Suicide risk in long-term care facilities: a systematic review
Open accessAbstract
Objective: Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long‐term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long‐term care settings over the past 25 years. Methods: Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Results: Of the included reports, 21 were cross‐sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5–33%), although completed suicide is rare. Correlates of suicidal thoughts among long‐term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual‐level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Conclusions: Existing research on suicide risk in long‐term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non‐nursing home residential settings, as well as the potential role of organizational characteristics on emotional well‐being for residents. Copyright © 2014 John Wiley & Sons, Ltd.
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Social isolation is associated with suicidal ideation amongst nursing and care home residents.
“and nursing and care home residents 55”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [55]
The overview found an association (+) between social networks and relationships and suicide, supported by one review or multiple lower quality reviews.
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Mezuk et al 2014
The overview found an association (+) between loneliness and suicide, supported by one review or multiple lower quality reviews.
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Mezuk et al 2014
The overview found an association (+) between social isolation and suicide, supported by one review or multiple lower quality reviews.
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Mezuk et al 2014
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Cites
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“A systematic review conducted over a 25-year period reported loneliness in old age as a predictor of increased suicide ideations (19) which is supported by later studies (20, 21).”
Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults
Schepis, T. S., Simoni‐Wastila, L., & McCabe, S. E. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4999 · Cited by 78 · see citing works
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“Primarily, participants of the LISTEN group reported diminished depressive symptoms; this result is significant, given the links between depression and negative health outcomes, which recently included sensory impairments and suicide [49,50].”
BackgroundThe relation between social isolation and increasing suicide rates in the elderly
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Completed suicide among nursing home residents: a systematic review
Murphy, B., Bugeja, L. C., Schumann, J., & Ibrahim, J. (2015) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4299 · Cited by 46 · see citing works
“Mezuk et al. (2014) also noted the importance of understanding suicide in the context of the specific environment in which it occurs in order to develop appropriate and applicable prevention strategies.”
BackgroundInfluentialSuicide Among Older Adults Living in or Transitioning to Residential Long-term Care, 2003 to 2015
Mezuk, B. R., Ko, T. M., Kalesnikava, V. A., & Jurgens, D. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.5627 · Cited by 46 · see citing works
Self-citationSuicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011
Mezuk, B. R., Lohman, M. C., Leslie, M., & Powell, V. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302573 · Cited by 41 · see citing works
“Suicidal ideation is common among LTC residents, with between 5% and 33% reporting ideation (active or passive) within the past month.(15) As a result, suicide risk may be substantial in these facilities despite countervailing factors such as regular monitoring by staff and limited access to lethal means.”
Self-citationRisk Factors for Depression in Long-Term Care: A Systematic Review
Chau, R., Kissane, D. W., & Davison, T. E. (2018) · Clinical Gerontologist · doi:10.1080/07317115.2018.1490371 · Cited by 38 · see citing works
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“Data regarding whether being housed in a nursing home is a risk factor for suicide are scarce and inconclusive.(17,18) While Abrams and colleagues estimated the cumulated incidence of suicide in nursing homes to be lower than in the general population,(19) Scocco and colleagues found it to be higher.”
BackgroundDemographic and Clinical Characteristics of Completed Suicides in Mexico City 2014–2015
Romero-Pimentel, A. L., Mendoza-Morales, R., Fresán, A., García‐Dolores, F., González-Sáenz, E. E., Morales-Marín, M. E., Nicolini, H., & Borges, G. L. G. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00402 · Cited by 24 · see citing works
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“However, earlier work and a systematic review of suicide risk in long-term aged care facilities identified several studies that found dementia was a risk factor for suicidal thoughts or self-destructive behaviours among aged care residents (Draper et al., 2002; Mezuk et al., 2014).”
BackgroundStefanidou, T., Wang, J., Morant, N. J., Lloyd‐Evans, B., & Johnson, S. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03138-w · Cited by 19 · see citing works
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Suicidal Ideation in US Nursing Homes: Association With Individual and Facility Factors
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“the assessments closest to the time periods examined, included: functional status (level of impairments in activities of daily living, scale from 0 to 28); cognitive status (scale of 0–3 categorized as none/mild [0, 1] versus moderate/severe [2, 3] impairment);22 aggressive behavior (scale of 0–12 categorized as none/…”
BackgroundMills, P. D., Gallimore, B. I., Watts, B. V., & Hemphill, R. R. (2015) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4357 · Cited by 17 · see citing works
“The prevalence of suicidal behavior in nursing homes and long-term care (LTC) facilities was estimated to be 1% (Mezuk et al., 2014).”
