How ‘deaths of despair’ differ by race and ethnicity

White Americans are more likely than Black and Hispanic people in the United States to experience “deaths of despair” even though they are less likely to suffer from severe psychological distress, a new study finds.

The results suggest that, for some reason, whites are more vulnerable to the damaging effects of psychological distress than Blacks or Hispanics, said .

Zheng said the study provides a direct test on despair as a determinant of death and evaluates how it may vary over time and by race and ethnicity.

Anne Case and Angus Deaton, economists at Princeton University, first wrote about “deaths of despair” in a 2015 PNAS paper. They argued that despair had led to a surge in deaths involving drugs, alcohol and suicide, particularly among less-educated white Americans.

In this new study, Zheng and Choi reevaluated this deaths of despair narrative, using data from a variety of sources, including the U.S. National Health Interview Survey Linked Mortality File, Centers for Disease Control and Prevention Multiple Cause of Death database, CDC bridged-race population files, Current Population Survey, and the American Community Survey.

Their final sample included 409,095 people. The researchers used “psychological distress” as a way to measure despair. In one of the datasets, respondents reported how often during the preceding 30 days they felt sad, nervous, restless, hopeless, or that everything was an effort. Based on their responses, participants were categorized into three groups, the highest being severely distressed.

The researchers examined deaths between 1997 and 2014.

Findings showed that the percentage of white Americans experiencing moderate or severe psychological distress showed a consistent rise during the time studied.  The increase was largest among whites without a college degree, which rose from 12.5% to 14.9%.

The trends in levels of psychological distress for Blacks and Hispanics varied over the time period – but Zheng noted that whites had a lower prevalence than the other groups through the entire period studied.

This study can’t say why despair levels rose among whites, but others have pointed to the loss of good-paying blue-collar jobs, a perceived relative loss of status, less religious participation and a decline in marriage, Zheng said.

What was clear from this study was that the impact of psychological distress was harder on white Americans.

For example, in 1997-2002, one model showed that severe distress was associated with a 114% increase in mortality among whites, but only a 44% and 51% increase among Blacks and Hispanics, respectively.

“The issue is that white Americans seem more vulnerable to despair – they are more likely to die from it,” Zheng said.

Other researchers have speculated that Black and Hispanic Americans may be protected from the worst effects of psychological distress by higher levels of religiosity and stronger social support.

“These protective factors may temper the impact of despair for Blacks and Hispanics,” he said.

This study made another major finding that may revise the original conclusions of Case and Deaton. The deaths of despair narrative generally assumes that despair leads mainly to deaths involving drugs, alcohol and suicide.

But Zheng and Choi found that in 1997, deaths from alcohol, drugs and suicide only approximated to about half of the total deaths in Black and white Americans that could be linked to psychological distress.

“Just looking at deaths due to drugs, alcohol and suicide underestimates the toll that despair takes on Blacks and whites in the U.S.,” Zheng said.

“Psychological distress can lead to other health issues tied to mortality. It leads to stress, obesity, poor sleep, unhealthy eating habits and other habits that contribute to cardiovascular disease, diabetes and cancer.”

On the other hand, focusing on mortality related to drugs, alcohol and suicide overestimates the impact of despair on mortality among Hispanics, the study found.

This suggests that despair may not be the sole reason for deaths from drugs, alcohol and suicide, he said.

Overall, the findings suggest that despair may be one of the driving factors behind the trend of deaths linked to alcohol, drugs and suicide in whites, but not for Blacks and Hispanics.

“We need more research to identify the underlying factors that create these differing trends in susceptibility to despair across the various racial and ethnic groups,” Zheng said.

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