Diseases of despair

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The diseases of despair are three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic outlook is bleak. The three disease types are drug overdose (including alcohol overdose), suicide, and alcoholic liver disease.

Diseases of despair, and the resulting deaths of despair, are high in the Appalachia region of the United States. The prevalence increased markedly during the first decades of the 21st century, especially among middle-aged and older working class white Americans starting in 2010, followed by an increase in mortality for Hispanic Americans in 2011 and African Americans in 2014.[1] It gained media attention because of its connection to the opioid epidemic.[2] For 2018, some 158,000 U.S. citizens died from these causes, compared to 65,000 in 1995.[3]

Deaths of despair have increased sharply during the Covid-19 pandemic and associated recession, with a 10% to 60% increase above pre-pandemic levels.[4]

Risk factors[edit]

Although addiction and depression affect people of every age, every ethnicity, and every demographic group, the excess mortality and morbidity from diseases of despair affects a smaller group. In the US, the group most affected by these diseases of despair are non-Hispanic white men and women who have not attended university. Compared to previous generations, this group is less likely to be married, less likely to be working, less likely to be able to provide for their families, and more likely to report physical pain, overall poor health, and mental health problems, such as depression.


The factors that seem to exacerbate diseases of despair are not fully known, but they are generally recognized as including a worsening of economic inequality[5][6] and feeling of hopelessness about personal financial success. This can take many forms and appear in different situations. For example, people feel inadequate and disadvantaged when products are marketed to them as being important, but these products repeatedly prove to be unaffordable for them.[7] The overall loss of employment in affected geographic regions, and the worsening of pay and working conditions along with the decline of labor unions, is a widely hypothesized factor.[8]

The changes in the labor market also affect social connections that might otherwise provide protection, as people at risk for this problem are less likely to get married, more likely to get divorced, and more likely to experience social isolation.[9] Economists Anne Case and Angus Deaton argue that the ultimate cause is the sense that life is meaningless, unsatisfying, or unfulfilling, rather than strictly the basic economic security that makes these higher order feelings more likely.[9]

Diseases of despair differ from diseases of poverty because poverty itself is not the central factor. Groups of impoverished people with a sense that their lives or their children's lives will improve are not affected as much by diseases of despair. Instead, this affects people who have little reason to believe that the future will be better.[8] As a result, this problem is distributed unevenly, for example by affecting working-class people in the United States more than working-class people in Europe, even when the European economy was weaker.[8] It also affects white people more than racially disadvantaged groups, possibly because working-class white people are more likely to believe that they are not doing better than their parents did, while non-white people in similar economic situations are more likely to believe that they are better off than their parents.[9]


Starting in 1998, a rise in deaths of despair has resulted in an unexpected increase in the number of middle-aged white Americans dying (the age-specific mortality rate).[9] By 2014, the increasing number of deaths of despair had resulted in a drop in overall life expectancy.[9] Anne Case and Angus Deaton propose that the increase in mid-life mortality is the result of cumulative disadvantages that have occurred over decades, and that solving it will require patience and perseverance for many years, rather than a quick fix that produces immediate results.[9] The number of deaths of despair in the United States has been estimated at 150,000 per year in 2017.[10]


The phrase diseases of despair has been criticized for medicalizing problems that are primarily social and economic, and for underplaying the role of specific drugs, such as OxyContin, in increasing deaths.[11] While the disease model of addiction has a strong body of empirical support,[12] there is weak evidence for biological markers of suicidal thoughts and behaviors and no evidence that suicide fits a disease model.[13][14] The use of the phrase diseases of despair to describe suicide in medical literature is more reflective of the medical model than suicidal thoughts and behaviors.


  1. ^ Achenbach, Joel (November 26, 2019). "'There's something terribly wrong': Americans are dying young at alarming rates". The Washington Post. Archived from the original on 2 December 2019. Retrieved December 18, 2019.
  2. ^ Cunningham, Paige Winfield (30 October 2017). "Appalachian death from drug overdoses far outpace nation's". The Washington Post.
  3. ^ Case, Anne; Deaton, Angus (April 14, 2020). "American capitalism is failing Trump's base as white working-class 'deaths of despair' rise". NBC News. Retrieved April 15, 2020.
  4. ^ Fottrell, Quentin (January 5, 2021). "'Deaths of despair' during COVID-19 have risen significantly in 2020, new research says". MarketWatch. Retrieved January 5, 2021.
  5. ^ Woodward, Aylin (November 30, 2019). "Life expectancy in the US keeps going down, and a new study says America's worsening inequality could be to blame". Business Insider. Retrieved December 18, 2019.
  6. ^ Coughlan, Sean; Brown, David (May 14, 2019). "Inequality driving 'deaths of despair'". BBC. Retrieved December 18, 2019.
  7. ^ Danny, Dorling (2015-06-03). Injustice (revised edition): Why social inequality still persists. Policy Press. ISBN 9781447320777. Part of the mechanism behind the worldwide rise in diseases of despair is suggested, with evidence provided below, to be the anxiety caused when particular forms of competition are enhanced....The effects of the advertising industry in making both adults, and especially children, feel inadequate, are also documented here
  8. ^ a b c McGreal, Chris (13 November 2018). American overdose: The opioid tragedy in three acts (1st ed.). New York, NY. pp. 109–112. ISBN 978-1-61039-861-9. OCLC 1039238075.
  9. ^ a b c d e f Case, Anne; Deaton, Angus (2017). "Mortality and Morbidity in the 21st Century". Brookings Papers on Economic Activity. 2017 (1): 397–476. doi:10.1353/eca.2017.0005. PMC 5640267. PMID 29033460.
  10. ^ Hassan, Adeel (March 7, 2019). "'Deaths From Drugs and Suicide Reach a Record in the U.S." The New York Times.
  11. ^ Brignone, Emily; George, Daniel R; Sinoway, Lawrence; Katz, Curren; Sauder, Charity; Murray, Andrea; Gladden, Robert; Kraschnewski, Jennifer L (October 2020). "Trends in the diagnosis of diseases of despair in the United States, 2009–2018: a retrospective cohort study". BMJ Open. 10 (10): e037679. doi:10.1136/bmjopen-2020-037679. PMID 33168586. S2CID 226296925.
  12. ^ Volkow, Nora D.; Koob, George F.; McLellan, A. Thomas (January 28, 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". New England Journal of Medicine. 374 (4): 363–371. doi:10.1056/nejmra1511480. PMC 6135257. PMID 26816013.
  13. ^ Oquendo, Maria A.; Sullivan, Gregory M.; Sudol, Katherin; Baca-Garcia, Enrique; Stanley, Barbara H.; Sublette, Elizabeth; Mann, J. John (October 31, 2014). "Toward a Biosignature for Suicide". American Journal of Psychiatry. 171 (12): 1259–1277. doi:10.1176/appi.ajp.2014.14020194. PMC 4356635. PMID 25263730.
  14. ^ Chang, B P; Franklin, J C; Ribeiro, J D; Fox, K R; Bentley, K H; Kleiman, E M; Nock, M K (September 2016). "Biological risk factors for suicidal behaviors: a meta-analysis". Translational Psychiatry. 6 (9): e887. doi:10.1038/tp.2016.165. PMC 5048204. PMID 27622931.

Further reading[edit]

External links[edit]

External video
video icon Krystal and Saagar: New Study Shows Deaths Of Despair Hitting Poor Working Class Of ALL Races on YouTube