Disease of despair
A disease of despair is one of three classes of behavior-related medical conditions that increase in groups of people who experience
Diseases of despair, and the resulting deaths of despair, are high in the Appalachia region of the United States, especially, in Pennsylvania, West Virginia, and Delaware.[1] 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.[2] It gained media attention because of its connection to the opioid epidemic.[3] For 2018, some 158,000 U.S. citizens died from these causes, compared to 65,000 in 1995.[4]
Deaths of despair have increased sharply during the COVID-19 pandemic and associated recession, with a 10% to 60% increase above pre-pandemic levels.[5] Life expectancy in the United States declined further to 76.4 years in 2021, with the main drivers being the COVID-19 pandemic along with deaths from drug overdoses, suicides and liver disease.[6]
Definitions
Despair often breeds disease.
The concept of despair in any form can not only affect an individual person, but can also arise in and spread through social communities.[7]
There are four basic types of despair. Cognitive despair denotes thoughts connected to defeat, guilt, hopelessness and pessimism. It may make a person perceive other people's actions as hostile and discount the value of long-term outcomes.[8] Emotional despair refers to feelings of sadness, irritability, loneliness and apathy and may partly impede the process of creating and nourishing interpersonal relationships. The term behavioural despair describes risky, reckless and self-destructive acts reflecting little to no consideration of the future (such as self-harm, reckless driving, drug use, risky sexual behaviours and others). Lastly, biological despair relates to dysfunction or dysregulation of the body's stress reactive system and/or to hormonal instability.[7]
Being under the influence of despair for an extended amount of time may lead to the development of one or more of the diseases of despair, such as suicidal thoughts or drug and alcohol abuse. If an individual has a disease of despair, there is an increased risk of death of despair, usually classified as a suicide, drug or alcohol overdose, or liver failure.[7][9]
Risk factors
Unstable mental health, depression, suicidal thoughts and addiction to drugs and alcohol affect people of every age, every
Recent trends in numbers
Mortality and morbidity rates in the United States have been decreasing for decades. Between 1970 and 2013, mortality rates for middle-aged Americans fell by 44% and morbidity was on a decline even among the elderly.[10] After 1998, mortality rates in other rich countries have been declining by 2% a year; midlife mortality fell by more than 200 per 100,000 for Black non-Hispanics and by more than 60 per 100,000 for Hispanics during the 1998–2013 period.[10] The AIDS epidemic in the US was brought under control; in 2018, only 37,968 people received an HIV diagnosis in the USA and its 6 dependent areas, which is an overall 7% decrease compared with the year 2014.[12] Cardiovascular disease and cancer, the two biggest killers in middle age, are also on a decline,[9] even though the still growing problem with obesity remains uncontrolled. Despite all of these satisfactory numbers, White non-Hispanic population exhibits an increase in premature deaths, especially in those caused by suicide, drug overdose and alcoholic liver disease.
There are two main factors driving this trend. Firstly, the data show the US White non-Hispanic population significantly differs from populations in other countries. For example, in 2015, drug, alcohol and suicide mortality was more than two times higher among US White non-Hispanics in comparison to people from the United Kingdom, Sweden or Australia. In comparison to US Black non-Hispanics, the mortality and morbidity rates are still lower; nevertheless the gap between these groups is narrowing quickly and, for example, for people aged 30–34 the difference between these two ethnicities has almost completely diminished. Also, White non-Hispanics aged 50–54 with no more than a high school diploma reached almost 1,000 premature deaths per 100,000 in the year 2015, whereas the average for all White non-Hispanics regardless of their education was only around 500 deaths per 100,000. Therefore, the factor of education probably negatively correlates with the probability of developing a disease of despair (that means higher education correlates with lower probability of developing a disease of despair).[9]
Secondly, the excess premature deaths are, as stated above, caused primarily by suicide, poisonings or drug overdoses and other causes connected especially to
Suicides reached record levels in the United States in 2022, with 49,369 suicide deaths. Since 2011, roughly 540,000 people have died by suicide in the United States.[14]
Life expectancy for working class Americans without a college degree peaked in 2010 and has been declining since, with adult life expectancy after the age of 25 being 49.8 years, down from 51.6 in 1992. Anne Case and Angus Deaton attribute this trend in part to rising deaths of despair.[15]
COVID-19 pandemic
The COVID-19 pandemic is the most severe global pandemic since the 1918 Spanish flu outbreak with lockdowns, social and economic disturbances and a sharp rise in unemployment.[citation needed]
