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Am J Public Health. 2013 Dec;103(12):2261-6. doi: 10.2105/AJPH.2013.301292. Epub 2013 Oct 17.

Suicide mortality following nursing home discharge in the Department of Veterans Affairs health system.

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John F. McCarthy, Bradley E. Karlin, and Ira R. Katz are with the Department of Veterans Affairs (VA), Washington, DC. John F. McCarthy and Ira R. Katz are also with the VA Office of Mental Health Operations, Washington, DC. Bradley E. Karlin is also with VA Mental Health Services, Washington, DC. Benjamin R. Szymanski is with the Yale School of Public Health, New Haven, CT.



We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes.


In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches.


Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk.


Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up.

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