Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.
Adult ; Case Management ; Female ; Humans ; Male ; Mental Disorders/diagnosis/*psychology ; Middle Aged ; Republic of Korea ; Suicide, Attempted/*prevention & control/*psychology ; Treatment Refusal/*psychology

Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Databases, Factual ; Female ; Humans ; Male ; Middle Aged ; Palliative Care ; Renal Replacement Therapy ; Retrospective Studies ; Singapore ; Treatment Refusal ; psychology

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.
Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital/utilization ; Female ; Humans ; Male ; Patient Discharge/*statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Self-Injurious Behavior/*psychology ; Suicide, Attempted/*psychology ; Treatment Refusal/*psychology ; Young Adult

Symptom control is the essence of palliative care but is not without problems, especially in the difficult socio-economic conditions of a developing country. We present our experience with over 2000 hospice admissions over six years in India's first hospice, to highlight our problems and the measures we have taken to solve them. The prevalent habit of tobacco smoking and chewing in India gives rise to a high incidence of head and neck cancers which form 50% of our admissions. Another 24% is formed by breast and gynaecological cancers. The difficult symptoms in head and neck cancers are pain, dysphagia, fungation and trismus. Almost 25% of our head and neck cancers have feeding tubes, which we feel are justified and most useful for medication and basic nutrition. Difficult problems in gynaecological cancers are pain, chronic blood loss, ulcerations and fistulae. The inadequate or sporadic availability of oral and injectable morphine adds to our problems in pain control. Non-compliance of patients to take adequate medications and the resistance from relatives make it sometimes difficult to achieve optimum symptom control. India has many systems of alternate and unorthodox medicine. We find that these are best tried outside the hospice unless they are in fully-studied clinical trials. In the end there is always the difficult choice of either remaining in the hospice for optimal symptom control or going back to their homes, where this may not be available.
Breast Neoplasms ; physiopathology ; therapy ; Choice Behavior ; Complementary Therapies ; Family ; psychology ; Female ; Genital Neoplasms, Female ; physiopathology ; therapy ; Head and Neck Neoplasms ; physiopathology ; therapy ; Hospice Care ; methods ; Humans ; India ; Male ; Patient Acceptance of Health Care ; Pharmaceutical Preparations ; supply & distribution ; Practice Patterns, Physicians' ; Socioeconomic Factors ; Treatment Refusal