Prevalence and factors associated with signing against medical advice among psychiatric inpatients at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Abstract

Background: Leaving against medical advice (LAMA) is common and poses significant challenges among psychiatric inpatients, reflecting patients' legal rights while remaining linked to severe noncompliance, higher morbidity and mortality, increased readmissions, substantial costs, and distress for psychiatrists. Aim: To the determine the prevalence and factors associated with signing against medical advice (SAMA) among psychiatric inpatients at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and methods: A retrospective study was conducted over an eight-year period on 435 patients admitted to the psychiatric ward at Usmanu Danfodiyo University Teaching Hospital. Socio-demographic and clinical data were analyzed using SPSS software. The statistical significance of the findings was assessed using Chi-squared and Fisher's exact tests, with a 5% significance level. Results: The prevalence of signing against medical advice among psychiatric inpatients was 10.2%. There was a statistically significant association between signing against medical advice and gender (P = 0.012), but no significant association was found with diagnosis (P = 0.337) or length of stay (P = 0.074). Conclusion: The high prevalence of signing against medical advice among psychiatric inpatients is associated with factors such as female gender. However, there is a significant lack of research on this issue in Nigeria, highlighting the need for further studies with rigorous methodologies. Standardized definitions, reporting, and targeted interventions are crucial to address this problem and its complications.

Keywords

• Signed against medical advice
• Complied with medical advice
• psychiatric inpatients