Lives of despair at risk for deaths of despair: tracking an under-recognized, vulnerable population

Purpose The substantial and unexpected increase in deaths of despair in the US (e.g., deaths from drug overdose, suicide, and alcohol-related liver diseases) reported by economists Case and Deaton in 2015 raises questions about the number and characteristics of US adults potentially living lives of despair with these problems. Methods We used data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to examine population estimates and characteristics of adults with lifetime history of substance use disorder (SUD) and suicide attempt, or either condition alone, as compared to those with neither. Results An estimated 7.2 million adults had both lifetime SUD and suicide attempt and 78.8 million had either. Those with both faced far more psychosocial adversities, familial adverse experiences and psychiatric disorders compared to those with the other two groups, and reported greater mental health service utilization. Multivariable analysis showed that psychiatric multimorbidity and violence were the strongest correlates of having both conditions as compared to neither while those with either condition fell in between. Conclusion A substantial number of US adults live with a lifetime SUD and suicide attempt with a multiplicity of additional socioeconomic, psychiatric and familial problems. While their utilization of mental health care service exceeds those with either or neither conditions, quality of life remained much poorer, suggesting that mental health treatment alone may not be enough to mitigate their sufferings, and a combination of both social policy support and quality mental health care may be needed.

Automated summary

This study examines the population characteristics of US adults with a lifetime history of substance use disorder (SUD) and suicide attempt, or either condition alone. The findings indicate that individuals with both conditions face more psychosocial adversities and psychiatric disorders, and have higher mental health service utilization compared to those with only one condition or neither. However, their quality of life remains poor, suggesting that a combination of social policy support and quality mental health care may be necessary to address their suffering.