Discharge against medical advice from inpatient psychiatric treatment: A literature review

Michael Brook*, Donald M. Hilty, Weiling Liu, Rona Hu, Mark A. Frye

*Corresponding author for this work

Research output: Contribution to journalReview article

61 Citations (Scopus)

Abstract

Objective: A comprehensive review of the literature examined discharge from inpatient psychiatric settings against medical advice (excluding elopements) over the past 50 years. Specifically, definitions, prevalence, predictors, temporal patterns, consequences, and interventions pertaining to such discharge were explored. Methods: The authors searched the PubMed and PsycINFO databases and selected articles for review if studies had been conducted in an inpatient setting or included discharge against medical advice as one of the aims or results and if findings were based on formal statistical analyses. Results: Sixty-one articles met the selection criteria. Prevalence of discharge against medical advice ranged from 3 to 51 percent and increased over time. Discharge against medical advice was most commonly predicted by patient factors, such as young age; single marital status; male gender; comorbid diagnosis of personality or substance use disorders; pessimistic attitudes toward treatment; antisocial, aggressive, or disruptive behavior; and history of numerous hospitalizations ending in discharges against medical advice. It was also predicted by provider variables, such as failure to orient patients to hospitalization and failure to establish a supportive provider-patient relationship, and by temporal variables, such as evening and night shifts. Outcomes of patients discharged against medical advice were characterized by poor outcomes in several domains of functioning and more frequent rehospitalizations. Conclusions: Prediction of patients at risk of discharge against medical advice is possible with several defined variables. Awareness of the factors involved in discharge against medical advice should facilitate clinical decision making and the development of successful interventions for high-risk patients.

Original languageEnglish (US)
Pages (from-to)1192-1198
Number of pages7
JournalPsychiatric Services
Volume57
Issue number8
DOIs
StatePublished - Jan 1 2006

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Psychiatry
Inpatients
Hospitalization
Therapeutics
Marital Status
PubMed
Patient Selection
Substance-Related Disorders
Personality
Databases

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Brook, Michael ; Hilty, Donald M. ; Liu, Weiling ; Hu, Rona ; Frye, Mark A. / Discharge against medical advice from inpatient psychiatric treatment : A literature review. In: Psychiatric Services. 2006 ; Vol. 57, No. 8. pp. 1192-1198.
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Discharge against medical advice from inpatient psychiatric treatment : A literature review. / Brook, Michael; Hilty, Donald M.; Liu, Weiling; Hu, Rona; Frye, Mark A.

In: Psychiatric Services, Vol. 57, No. 8, 01.01.2006, p. 1192-1198.

Research output: Contribution to journalReview article

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