Accidental overdose, alcohol-related disease, and suicide all contribute to decreasing life expectancy in the United States. All of these “diseases of despair” have risen dramatically over the past 10 years; the most notable of these is suicide.
Although suicide rates have increased sharply in all age groups, the trend is most notable in teens. The authors of a recent retrospective study found suicide rates among individuals aged less than 18 years rose 287% between 2009 and 2018.
Researchers used claims data from the health insurance company Highmark. Members are concentrated in states with disproportionately high rates of diseases of despair, including Pennsylvania, West Virginia, and Delaware.
The cohort study included more than 12 million individuals across age groups. Overall, 4.2% of individuals in the cohort were diagnosed with a disease of despair during follow-up. Between 2009 and 2018, incidence of all diseases of despair increased by 44% and prevalence increased by 68%.
Incidence and prevalence of substance-related diagnoses increased by 48% and 94%, respectively. Increases were highest among people aged 55 to 74 years. Incidence and prevalence of suicide-related diagnoses increased by 149% and 170%, respectively, across age groups. Prevalence increased 287% in people younger than 18 years of age.
The rate of chronic health conditions was twice as high among people with a disease of despair diagnosis compared to those without. Rates of anxiety and mood disorders were also higher.
Limitations of this study include incomplete social determinants of health data. Also, the study did not include people who lacked health insurance.
“Identifying diseases of despair is critical for interrupting their progression towards deaths of despair, but diagnoses do not necessarily guarantee the provision of appropriate and adequate care for acute problems or general well-being,” the researchers concluded. “[F]uture research may build on these findings by quantifying treatment following disease identification and linking this treatment to longer-term morbidity and mortality.”
The researchers also noted future studies should evaluate diseases of despair under the socially distanced conditions of COVID-19.
Brignone E, George DR, Sinoway L, et al. Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study. BMJ Open. 2020;10(10):e037679. doi:10.1136/bmjopen-2020-037679