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Suicide and self-harm in older adults
Connors, M. H., Draper, B., Wand, A. P. F., Leo, D. D., & Reppermund, S. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00454-w · Cited by 17 · see citing works
“In particular, moving to or from nursing homes has been associated with increased risk of suicide in multiple studies 123–127 .”
Dying by Suicide in Nursing Homes: A Preventable End of Life Outcome for Older Residents
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“Passive and active thoughts of suicide are common in SNFs (Mezuk et al., 2014).”
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Management of Grief, Depression, and Suicidal Thoughts in Serious Illness.
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“A systematic review concluded that LTCF residents’ suicidal thoughts were significantly associated with depression (Mezuk et al. 2014).”
BackgroundNurses’ roles and responsibilities in suicide prevention: a scoping review
Riedel, A., Feinauer, S., Jacob, E., Haug, P. M., Klotz, K., & Heidenreich, T. (2025) · BMC Nursing · doi:10.1186/s12912-025-04009-5 · Cited by 8 · see citing works
Psychoactive medication use and risk of suicide in long‐term care facility residents
Hedna, K., Fastbom, J., Jonson, M., Wilhelmson, K., & Wærn, M. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5684 · Cited by 10 · see citing works
“grouping three small studies and indicating that 52% of residents who died by suicide resided in the LTCF for less than 12 months(46) Transition to LTCF can be disruptive both on its own and as a correlate of precipitating changes (as becoming widowed or developing difficulties with activities of daily living) that ar…”
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“However, whether in urban or rural areas, the incidence of suicidal ideation among the elderly in pension institutions is generally higher than that in the elderly living in the community (Mezuk et al., 2014).”
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Barriers to the Prevention of Suicide in Nursing Homes
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Innovative Approaches for Long Term Care
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Life weariness and suicidal thoughts in late life: a national study in Sweden
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Passive and active suicidal ideation in Swedish 85-year-olds: Time trends 1986–2015
Jonson, M., Sigström, R., Fässberg, M. M., Wetterberg, H., Rydén, L., Sterner, T. R., Hedna, K., Nilsson, U. L., Skoog, I. G., & Wærn, M. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.060 · Cited by 9 · see citing works
Lohman, M. C., Ko, T. M., Redding, A., Bennion, E., & Mezuk, B. R. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.02.008 · Cited by 8 · see citing works
Self-citationZeas-Sigüenza, A., Voldstad, A., Ruisoto, P., Ganho-Ávila, A., Guiomar, R. N. R. M., Cacho, R., Muntané, F., & Benach, J. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15070131 · Cited by 7 · see citing works
“…(J. T. Cacioppo & Hawkley, 2009; S. Cacioppo et al., 2014) and is associated with a wide range of adverse health outcomes, including depression (Vanhalst et al., 2012), suicidal behavior (Mezuk et al., 2014), poor sleep quality (Hom et al., 2020), and cardiovascular disease (Valtorta et al., 2018).”
Liu, Y., Zhang, D., Wang, R., Wang, P., & Su, Y. (2022) · Aging & Mental Health · doi:10.1080/13607863.2022.2032595 · Cited by 7 · see citing works
Risk Factors and Prevention Strategies for Late-Life Mood and Anxiety Disorders
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Suicidality in the elderly: socio-cultural and clinical risk factors
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Development and initial validation of the Hopelessness Inventory for Later Life (HILL)
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“Mezuk 2014 Mezuk B, Rock A, Lohman MC, Choi M. Suicide risk in long-term care facilities: a systematic review.”
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Addressing Mental Health in Aged Care Residents
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Suicide in Illinois, 2005–2010
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Factors associated with suicidal ideation among older people in medical outpatient clinic
Elias, S. M. S., Makhtar, A., & Tarmidi, N. H. A. (2021) · Enfermería Clínica · doi:10.1016/j.enfcli.2020.09.026 · Cited by 5 · see citing works
Health profiles of older nursing home residents by suicidal ideation: A latent class analysis
Yuan, Y., Barooah, A., Lapane, K. L., Mack, D. S., Rothschild, A. J., & Ulbricht, C. M. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5829 · Cited by 5 · see citing works
“Among older nursing home residents, past‐month prevalence of SI has historically ranged from 5% to 33%.(6) However, most work on SI in nursing homes were conducted decades ago or outside of the U.”
