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"Diseases of Despair" Have Soared in the United States

A new study explores increases in suicidality and alcohol and substance abuse.

Photo by Road Trip with Raj on Unsplash
"Diseases and deaths of despair" in the United States coincided with decades of economic decline.
Source: Photo by Road Trip with Raj on Unsplash

According to data published in the journal BMJ Open, “diseases of despair” soared over the past decade in the United States. In the study, diseases of despair were defined as diagnoses related to alcohol dependency, substance misuse and suicidal thoughts or behaviors and analyzed among the following age groups: under 12 months; ages 1 to 17; 18 to 34; 35 to 54; 55 to 75; and those aged 75-and up.

The researchers examined data on 12 million people who were enrolled in Highmark, a large U.S.-based health insurance company, between 2007 and 2018 and who had valid, detailed claims on file--mostly in Pennsylvania, West Virginia, and Delaware.

A total of 515,830 or just over 4% of those insured were reported to have at least one disease of despair at some point, mostly male (58.5% with an average of 36). More than 54% of these insured were diagnosed with an alcohol-related disorder; 44% were diagnosed with a substance-related disorder; and 16% reported suicidal thoughts or behaviors, while nearly 13% had more than one of these conditions.

The rate of diseases of despair rose by 68% between 2009 and 2018. The rate of alcohol diagnoses jumped by 37%, substance-abuse by 94%, and suicide diagnoses increased by 170% with largest increases. Although the statistics for suicide diagnoses were lower than other reported diseases, they increased 287% among children up to 17-years of age. In adults between 18 and 34 years old, the rates jumped by 210%. In other age groups, the a 70% increase was recorded. Not surprisingly, disease-of-despair diagnoses were associated with significantly higher rates of anxiety and mood disorders and schizophrenia for both men and women.

Between 2015 and 2017, life expectancy fell year on year in the U.S., the longest sustained decline since 1915-18. And deaths among middle-aged white non-Hispanic men and women rose sharply between 1999 and 2015. These premature deaths are largely attributable to accidental overdose, alcohol-related disease, and suicide.

Such "deaths of despair" coincided with decades of economic decline, particularly among those with low levels of education, loss of social safety nets, and falling wages and family incomes in the U.S., all of which are thought to have contributed to growing feelings of despair.

“Diseases of despair” may affect the well-being of family members and friends now more than ever. It’s important to note that this study was conducted before the onslaught of COVID-19, so it’s likely that the incidences of diseases of despair have risen due to pandemic-related stress. If you or someone you know is struggling with alcohol or substance abuse, suicidal thoughts, depression, anxiety, or other mental health challenges, seek help.


Emily Brignone, Daniel R George, Lawrence Sinoway, Curren Katz, Charity Sauder, Andrea Murray, Robert Gladden, Jennifer L Kraschnewski. (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

BMJ. (2020, November 9). 'Diseases of despair' have soared over past decade in US: Suicidal thoughts/behaviors among under 18s up by 287%, and by 210% among 18-34 year olds. ScienceDaily.