Schizophrenia patients discharged against medical advice at a mental hospital in Taiwan

Aim: The purpose of the present study was to evaluate the risk factors associated with discharge against medical advice (AMA) and compare the time to rehospitalization between patients with AMA discharges and those with regular discharges. Methods: All schizophrenia inpatients discharged from a psychiatric hospital between 1 January 2006 and 31 December 2006 were monitored. The clinical variables were compared between the patients discharged AMA and those with regular discharges. Logistic regression was used to determine the best predictor for AMA discharge. Times to rehospitalization within 15 and 60 days after discharge were measured using the Kaplan-Meier method. Results: Compared to patients with regular discharges, patients discharged AMA were significantly more likely to be male (P = 0.007), to have comorbid alcohol abuse/dependence (P = 0.007), to take typical antipsychotic agents (P = 0.005) and to have shorter lengths of hospital stay (P < 0.001). Logistic regression demonstrated that male gender (odds ratio [OR], 1.631; 95% confidence interval [CI]: 1.067-2.493)] and prescription of typical antipsychotic agents (OR, 1.729; 95% CI: 1.098-2.723) were the most influential predictors for discharge AMA. There were significant differences in time to rehospitalization between these two groups during the 15-day (P = 0.009) and 60-day (P = 0.038) follow-up periods. Conclusion: Male gender and prescription of typical antipsychotic agents increased the likelihood of AMA discharge. The consequence for patients with AMA discharges was earlier rehospitalization. Future studies are needed in many different mental health systems to better generalize the findings.