BackgroundDeath by suicide among aged care recipients in Australia 2008–2017
Cations, M., Lang, C. E., Draper, B., Caughey, G. E., Evans, K. E., Wesselingh, S. L., Crotty, M., Whitehead, C., & Inacio, M. C. S. (2023) · International Psychogeriatrics · doi:10.1017/s104161022300008x · Cited by 5 · see citing works
Understanding Suicide over the Life Course Using Data Science Tools within a Triangulation Framework
Johns, L., Zhong, C., & Mezuk, B. R. (2023) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20230003 · Cited by 5 · see citing works
“[43] found that transitioning Johns et al.”
Self-citationPlaces of living and places of dying: the case for preventing suicide in residential long-term care
Jain, B., Kalesnikava, V. A., Ibrahim, J., & Mezuk, B. R. (2020) · Ageing and Society · doi:10.1017/s0144686x20000173 · Cited by 6 · see citing works
“Suicidal behaviour among residents in LTC is beginning to receive attention from public health researchers and practitioners (Mezuk et al., 2014; Murphy et al., 2015).”
BackgroundSelf-citationAnalysis of Professionals' Perceptions of Suicide in Older Adults Living in Care Homes
Redondo, R., Pinazo‐Clapés, C., Checa, I., Hernandis, S. P., & Sales, A. (2025) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.70152 · Cited by 3 · see citing works
“While some studies suggest that the incidence is lower than in the general population [6], others indicate it is higher [7].”
Self-harm in older adults: room to improve clinical care
Mitchell, R. J. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30358-4 · Cited by 3 · see citing works
Webster, T. N., Yorgason, J. B., Maag-Winter, A., Clifford, C. E., Baxter, K., & Thompson, D. (2016) · American Journal of Family Therapy · doi:10.1080/01926187.2016.1214088 · Cited by 3 · see citing works
Social network interventions in mental healthcare: a protocol for an umbrella review
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Bhar, S. S., Davison, T. E., Schofield, P. E., Quinn, S. J., Ratcliffe, J., Waloszek, J. M., Dunkerley, S., Silver, M., Linossier, J., Koder, D., et al. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04257-7 · Cited by 3 · see citing works
“Depressive symptoms among residents is associated with anxiety [5], suicide ideation [6], poor sleep [7] and poor quality of life [8, 9], highlighting the importance of developing effective treatments for such symptoms.”
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“Only a handful of studies have looked at suicide prevention in LTC facilities, but the efficiency of the intervention is largely unknown [54,58–61].”
Reilev, M., Møller, J. K., Stenager, E. N., & Christiansen, E. (2025) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1781 · Cited by 2 · see citing works
“Only few studies have investigated this and with ambiguous results [23, 24].”
Bozzay, M. L., Jiang, L., Zullo, A. R., Riester, M. R., Lafo, J., Kunicki, Z. J., Rudolph, J. L., Madrigal, C. B., Clements, R., Erqou, S. A., et al. (2022) · PubMed Central · doi:10.11909/j.issn.1671-5411.2022.03.009 · Cited by 2 · see citing works
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Yuan, Y., Barooah, A., Lapane, K. L., Mack, D. S., Rothschild, A. J., & Ulbricht, C. M. (2024) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.70003 · Cited by 1 · see citing works
Lee, L., Nicholson, P., Gerber, K., Naicker, R., & Hutchinson, A. M. (2025) · Campbell Systematic Reviews · doi:10.1002/cl2.70023 · Cited by 1 · see citing works
Lane, A., Dang, L., Qin, W., Burgard, S. A., & Mezuk, B. R. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02975-4 · Cited by 1 · see citing works
“As discussed above, the process of moving into LTC is often associated with a range of negative emotions including suicidal behaviors [3, 21, 22].”
