Factors associated with refusal of transport to hospital among patients experiencing suicidal crisis in South Korea

Abstract

Introduction: Preventing suicide requires identifying psychosocial characteristics and risk factors of people who do not go to the hospital. This study examined factors associated with refusal of transport to the hospital after reporting suicidal ideation or suicide attempt to emergency medical services.

Methods: This retrospective observational study involved reviewing emergency medical service dispatch records collected from January 2019 to December 2020 in Gyeonggi Province, South Korea on patients seeking emergency assistance for suicidal ideation or attempt. Univariate and multivariable regression analyses were employed to identify factors associated with refusal of transport to the hospital. Additionally, predictors of refusal stratified by suicidal ideation and attempt were examined.

Results: A total of 3449 cases were included in the analysis. Patients with suicidal ideation and no psychiatric or medical issues were more likely to refuse transport. In the suicide attempt group, certain patient characteristics were linked to a higher probability of refusal, including age 25 to 44 or 45 to 64, male gender, and/or not intoxicated by alcohol.

Conclusions: The pre-hospital phase is a critical link between patients and mental health services. Therefore, identifying the characteristics of patients who refuse transport to the hospital and developing intervention measures for them is essential.

Keywords: Refusal of transport; Suicidal ideation; Suicide attempt.

Fig. 1

Study flowchart. EMS = emergency medical service.

Fig. 2

Association between potential predictors of refusal of transport stratified by suicidal ideation and suicide attempt. COVID-19 period: March 1, 2020 to December 31, 2020. Spring: March–May. Summer: June–August. Fall: September–November. Winter: December–February. aOR = adjusted odds ratio; CI = confidence interval.