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Does Despair Really Kill? A Roadmap for an Evidence-Based Answer


Shanahan, Lilly; Hill, Sherika N.; Gaydosh, Lauren; Steinhoff, Annekatrin; Costello, E. Jane; Dodge, Kenneth A.; Harris, Kathleen Mullan; & Copeland, William E. (2019). Does Despair Really Kill? A Roadmap for an Evidence-Based Answer. American Journal of Public Health, 109(6), 854-858. PMCID: PMC6506367


Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Public Health


Shanahan, Lilly
Hill, Sherika N.
Gaydosh, Lauren
Steinhoff, Annekatrin
Costello, E. Jane
Dodge, Kenneth A.
Harris, Kathleen Mullan
Copeland, William E.