Psychiatric discharge against medical advice is a risk factor for suicide but not for other causes of death.

To the Editor: Discharge against medical advice (DAMA) is common among psychiatric inpatients. A comprehensive review reported that the estimated prevalence ranged from 3% to 51% and increased over time.1 DAMA has received little attention in the medical literature, and most works were published a decade ago. The literature shows that patients requesting DAMA have poorer long-term prognoses,1 have greater rehospitalization rates, overuse emergency care, and underuse outpatient services. Nonetheless, regarding the outcome of suicide mortality and other causes of death, few evidence-based data2,3 have been published. To estimate the risks of DAMA on various causes of death is important for implementing effective postdischarge care. We investigated the association between DAMA and suicide as well as other causes of death by following a large cohort of psychiatric inpatients. We found that DAMA was associated with a significantly higher risk of suicide compared to nonsuicide mortality.