Abstract
PurposeThere is growing interest in the concept of ‘deaths of despair’ (DoD)—defined as deaths from three causes: suicide, drug poisoning, and alcohol-related conditions—as a more comprehensive indicator of the impact of psychological distress on mortality. The purpose of this study is to investigate the degree of commonality in trends and geographic patterning of deaths from these causes in England and Wales.MethodsWHO mortality data were used to calculate age-standardised, sex-specific temporal trends in DoD mortality and in mortality from suicide, drug poisonings, and alcohol-related conditions in England and Wales, 2001–2016. Three-year average crude rates were calculated for English local authorities for 2016–2018 and associations between rates were assessed using Spearman’s rank correlation.ResultsBetween 2001 and 2016, the DoD mortality rate increased by 21·6% (males) and 16·9% (females). The increase was largely due to a rise in drug poisoning deaths, with limited tracking between trends in mortality by each cause. DoD mortality risk was highest in middle-aged people; there were rises in all age groups except 15–24 year old males and 65 + females. There were strong positive correlations (r = 0.66(males) and 0.60(females)) between local authority-area drug poisoning and alcohol-specific mortality rates in 2016–2018. Correlations of these outcomes with suicide were weaker (r = 0.29–0.54).ConclusionsDoD mortality is increasing in England and Wales but there is limited evidence of commonality in the epidemiology of cause-specific mortality from the component causes of DoD (suicide, drug poisoning and alcohol-related conditions), indicating the need for tailored prevention for each outcome.
Highlights
Economists Case and Deaton recently identified that a decades-long decline in mortality rate amongst middle-aged white non-Hispanics in the USA is reversing [1]
Suicide mortality is commonly used as an indicator of mental health, the concept of deaths of despair’ (DoD) centres on the notion that such intentional deaths underestimate the burden of despair on mortality
The secondary aim of this study is to investigate whether English local authorities experiencing high rates of one of the components of ‘deaths of despair’ had higher levels of the other causes, as an indication of the consistency of these three markers of psychological distress
Summary
Economists Case and Deaton recently identified that a decades-long decline in mortality rate amongst middle-aged white non-Hispanics in the USA is reversing [1]. This phenomenon is largely attributable to increased mortality from suicide, drug and alcohol poisonings, and long-term alcoholrelated conditions. They coined the term ‘deaths of despair’ (DoD) to describe this group of causes of death [2]. Suicide mortality is commonly used as an indicator of mental health, the concept of DoD centres on the notion that such intentional deaths underestimate the burden of despair on mortality. Case and Deaton argue that drug and alcohol misuse are utilised as coping mechanisms for those experiencing distress brought on
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