healthHealth and Medicine

Opioids And Suicides Coincide With Increasing Despair Among Poorer Americans


Stephen Luntz

Stephen has a science degree with a major in physics, an arts degree with majors in English Literature and History and Philosophy of Science and a Graduate Diploma in Science Communication.

Freelance Writer

opioid wrecking ball

The opioid crisis may be putting a wrecking ball through much of America, but it has been made possible by increasing despair among poorer Americans. Lightspring/Shutterstock

The mental health of poorer Americans has declined over the last 20 years, and despair is rising. Meanwhile, those in the middle economically have experienced only small regressions, and for wealthier Americans some measures of mental health are getting better, pointing the finger at economic inequality.

A phenomenon such as America's opioid crisis has many causes, including over-prescription of drugs and changes in availability. Nevertheless, the fact that the crisis is coinciding with an increase in suicides and deaths related to alcohol has inspired the hypothesis that an underlying decline in mental health may be at the heart of it, captured in the phrase “deaths of despair”. Collectively, these factors have caused life expectancy to fall for white Americans without university educations, an almost unprecedented event outside wars or infectious disease epidemics.


“Scholars have failed to undertake a broad examination of the psychological health of Americans, one that goes beyond assessments of distress and depression, to determine whether 'despair' has become more widespread in recent years,” Professor Noreen Goldman of Princeton University argues in Proceedings of the National Academy of Sciences

Unfortunately, Goldman and her co-authors acknowledge that there is no agreed-upon measure of despair. Nevertheless, the Midlife in the United States study asked thousands of randomly selected Americans many relevant questions regarding mental health. By looking at questions that assessed characteristics such as depression and feelings of hopelessness, as well as those that examined the opposite, the authors created a picture of how America's national mood has shifted between the mid-1990s and 2014.

On every relevant measure, non-Latino white Americans with low incomes scored worse in 2011-14 than in 1995-96. In some cases, the shift didn't achieve statistical significance, but on four measures – increased negative affect, decreased life satisfaction, psychological well-being, and positive affect – it did. When the authors looked at populations of middle or upper socioeconomic status (SES), however, things were very different. The higher up the SES they went, the better people's mental health, not only absolutely but in terms of the shift between the two periods examined. At the top, while a few measures had got worse, others had improved.

Money may not buy you happiness, but it certainly increases your chances, and the chance of being unhappy without money has grown dramatically in recent decades.


There were hints of positive trends among black Americans, but the sample sizes were too small for confidence; the same was true for white Latinos.

The results imply that many of the disturbing trends America is experiencing are rooted in declining mental health, and are unlikely to be truly fixed without tackling this issue. This despair, in turn, appears to have economic origins, whether in falling incomes, reduced economic opportunity, or both.


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  • opioid crisis,

  • deaths of despair,

  • economic inequality,

  • suicide rate