Preliminary studies indicate an aggravation of depression, anxiety, drug overdoses, and suicidal ideation following the beginning of the COVID-19 pandemic.[16][17] Though certain health aspects like stress can be concurrent with the crisis, other biopsychosocial risk factors such as job loss, housing precarity, and food insecurity can manifest over time.[18] This range of social determinants, commonly experienced during an economic downturn, can induce and aggravate a sense of despair. Loneliness, which is associated with despair, was also aggravated by social isolation practices put in place during the COVID-19 pandemic, which may contribute to a rise in diseases of despair.[10]
A preliminary review of 70 published studies conducted in 17 countries concerning the potential impacts of COVID-19 on deaths of despair indicates that women, ethnic minorities and younger age groups, may have suffered disproportionately more than other groups.[19]
Drug overdoses
Preliminary indications in Canada and the United States demonstrate that the trajectory of drug overdose-related deaths was exacerbated by the Covid-19 pandemic.[21] In Canada, drug overdose-related deaths stabilized prior to the onset of COVID-19, but increased after the onset of COVID-19.[21] In the United States, drug overdose-related deaths increased prior to and accelerated after the onset of COVID-19.[21]
More specifically, the opioid overdose crisis worsened within the three years, from 2017 to 2020, in Wisconsin.[22] As a result of the difficulty in daily life and for individuals to ensure their health and safety amidst such a dangerous and widespread pandemic, and due to the challenges faced by people on a wide range of issues environmentally, socially, economically, and mentally, it is quite obvious as to why the drug problems around the globe have been aggravated. Particularly in Milwaukee County, Wisconsin, it was found that the pandemic had remarkably escalated the number of monthly overdose deaths, due to opioids.[22] In addition, it was found that the worst of these drug impacts seemed to primarily occur in poor and urban neighborhoods, especially affecting Black and Hispanic communities. Despite this, even wealthy and prosperous, White communities within the suburbs, also faced an increase in the number of overdose deaths.
Causes
Our account echoes the account of suicide by
Emile Durkheim, the founder of sociology, of how suicide happens when society fails to provide some of its members with the framework within which they can live dignified and meaningful lives.
— Anne Case and Angus Deaton, Deaths of Despair and the Future of Capitalism (2020)[23]
The factors that seem to exacerbate diseases of despair are not fully known, but they are generally recognized as including a worsening of
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] However, some experts claim the correlation between income and mortality/morbidity rate is only coincidental and may not be associated with deaths for all groups. Anne Case and Angus Deaton argue that "after 1999, blacks with a college education experienced even more severe percentage declines in income than did whites in the same education group. Yet black mortality rates have fallen steadily, at rates between 2 and 3 percent per year for all age groups." Many other examples from Europe also show that decreased incomes and/or increased unemployment do not, in general, correlate with increased mortality rates.[9][34] They 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] In a later work Case and Deaton assert that in the United States, much more so than in peer countries such as those of Western Europe, globalization and technological advancement dramatically shifted political power towards capital and away from labor by empowering corporations and weakening labor unions. As such, other rich countries, while facing challenges associated with globalization and technological change, did not experience a "long-term stagnation of wages, nor an epidemic of deaths of despair."[35]
Recent data show that diseases of despair pose a complex threat to modern society and that they are not correlated only to the economic strength of an individual. Social connections, level of education, place of residence, medical condition, mental health, working opportunities, subjective perception of one's own future – all of these play a role in determining whether the individual will develop diseases of despair or not.[36] Additionally, the younger generations are more and more influenced by social media and other modern technologies, which may have unexpected and unfavourable effects on their lives as well. For example, according to a study from 2016, the use of social media "was significantly associated with increased depression."[37]
Contrasted with diseases of poverty
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.[30] 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.[30] 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]
Effects
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
Even though the main cause of diseases of despair may not be purely economical, the consequences of this phenomenon are, in terms of money, expensive. According to a report from 2016, alcohol misuse, misuse of illegal drugs and non-prescribed medications, treatment of associated disorders and lost productivity cost the U.S. more than $400 billion every year.[39] About 40 percent of those costs were paid by government, which implies a huge cost of alcohol and drug misuse to taxpayers. Another study claims even higher costs of around $1.5 trillion in economic loss, loss of productivity, and societal harm.[40]
Terminology
The phrase diseases of despair has been criticized for
See also
References
- ^ Saplakogu, Yasemin (November 2020). "'Diseases of despair' on the rise across the US". Livescience.
