# Discharge Against Medical Advice Among Schizophrenia Patients in Germany: A Multicenter Cross-Sectional Study

## TL;DR

This study found that nearly a third of schizophrenia patients in Germany leave hospitals against medical advice, with younger patients and those with substance use disorders being more likely to do so.

## Contribution

The study provides new insights into DAMA rates and risk factors among schizophrenia patients in Germany using a large multicenter dataset.

## Key findings

- The DAMA rate was 31.1% for patients with schizophrenia as the primary diagnosis and 6.0% for secondary diagnosis.
- Younger age, primary schizophrenia diagnosis, alcohol-related disorders, and cannabis-related disorders were significantly linked to DAMA.
- Adjusting for multiple variables showed strong associations between DAMA and substance use disorders.

## Abstract

Background: The objective of this study was to investigate the prevalence of discharge against medical advice (DAMA) among schizophrenia patients in Germany and to identify factors associated with the risk of DAMA. Methods: This multicenter cross-sectional study was based on data from the IQVIA hospital database, which contains records from 36 hospitals across Germany. This study included all hospitalizations for patients with a primary or secondary diagnosis of schizophrenia between January 2019 and December 2023. Multivariable logistic regression analyses adjusted for age, sex, primary or secondary schizophrenia diagnosis, as well as codiagnoses, were conducted to assess the associations between demographic and clinical variables and DAMA. Results: A total of 7663 hospitalization cases (mean age: 49.5 years, 40.6% female) were included in the study. The DAMA rate was 31.1% in patients with schizophrenia as the primary diagnoses and 6.0% in patients with schizophrenia as a secondary diagnosis. Younger age (i.e., adjusted odds ratio (aOR): 7.44; 95% CI: 4.35–12.73 in the age group 18–30; aOR: 6.63; 95% CI: 3.89–11.29 in the age group 31–40; aOR: 5.59; 95% CI: 3.28–9.54 in the age group 41–50), schizophrenia as the primary diagnosis (aOR: 3.61; 95% CI: 3.05–4.26), alcohol-related disorders (aOR: 1.68; 95% CI: 1.38–2.04), and cannabis-related disorders (aOR: 1.43; 95% CI: 1.18–1.72) were significantly associated with an increased risk of DAMA. Conclusions: This study highlights the high prevalence of DAMA among hospitalized schizophrenia patients and identifies the important factors (i.e., younger age, alcohol-related disorders, and cannabis-related disorders) associated with DAMA risk. Additional studies are recommended for further exploration into the reasons for DAMA.