Deaths of Despair
Anne Case and Angus Deaton coined the term “deaths of despair” for deaths related to suicide, drug use, and alcohol poisoning in their influential 2015 paper. They argued that such deaths often share a context of hopelessness and indifference toward living. Deaths of despair have increased dramatically over the past couple of decades, and especially so for white men and women without a college degree. Recent trends have in fact been so severe that they led to reduced life expectancies in the United States for three consecutive years, in 2015, 2016, and 2017. This is the longest consecutive decline since World War I. Our recent paper at the Human Flourishing Program at Harvard, just published this month in JAMA Psychiatry, which also ran a podcast, explores the potential protective power of religious community in preventing such deaths of despair.
Our study examined 66,492 women from the Nurses’ Health Study II and 43,141 men from the Health Professionals Follow-Up Study, following them for roughly two decades. We examined whether attending religious services was associated with a lower likelihood of death due to suicide, drug overdose, or alcohol in the roughly 20 years that followed. We controlled for numerous other characteristics including age, race, geographic region, income, health status, health behaviors, smoking, mental health, other forms of social support, and numerous other variables as well.
What We Found
The women in the Nurses’ Health Study II were followed from 2001, when religious service attendance was assessed, all the way through 2017. Compared to those who never attended religious services, participants who attended at least once a week were 68 percent less likely to die by suicide, drug overdose or alcohol, during the 16 years that followed. This was true even after controlling for a potentially wide range of confounding factors. For the men in the Health Professionals Follow-Up Study, followed from 1988 through 2014, those attending weekly, compared to not at all, were 33 percent less likely to die by suicide, drug overdose or alcohol, during the 26 years that they were followed. Our paper considered a wide range of sensitivity analyses to see if the results varied much based on different ways of analyzing and looking at the data and the results were quite consistent. These reductions in deaths are substantial. The reductions are of such a magnitude that they were covered in the headlines of the Harvard Gazette. Associations of this magnitude are worth considering further.
Economic and Social Contexts
The observed increase in deaths of despair over time is clearly worrying. Reflection is needed to address this problem. Authors Case and Deaton have argued that one cause is declining job opportunities for the working class, which leads to financial difficulties, frustrated expectations, and hopelessness. These problems are then amplified by declining social and family support structures, and declining marriage rates to which the economic difficulties undoubtedly also contribute. Struggles like these have moreover, and unfortunately, coincided with the increased availability and use of opioids which have in turn also contributed to an increase in these deaths of despair. The economic hardship and job-related difficulties are certainly an important context within which despair can arise.
However, despair is not restricted to the working class or to economic struggles. Despair can arise any time seemingly insurmountable problems come up. One such context is clinician burnout. The increasing stresses placed on physicians, nurses, and other health-care professionals have led to increasing burn-out and decreasing job satisfaction. Studies have reported higher suicide rates among clinicians than the general public, perhaps especially for women. The increasing demands placed on healthcare workers during the pandemic of coronavirus (COVID-19) will likely yet further increase these stresses as potential causes of despair.
We thus need to consider important resources for confronting despair and for preventing deaths from despair, both in these contexts and in others. Religious community may be one such resource.
Religion and Confronting Despair
Our study was not able to examine the mechanisms by which religious services seemed to prevent these deaths of despair. We will try to examine this in subsequent work. However, a number of mechanisms do seem plausible. Social relationships formed within a religious community may help provide support and encouragement when individuals face problems and are confronted with despair. Religious communities may also foster a sense of greater purpose that helps during times of struggle. Religious teachings on the value and inherent worth and dignity of each and every life, and teachings that suicide is therefore wrong, likewise likely contribute.
Teachings on the responsibility one has for the care of one’s body may prevent riskier behaviors concerning excessive alcohol and the use of drugs. A belief or hope that God is present, or will provide a better future may also counter a sense of despair. Religious teachings may also help make better sense of suffering and assist people in finding meaning within suffering. Suffering itself, while inevitably difficult, may provide opportunities for growth in character, causing one to turn to transcendent sources of faith and hope and meaning, and may lead to re-evaluating one’s purposes and values. Such new meanings may likewise help prevent severe struggles with despair, and thereby also prevent deaths of despair. Religious communities may very well contribute in all of these ways, as an antidote to despair.
While our study specifically concerned the role of religious community, other forms of communal participation are valuable as well and may be associated with lower suicide. However, that religious communities offer not only social support but also purpose, hope, and meaning within suffering may in part be why both we, and others, have found religious community more strongly beneficial for preventing suicide and mortality than other forms of social support. Social support and other forms of community life do matter. However, for those with religious commitments, communal forms of religious participation may be especially helpful.
With the world in a state of crisis of the coronavirus pandemic, issues of despair may well be on the rise. Suicide rates in the United States have been rising for some time. We do need to approach these problems from a variety of perspectives including those concerning economic contexts, potential therapeutic approaches, and addressing the conditions that give to despair. However, we should also look at resources that help us confront despair directly. Religious community is one such resource. The data from our study provides strong evidence that this is so for health professionals. Further work could examine whether similar associations are also at play in difficult economic contexts currently confronted by the working class.
Unfortunately, however, the present pandemic, itself the source of despair for many, has generally necessitated the suspension of communal religious gatherings. In a future posting, we will explore how individuals and communities might navigate these challenges when one of the most important means of confronting despair is seemingly inaccessible.
The Human Flourishing Program at Harvard’s Institute for Quantitative Social Science aims to study and promote human flourishing, and to develop systematic approaches to the synthesis of knowledge across disciplines. You can sign up here for a monthly research e-mail from the Human Flourishing Program, or click here to follow us on Twitter. For past postings please see our Psychology Today Human Flourishing Blog.
Chen, Y., Koh, H.K., Kawachi, I., Botticelli, M., and VanderWeele, T.J. Religious service attendance and deaths related to drugs, alcohol, and suicide among US health care professionals. JAMA Psychiatry, in press. DOI:10.1001/jamapsychiatry.2020.0175.