To investigate the associations between self-injury ideation and pain severity, pain control, and their combination in older adults receiving home care and to examine sex differences in the associations.Secondary data analysis, mixed-model repeated-measures design.Two publicly funded home care programs in Michigan.Elderly participants of home care programs (N=16,700).All participants received in-home assessments at baseline and every 3 months thereafter using a standardized instrument that included questions about self-injury ideation and pain experience. Assessment data collected over 1 year after baseline were used.Participants' average age was 77.5; 72.2% were female, and 81.4% were white. At baseline, 1.4% of the sample (2.1% of men and 1.2% of women) had self-injury ideation. The risk of self-injury ideation in men increased with pain severity (some pain: adjusted odds ratio (AOR)=1.88, 95% confidence interval (CI)=1.12–3.13; severe pain: AOR=2.36, 95% CI=1.29–4.30) and pain control (controlled by medication: AOR=1.81, 95% CI=1.08–3.04; uncontrolled by medication: AOR=3.39, 95% CI=1.45–7.95). Men with severe and uncontrolled pain were at especially high risk (AOR=4.10, 95% CI=1.37–12.28). No measures of pain were significantly associated with self-injury ideation in women. Sex differences in the association between pain severity and self-injury ideation were significant at P <.05.Pain in older adults receiving home care should be taken seriously and treated as one means to reduce risk of suicide. Pain assessment should include severity and control of pain. In men, complaints about pain should prompt questioning about self-injury ideation
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