The study focuses on the "near-suicide" phenomenon, where patients with serious illnesses choose to forgo treatment due to financial burdens. This decision, while seemingly irrational, is a result of a complex cost-benefit analysis that weighs individual suffering against the financial stability of the family. The study's research question is: How do the seriousness of the patient's illness or injury and the subjective evaluation of the patient's and family's financial situation after paying treatment fees affect the final decision on the treatment process? The study highlights the critical importance of understanding the psychological mechanisms underpinning such decisions, particularly in contexts where healthcare costs are high and access to health insurance is limited.

The study reviews existing literature on suicide, exploring various theories and perspectives. It emphasizes that suicide is not always a mental disorder, but can also be a subjectively rational choice based on information processing and perceived cost-benefit analyses. The study delves into established theories such as Durkheim's categorization of suicide types, the Economic Theory of Suicide, the three-step theory (3ST), the Interpersonal Theory of Suicide (ITS), and the Integrated Motivational-Volitional Model (IMV). While these theories provide insights, they may not fully account for the complex psychosocial dynamics involved in "near-suicide", particularly within unique sociocultural contexts like Vietnam. The study identifies limitations in suicide-related research, such as the challenges of data collection and the lack of sufficient studies in non-Western countries. It also underscores the need for more flexible and systematic models that can effectively address context-specific psychological processes.

The study utilizes a dataset of 1042 Vietnamese patients randomly selected from various hospitals in the northern region of Vietnam. The data were collected through a three-phase survey process involving detailed questionnaires that included sensitive information about patients' family situations, income levels, and financial burdens associated with treatment. The dataset includes three key variables: End (outcome of treatment), Illness (seriousness of illness or injury), and Burden (evaluation of financial situation after paying treatment fees). The researchers employed Bayesian Mindsponge Framework (BMF) analytics, which combines the theoretical reasoning of mindsponge theory with the statistical power of Bayesian inference. This approach allowed for the analysis of complex hierarchical data and provided a robust method for studying extreme psychosocial phenomena. The study employed a rigorous three-step validation strategy to ensure the appropriateness and robustness of the constructed model. This involved conducting a Pareto smoothed importance-sampling leave-one-out cross-validation (PSIS-LOO) test to check for overfitting or underfitting, examining the effective sample size (n_eff) and Gelman-Rubin shrink factor (Rhat) to assess the convergence of Markov chains, and performing prior-tweaking to test the robustness of the estimated results using both uninformative and informative prior distributions. The study utilized the bayesvl R package for Bayesian multilevel regression analysis, ensuring user-friendly operation, comprehensive visualization, and cost-effectiveness.

The study found a strong correlation between the severity of the patient's illness, perceived financial burden, and the likelihood of choosing to forgo treatment. The results indicate that the more severe the illness and the greater the financial burden, the higher the probability of a near-suicide decision. Specifically, only 24% of patients with the most severe health issues who believed that continuing treatment would lead to destitution would opt to continue treatment. Conversely, patients with less serious illnesses and a perception of financial stability had a much higher chance of continuing treatment. These findings highlight the significant influence of financial factors on patients' decisions, particularly for those with serious illnesses.

The study's findings support the idea that suicide can be a rational choice, driven by a complex interplay of emotions and reasoning. Patients facing life-or-death decisions often prioritize the long-term financial stability of their families over their own survival. This rationale is rooted in deeply ingrained cultural values, particularly in Vietnamese society, which emphasizes family ties and collective well-being. The study also acknowledges the influence of cultural additivity, where traditional values from Confucianism, Taoism, and Buddhism contribute to the collectivistic thinking that permeates Vietnamese society. This cultural context may contribute to the higher likelihood of patients choosing to forgo treatment to protect their families' financial futures. The study differentiates the "near-suicide" phenomenon from euthanasia, emphasizing that both decisions arise from the subjective perception of the patient as the optimal choice among limited alternatives. In the case of "near-suicide", the potential for financial destitution for the family outweighs the patient's individual suffering and impending death. The study's findings highlight the need for policy interventions to mitigate the financial burdens associated with healthcare. The Vietnamese government's goal of achieving 100% universal health insurance coverage is commendable, but the study suggests that the effectiveness of insurance is undermined by factors such as inadequate coverage and the persistence of significant out-of-pocket expenses for patients. The authors propose a shift towards evidence-based policymaking, which would involve targeting specific disadvantaged groups, such as non-resident poor patients, and implementing policies that effectively address the financial barriers to accessing healthcare. This approach would be more effective in reducing the likelihood of patients making "near-suicide" decisions and promoting social equality in the healthcare system.

This research provides empirical evidence for the "near-suicide" phenomenon in Vietnam, demonstrating the impact of socioeconomic factors on healthcare decisions. The study's findings highlight the need for policy interventions to address the financial burden on patients and promote social equality in healthcare systems. Future research should explore the phenomenon in other cultural contexts and investigate the interplay of social, economic, and cultural factors that influence patients' decisions in desperate situations.

The study's findings are limited by the use of data from Vietnamese patients only, potentially limiting the generalizability of the results to other cultural contexts. Additionally, the data were collected solely from hospitals in northern Vietnam, potentially limiting its representativeness of the entire Vietnamese population. Further research is required to investigate the phenomenon in other geographical regions and cultural settings. The study also acknowledges the potential influence of the COVID-19 pandemic on patients' perceptions and behaviors, necessitating further research on the phenomenon in the context of global health crises.