Despair among young adults may increase risk for suicidality, substance misuse

Despair appeared associated with increased risk for suicidality and substance misuse among young adults, according to results of a study published in JAMA Network Open.

“In recent decades, income stagnation and economic declines have coincided with premature deaths from suicide, alcoholism, and drug (especially opioid) overdoses, particularly among white non-Hispanic adults with low education in rural areas,” William E. Copeland, PhD, of the department of psychiatry at University of Vermont College of Medicine, and colleagues wrote. “Recent work reports that premature mortality from these causes occurs not only among middle-aged white adults but also among young adults and additional racial/ethnic groups. This reversal of U.S. life-expectancy improvements was coined deaths of despair and has raised public and scientific interest.”

Prior research on despair did not examine whether it is a shared risk pathway to death by suicide and alcohol- and drug-related deaths or their precursors — suicidal thoughts and behaviors, alcohol dependence and misuse and illicit drug use, all of which are considered the “diseases of despair.” Further, the researchers noted that despair has not been evaluated as an independent construct in and of itself.

Copeland and colleagues aimed to determine whether despair among young adults was associated with suicidality, drug misuse and alcohol misuse. They analyzed data of 1,420 participants of the Southeastern, mixed urban-rural population-based Great Smoky Mountains Study, which was conducted between Nov. 10, 1992 and Sept. 22, 2015. Participants aged 9, 11 and 13 years were followed up 11 times to age 30 years. The researchers evaluated 1,154 participants (82.4%) at age 30 years. To assess indicators of despair, such as hopelessness, helplessness low self-worth and feeling unloved, they used two structured interviews — the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. Main outcomes and measures included suicidal thoughts and behavior, substance use and DSM-5 diagnoses of alcohol use disorder and drug use disorder in young adulthood.

Between ages 25 and 30 years, the 3-month weighted prevalence of any despair was 19.5%, and 7.6% of participants reported two or more despair items. Longitudinal, lagged models revealed despair scores were associated with more suicidal thoughts and behaviors (OR = 1.5; 95% CI, 1.1-2), illicit drug use (OR = 1.7; 95% CI, 1.2-2.5) and opioid use (OR = 1.9; 95% CI, 1.1-3.3); however, they were not associated with alcohol use disorder (OR = 0.8; 95% CI, 0.6-1.2). After accounting for sociodemographic factors, such as educational level and poverty, as well as lagged outcomes status and lagged depression status, the associations persisted. In models that accounted for long-term despair extending from childhood, the associations between despair and study outcomes appeared stronger.

Copeland and colleagues observed no consistent pattern of moderation by sociodemographic factors.

“This study takes a step toward understanding how a psychological state could derail the seemingly inexorable progress of modern medicine,” they wrote. “However, this study is only [one] step, and additional work is needed to understand the origins of despair and premature mortality within individuals, families and communities and how we can intervene to recover hope and forestall further morbidity and mortality.”