Volume 9, Issue 3 (10-2025)
EBHPME 2025, 9(3): 145-151 |
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Salarikhah E, Farahzadi M H, Moazen H, Masoud M. Factors Associated with Discharge against Medical Advice among Patients Hospitalized in the Psychiatric Hospital of Yazd Province, Iran (2023–2024). EBHPME 2025; 9 (3) :145-151
URL: http://jebhpme.ssu.ac.ir/article-1-551-en.html
URL: http://jebhpme.ssu.ac.ir/article-1-551-en.html
Department of Health Care Management, Tehran South Branch, Islamic Azad University, Tehran, Iran , salarikhah_e@yahoo.com
Abstract: (22 Views)
Introduction: Patient satisfaction has increasingly become an important issue in the healthcare system. Discharge against medical advice (DAMA) is considered an important indicator of patient dissatisfaction and may negatively affect treatment outcomes while increasing hospital costs. This issue is particularly significant among psychiatric patients due to the chronic and vulnerable nature of mental disorders. Premature discharge in psychiatric patients can increase the risk of relapse, acute psychiatric crises, suicide, self-harm, or harm to others. From a healthcare system perspective, early discharge is associated with higher readmission rates, additional healthcare costs, and reduced efficiency of the healthcare system. Furthermore, due to the social stigma associated with mental disorders in Iranian society, patients and their families may experience additional pressure to leave the hospital prematurely. Therefore, identifying the factors influencing discharge against medical advice in psychiatric hospitals is essential not only for improving clinical outcomes but also for enhancing patient safety, optimizing healthcare resources, and improving the quality of care.
Materials and Methods: This analytical cross-sectional retrospective study was conducted from April 2023 to September 2024 among patients discharged against medical advice from the psychiatric hospital in Yazd Province, Iran. A list of patients who left the hospital against medical advice during the study period was prepared, and 156 patients were selected using simple random sampling.Data were collected through the Hospital Information System (HIS) and review of patients’ medical records and was analyzed through SPSS. In addition, telephone interviews with patients or their family members were conducted to validate the collected information and obtain additional details regarding the reasons for discharge.
Results: Among the 156 patients included in the study, the majority was male (67%). The highest proportion of patients belonged to the 30–39 age group. The most common reasons for discharge were fatigue from the hospital environment (23.1%), occupational and personal problems (20.5%), family dependency (17.3%), and perceived relative recovery (14.1%). Overall, 76.9% of the reasons were related to patient-related factors, while 23.1% were related to hospital-related factors.
Conclusion: The findings of this study indicate that most cases of discharge against medical advice in the psychiatric hospital of Yazd are primarily influenced by individual and psychosocial factors. Early discharge in psychiatric patients increases the likelihood of readmission and imposes significant costs on the healthcare system. Therefore, implementing early psychosocial interventions, improving hospital environmental conditions, and reducing social stigma toward mental illness are essential strategies for reducing DAMA rates.
Materials and Methods: This analytical cross-sectional retrospective study was conducted from April 2023 to September 2024 among patients discharged against medical advice from the psychiatric hospital in Yazd Province, Iran. A list of patients who left the hospital against medical advice during the study period was prepared, and 156 patients were selected using simple random sampling.Data were collected through the Hospital Information System (HIS) and review of patients’ medical records and was analyzed through SPSS. In addition, telephone interviews with patients or their family members were conducted to validate the collected information and obtain additional details regarding the reasons for discharge.
Results: Among the 156 patients included in the study, the majority was male (67%). The highest proportion of patients belonged to the 30–39 age group. The most common reasons for discharge were fatigue from the hospital environment (23.1%), occupational and personal problems (20.5%), family dependency (17.3%), and perceived relative recovery (14.1%). Overall, 76.9% of the reasons were related to patient-related factors, while 23.1% were related to hospital-related factors.
Conclusion: The findings of this study indicate that most cases of discharge against medical advice in the psychiatric hospital of Yazd are primarily influenced by individual and psychosocial factors. Early discharge in psychiatric patients increases the likelihood of readmission and imposes significant costs on the healthcare system. Therefore, implementing early psychosocial interventions, improving hospital environmental conditions, and reducing social stigma toward mental illness are essential strategies for reducing DAMA rates.
Type of Study: Original article |
Subject:
Healt care Management
Received: 2025/10/29 | Accepted: 2026/04/27 | Published: 2026/06/1
Received: 2025/10/29 | Accepted: 2026/04/27 | Published: 2026/06/1
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