Debts of despair: Education, financial losses, and precursors of deaths of despair

Abstract

Recent deaths of despair literature hypothesizes that financial losses are a key mechanism through which education is associated with higher risk for drug use, alcohol abuse, and suicidal ideation. However, few studies have empirically assessed the significance of this harmful pathway or compared it to other hypothesized explanations. Drawing on data from over 8000 respondents in the National Longitudinal Study of Adolescent to Adult Health, this paper finds that lower education-levels are associated with heightened risk of drug use, painkiller use, frequent binge drinking, and suicidal ideation; in turn, decompositions reveal that financial losses mediate about 20 percent of the association between education with drug use and suicidal ideation. The results support a core assumption of the deaths of despair hypothesis—that financial losses among those with low education-levels drive the increase in harmful despair-associated behaviors, which often precede disease and mortality. Future research should extend this work by linking individual-level socioeconomic and health patterns with broader economic changes to better understand how individuals’ educational attainment interacts with macro-level structural factors to shape their vulnerability to despair-associated disease and death.

Deaths of Despair: A Scoping Review on the Social Determinants of Drug Overdose, Alcohol-Related Liver Disease and Suicide

“…At the last stage of the review, 81 articles were excluded because the studies did not assess jointly the three potential causes of DoD as a common phenomenon or did not assess any SDH or were editorials or comments, leaving 21 eligible studies. The first study on DoD was published in 2015 by Case and Deaton [3], two studies were published in 2017 [25,26], and the rest of the literature identified was published during 2019-2022 [5,8,[15][16][17][18][19][20][21]24,[27][28][29][30][31][32][33][34]. In terms of geography, most of the studies were conducted with data of participants that resided nationwide [3,8,[15][16][17][18]20,21,25,29,30,32,34,35].…”

“…The first study on DoD was published in 2015 by Case and Deaton [3], two studies were published in 2017 [25,26], and the rest of the literature identified was published during 2019-2022 [5,8,[15][16][17][18][19][20][21]24,[27][28][29][30][31][32][33][34]. In terms of geography, most of the studies were conducted with data of participants that resided nationwide [3,8,[15][16][17][18]20,21,25,29,30,32,34,35]. Only five studies focused on a single USA state [24,27,28,31,33].…”

“…When analyzing deaths due to alcohol, Case and Deaton only included alcohol-related liver disease in DoD [3]; however, we considered alcohol-related deaths in more general terms following the criteria of subsequent authors [8,[15][16][17][18][19][20][21].…”

“…Seven studies [8,[15][16][17][18]26,33] assessed direct measures of economic conditions related to despair-related outcomes. The results and specific characteristics of each study are shown in Table 1.…”

“…In USA counties, higher economic insecurity has been associated with higher rates of DoD. Knap et al [16] showed that 20% of USA counties experienced an increase in economic insecurity between 2000 and 2010. Moreover, financial reductions, i.e., loss of assets and loss of income, were also factors that contributed to despair-related mortality [16].…”