).
Conclusion: This study assessed an annual service data and it has revealed that DAMA rate was quite high. DAMA risk was similar among all diagnostic groups, except there was an increase at DAMA risk for Obsessive compulsive disorder. However, clinical features of two groups were quite similar. Perhaps, the increase in the number of studies in this field will obtain new data, which would provide a better guidance for clinicians.