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Am J Public Health. 2015 Jul;105(7):1495-502. doi: 10.2105/AJPH.2015.302573. Epub 2015 May 14.

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

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At the time of the study, Briana Mezuk and Matthew Lohman were with the Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond. Briana Mezuk is also with the Institute for Social Research, University of Michigan, Ann Arbor. Marc Leslie and Virginia Powell are with the Office of the Chief Medical Examiner, Virginia Department of Health, Richmond.



We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide.


Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis.


Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC.


LTC may be an important point of engagement in suicide prevention.

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