Clinical Outcomes Following Suicide Attempts: In-Hospital Mortality and Discharge Against Medical Advice.

Abstract

Objective: Suicide attempts remain a major public health concern worldwide. This study aimed to analyze factors associated with inhospital mortality and treatment Discontinuation Againts Medical Advice (DAMA) following suicide attempts.

Methods: This retrospective, record-based, single-center observational study included adult patients who presented to the emergency department after a suicide attempt between January 2009 and December 2024. Data were obtained from the hospital information system, medical records, and forensic notification files. Factors associated with in-hospital mortality and DAMA were evaluated using logistic regression analyses.

Results: A total of 2,909 individuals were included (mean age 30±12 years; 64.4% female). Drug ingestion was the most common suicide method (84.2%). In-hospital mortality was observed in 2.2% of cases (n=63), with the highest lethality rate (94.1%) among individuals who attempted suicide by jumping from heights of five floors or higher. In multivariable analysis, older age (OR: 1.04; 95% CI: 1.02–1.06), male sex (OR: 4.40; 95% CI: 2.29–8.43), schizophrenia (OR: 3.63; 95% CI: 1.02–12.88), and alcohol use (OR: 2.38; 95% CI: 1.34–4.24) were identified as independent predictors of in-hospital mortality. Discontinuation against medical advice (DAMA) occurred in 53.8% of cases (n=1,564) and was significantly associated with younger age, absence of a prior suicide attempt, and fewer psychiatric comorbidities.

Conclusions: Suicide attempt aftercare should extend beyond acute medical stabilization and incorporate proactive, individualized strategies aimed at improving patient engagement and mitigating method-specific risks.