People who spend more of their lives living in socioeconomically disadvantaged neighborhoods appear to face as much as a 60% higher risk of a so-called “death of despair” — including suicide, drug overdose and alcohol-related disease — according to a new study led by University of Virginia clinical psychologist Aaron Reuben.
The research, published in Clinical Psychological Science1, found clear geographic markers of higher rates of deaths of despair, while also uncovering evidence of an underlying “syndrome of despair” marked by chronic health circumstances including but not limited to, substance misuse, chronic pain and sleep problems. Taken more broadly, the new paper – from scholars at eight globally prominent universities – helps address some key gaps in researchers’ and society’s work to grapple with deaths of despair, which have been rising for several decades.
“This paper will hopefully orient people to the idea that there might be something completely separate from individual risk factors – for things like suicide, drug overdose, and alcohol poisoning – that’s operating at the neighborhood level. We’d like people to think about deaths of despair as not always about our individual personal circumstances, but instead as operating from the result of upstream problems at a social level.” These problems, the researcher point out, could potentially be addressed outside the healthcare sector, via things like neighborhood greening initiatives or investments in safe, walkable streets, or community events. “Place, it turns out, matters a great deal.”
Reuben, an Assistant Professor in UVA’s Department of Psychology
“The big message from our work has to be: Let’s improve the places where people are struggling,” said Reuben, an assistant professor in UVA’s Department of Psychology and the study’s lead author.
Using two complementary nationwide datasets from New Zealand — including health and mortality records from 2.4 million people and a decades-long cohort study that followed participants from birth to age 45 — researchers found that people living longer in disadvantaged neighborhoods were consistently at greater risk for despair-related outcomes, even after accounting for income, education and a wide array of individual risk factors like childhood adversity, poor physical health, or financial insecurity. The title of the paper is “Longer Residence in Disadvantaged Neighborhoods Predicts Both a Syndrome of Despair and Deaths of Despair: Complementary Evidence From Nationwide Register and Birth-Cohort Studies.”
Supporting the headline numbers, the study suggests that life-long risks depend on the life stages of a person’s exposure to disadvantaged geographies. Poignantly, individuals who began adulthood living in a disadvantaged neighborhood — or whose neighborhood conditions failed to improve over the first two decades of adulthood — experienced more severe despair-related symptoms by midlife. Researchers say the findings point to neighborhoods themselves as potential targets for intervention.
“If we want to reduce deaths of despair, we may need to think beyond the doctor’s office,” Reuben said. “Improving neighborhood conditions and investing in communities could become part of a broader public health strategy for preventing despair-related illness and death.”
People living in disadvantaged neighborhoods across adulthood were approximately 60% more likely to die from suicide, drug overdose, or alcohol-related illness.
Associations between neighborhood disadvantage and despair remained even after accounting for childhood vulnerabilities, family psychiatric history, adult stress, unemployment, and financial hardship.
Neighborhood associations persisted after adjusting for participants’ own education, income and socioeconomic status, suggesting that a place itself may independently shape a person’s health outcomes.
The study was conducted in New Zealand, which has universal health care and comparatively strong social safety-net programs, suggesting that neighborhood-level disparities may persist even in countries with broad social supports.
The authors say the findings support expanding public-health approaches beyond individual treatment and toward community-level interventions, such as improving transportation access, increasing green space and strengthening neighborhood resources.
Reference:
1) https://www.newswise.com/pdf_docs/177827130490929_CPX1425570_REV1%20(2).pdf
(Newswise/HG)