Self-citationAssessment of suicidal ideation and behavior in community-dwelling older adults: a systematic review
Nieuwenhuijs, B. M., Witte, N. D., & Gorus, E. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2548431 · Cited by 1 · see citing works
“While older adults in long-term care facilities may experience significant risk factors for suicide, death by suicide is rare in this setting, with the vast majority of deaths by suicide occurring among community-dwelling adults (Mezuk et al., 2014).”
Gebhard, D. (2019) · Springer eBooks · doi:10.1007/978-3-662-58130-8_17 · Cited by 1 · see citing works
Conhecimento dos estudantes de enfermagem sobre parada cardiorrespiratória: revisão integrativa
de Vasconcelos, A. J., Daniel, L. P., de Oliveira, S. G., da Silveira, M. M. B. M., Xavier, A. T., & Cabral, J. V. B. (2021) · Revista Recien · doi:10.24276/rrecien2021.11.33.90-98 · Cited by 1 · see citing works
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“Furthermore, we found that most studies in this field, have investigated the risk factors of suicide and only a few of those have examined the protective factors of staying in LTCs as well as the role of psychotherapy, problem solving skills and coping skills on reducing the suicide risk in dementia.”
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Self-stigma, loneliness and culture among older adults with mental illness residing in nursing homes
Tzouvara, V. (2015) · University of Bedfordshire Repository (University of Bedfordshire)
Testing the Interpersonal Theory of Suicide in Community - Residing Older Adults
Murariu, D. (2016) · Scholarship@Western (Western University)
Jain, B. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.01.004
Interviewing and History Taking
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Selvmord i 2020 under Covid-19-pandemien
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Loneliness in the Maltese population: A comparison of data from 2019 and 2022
Azzopardi, A., Clark, M., Grech, A., & Camilleri, L. (2025) · Journal of Social and Personal Relationships · doi:10.1177/02654075241313238
“…exacerbating or predicting mental health conditions (Cacioppo & Cacioppo, 2018; Hawkley & Cacioppo, 2010) such as depression (Vanhalst et al., 2013), eating disorders (Levine, 2012), social anxiety (Lim et al., 2016), and suicidal action or ideation (Mezuk et al., 2014; Stickley & Koyanagi, 2016).”
Bhar, S. S., Davison, T. E., Schofield, P. E., Quinn, S. J., Ratcliffe, J., Waloszek, J. M., Dunkerley, S., Silver, M., Linossier, J., Koder, D., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24130281
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Choi, S. M., Lee, A. R., Yoon, S., Jeon, H. J., Lee, S. M., & Paik, J. (2026) · Psychology Research and Behavior Management · doi:10.2147/prbm.s561104
“26 Such environments may heighten psychological vulnerability, while lacking the necessary infrastructure to effectively detect and manage suicide risk.”
Prévenir le suicide des personnes âgées institutionnalisées
Chauliac, N. (2019) · theses.fr (ABES) · doi:10.70675/fef6a370z5158z4cbfz9da7z40502824c460
“a recensé 6 études évaluant l’incidence du suicide dans les EHPA (88).”
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Identifikation von Todeswünschen und Suizidalität seitens Pflegefachpersonen
Haug, P. M., Klotz, K., Feinauer, S., Riedel, A., & Heidenreich, T. (2026) · Springer eBooks · doi:10.1007/978-3-662-72796-6_5
- Authors
- Mezuk, B., Rock, A., Lohman, M. C., & Choi, M.
- Affiliations
- Virginia Commonwealth University (US)
- University of Kentucky (US)
- Corresponding author
- Mezuk, Briana
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2014-05-22
- Volume
- 29
- Issue
- 12
- Pages
- 1198-1211
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- PMC
- PMC4232590
- OpenAlex
- W2110311413
- Cited by
- 95
- References
- 52
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 5 · 2023: 6 · 2022: 10 · 2021: 18 · 2020: 10 · 2019: 8 · 2018: 8 · 2017: 6 · 2016: 6 · 2015: 5
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute of Mental Health (K01-MH093642)
- National Institute of Aging (F31-AG044974)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- suicide risk, long-term care facilities, nursing homes, assisted living, older adults, suicidal ideation, depression, social isolation, loneliness, functional decline, organizational characteristics, staffing, bed size, emotional well-being
- MeSH terms
- Aged, Homes for the Aged, Humans, Long-Term Care, Residential Facilities, Risk Factors, Suicide, Empirical Research, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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