New research reports that depression, suicidal ideation, drug use, and alcohol use — all ‘indicators of despair’ — are rising among Americans in their late 30s to early 40s.

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The increase in “deaths of despair” seen among low-educated, middle-aged white Baby Boomers (born 1946-1964) may be heavily mirrored among the youngest members of Generation X (born 1974-1983) in the years to come, the authors state. They hope the findings will be used to inform “efforts to reduce these indicators of despair”.

On a mid-age, dark and dreary

“What we wanted to do in this paper was to examine whether the factors that may be predictive of those causes of death — substance use, suicidal ideation and depression — are isolated to [the white non-Hispanic] population subgroup, or whether it’s a more generalized phenomenon,” says lead author Lauren Gaydosh, an assistant professor of Medicine, Health and Society and Public Policy Studies at Vanderbilt University.

In 2016, the U.S. saw its first decline in life expectancy in almost three decades. The prevailing theory at the time was that this decline was the product of a marked increase in deaths due to drug overdose, alcoholic cirrhosis, and suicide among middle-aged whites with low education or in rural areas. This group was struggling in the throes of “deaths of despair”, pushed to the brink by worsening employment prospects, a declining perception of socioeconomic status, and an erosion of social supports, the theory went.

However, studies aiming to understand those mortality trends did not definitively show that low-income rural whites were actually experiencing more despair than other groups. In order to get to the bottom of things, the team of this present study turned to the National Longitudinal Study of Adolescent to Adult Health (or ‘Add Health’), directed by Kathleen Mullan Harris at the University of North Carolina. Harris is also a co-author of this study. Add Health tracked the physical and mental health of thousands of Americans born between 1974-1983 from adolescence through their late 30s and early 40s (in 2016-18).

“We found that despair has increased in this cohort, but that increases are not restricted to non-Hispanic whites with low education,” Gaydosh said. “Instead, the increase in despair that occurs across the 30s is generalized to the entire cohort, regardless of race, ethnicity, education, and geography.”

The exact patterns of drinking, drug use, and mental health symptoms varied across races and education levels, the team reports: whites were more likely to binge-drink in adolescence; Hispanics and African Americans of all ages were more likely to report depressive symptoms.

However, the overall trends were roughly the same across cohorts, the authors add. Adolescence was a rocky time for everyone, followed by a period of improvement in their twenties. By the time those monitored under Add Health reached their late 30s, however, indicators of despair were trending back up across the board. In some cases, these indicators were higher for minority populations than they were for low-educated whites or rural adults.

The team says these results should concern us, as they suggest that midlife mortality may begin to increase across a wide range of demographic groups.

“Public health efforts to reduce these indicators of despair should not be targeted toward just rural whites, for example,” Gaydosh said, “because we’re finding that these patterns are generalized across the population.”

The paper “The Depths of Despair Among U.S. Adults Entering Midlife” has been published in the American Journal of Public Health.