- ^ Achenbach J (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.
- ^ Cunningham PW (October 30, 2017). "Appalachian death from drug overdoses far outpace nation's". The Washington Post.
- ^ Case A, Deaton A (April 14, 2020). "American capitalism is failing Trump's base as white working-class 'deaths of despair' rise". NBC News. Retrieved April 15, 2020.
- ^ Fottrell Q (January 5, 2021). "'Deaths of despair' during COVID-19 have risen significantly in 2020, new research says". MarketWatch. Retrieved January 5, 2021.
- ^ Noguchi, Yuki (December 22, 2022). "American life expectancy is now at its lowest in nearly two decades". NPR. Retrieved December 27, 2022.
The new numbers also speak to the acute mental health crisis that's run parallel to the pandemic: Deaths from drug overdoses reached over 106,000 last year — another major factor reducing life expectancy, according to the second CDC analysis released on Thursday. Deaths by suicide and from liver disease, or cirrhosis, caused by alcohol also increased — shortening the average American life span.
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- ^ "U.S. Statistics". HIV.gov. 2021-03-17. Retrieved 2021-04-14.
- ^ Gordon, Serena (November 2020). "What Are the 'Diseases of Despair' Gripping America?". MedicineNet.
- ^ Mateus, Benjamin (August 11, 2023). "Deaths of despair and suicides in the US at historic levels". World Socialist Web Site. Retrieved August 14, 2023.
- ^ Zickgraf, Ryan (October 9, 2023). "America's Working Class Is Struggling to Survive the Gauntlet of Middle Age". Jacobin. Retrieved October 10, 2023.
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- ^ Fentanyl. Image 4 of 17. US DEA (Drug Enforcement Administration). See archive with caption: "photo illustration of 2 milligrams of fentanyl, a lethal dose in most people".
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- ^ Woodward A (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.
- ^ Coughlan S, Brown D (May 14, 2019). "Inequality driving 'deaths of despair'". BBC. Retrieved December 18, 2019.
- 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
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: CS1 maint: location missing publisher (link - ^ ""Diseases of Despair" Have Soared in the US Over the Past Decade". SciTechDaily. May 19, 2021. Retrieved May 20, 2021.
Such 'deaths of despair' have coincided with decades of economic decline for workers, particularly those with low levels of educational attainment; loss of social safety nets; and stagnant or falling wages and family incomes in the US, all of which are thought to have contributed to growing feelings of despair.
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- ^ Hassan A (March 7, 2019). "'Deaths From Drugs and Suicide Reach a Record in the U.S." The New York Times.
- ^ U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016
- ^ "Economic Cost of Substance Abuse in the United States, 2016". Recovery Centers of America. Archived from the original on 2019-07-15.
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Further reading
- ISBN 978-0-691-19078-5.
- Meit M, Heffernan M, Tanenbaum E, Hoffmann T (August 2017). Appalachian Diseases of Despair (PDF). The Walsh Center for Rural Health Analysis (Report). University of Chicago. Archived from the original (PDF) on 2 October 2017.
- McGreal C (12 November 2015). "Abandoned by coal, swallowed by drugs". The Guardian.
- Bower B (2 November 2020). "Deaths of despair' are rising. It's time to define despair". Science News.
- Brignone E, George DR, Sinoway L, Katz C, Sauder C, Murray A, et al. (November 2020). "Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study". BMJ Open. 10 (10): e037679. S2CID 226296925.
External links
External videos | |
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Krystal and Saagar: New Study Shows Deaths Of Despair Hitting Poor Working Class Of ALL Races on YouTube |
- Why Americans Are Dying From Despair. The New Yorker, March 16, 2020.
- 'Deaths of Despair' and the Failure of Capitalism. Current Affairs, April 28, 2021.