Despair: The Not-So-Simple Villain Behind Our Self-Destructive Habits?

Hey there! So, I’ve been diving into some pretty heavy stuff lately, but stick with me, because it’s also incredibly important. We’ve all seen the headlines, right? For decades, life expectancy in the US was on a pretty steady upward climb. Then, around 2015, things took a bit of a nosedive. And a big part of this rather grim picture is the rising number of deaths among working-age folks (we’re talking 25 to 64 years old).

Now, what’s behind this? Well, a significant chunk is due to what some researchers, Anne Case and Angus Deaton, famously dubbed “deaths of despair.” It’s a term that bundles together deaths from drug overdoses (hello, opioid crisis!), suicides, and alcohol-related liver disease. The idea is that these aren’t just random tragedies; they might be linked by an underlying current of, well, despair. Hopelessness, a feeling that the future’s bleak, that sort of thing. It’s a compelling narrative, especially when you think about all the economic and social shifts we’ve been through.

So, Is Despair Really the Villain Here?

But here’s where I, and a bunch of researchers, start to scratch our heads. It’s one thing to have a theory, even a really compelling one, but it’s another to see if it holds up under the microscope. For despair to be the big bad wolf behind these “deaths of despair,” it first needs to be a good predictor of the behaviors that lead to them. Think about it: before someone tragically dies from an overdose, there’s drug use. Before an alcohol-related death, there’s often heavy drinking. And before suicide, there can be suicidal thoughts.

So, the million-dollar question becomes: does despair actually predict these self-destructive behaviors? And if it does, what kind of despair are we talking about? Is it all one big blob of gloom, or are there different flavors of despair that matter more for certain behaviors? This is exactly what a fascinating new study set out to investigate, and let me tell you, the findings are a real eye-opener.

How Do You Even Measure Despair? The Researchers’ Approach

Now, you might be wondering, ‘How on earth do you measure something as fuzzy as despair?’ That’s a great question! It’s not like you can just stick a thermometer in someone and get a despair reading. The researchers in this study were pretty clever about it. They used data from a massive, long-term project called the National Longitudinal Study of Adolescent to Adult Health (Add Health for short). We’re talking over 6,000 people tracked from their teens into adulthood.

They defined despair not as a single thing, but as something that can show up in four different areas, or ‘domains’:

• Emotional despair: Think feelings like sadness, loneliness, not being able to feel pleasure (that’s anhedonia, for the word nerds out there), and symptoms of depression.
• Cognitive despair: This is more about your thoughts – pessimism, hopelessness, feeling worthless, like you have no control over your life.
• Biosomatic despair: This is how despair can literally get under your skin. We’re talking about the physical toll, like obesity, poor self-rated health, or physical limitations.
• Behavioral despair: This captures actions that suggest a disregard for the future – things like risky sexual behavior, reckless driving, or even criminal activity. (Importantly, they didn’t include prior drug use or heavy drinking here, to avoid a circular argument).

Armed with this multi-faceted view of despair, they then used some fancy statistical footwork – supervised machine learning, to be precise – to see if these despair indicators could predict four key self-destructive behaviors: suicidal ideation (thinking about suicide), heavy drinking, illegal drug use, and prescription drug misuse.

Putting Despair to the Test: What the Crystal Ball (aka Machine Learning) Said

So, the researchers crunched the numbers, comparing how well their ‘despair model’ predicted these behaviors against other known risk factors, like clinical red flags (think diagnosed depression or anxiety measured around the same time as the behaviors) and a person’s history of these behaviors. And the results? Well, they were a bit of a mixed bag, and honestly, that’s what makes them so intriguing.

Let’s break it down:

• Suicidal Ideation: When it came to predicting who was thinking about suicide, the clinical risk factors actually did a better job than the despair measures alone. Not to say despair didn’t play a role, but those immediate clinical signs seemed to be stronger predictors.
• Heavy Drinking: Similar story here. Despair measures weren’t the star predictors. Clinical risk factors and, importantly, a history of heavy drinking, were more on the money. In fact, the despair model had its weakest performance predicting heavy drinking.

Now, this is where it gets really interesting:

• Illegal Drug Use: Ding, ding, ding! For predicting illegal drug use, the despair measures actually outperformed the clinical risk factors and prior behaviors. This suggests that feelings and experiences tied to despair might be particularly potent drivers for turning to illegal substances.
• Prescription Drug Misuse: Again, despair measures showed their strength. While a history of misusing prescription drugs was also a good predictor, the despair model held its own and performed better than just looking at clinical risk factors.

So, what we’re seeing is that despair isn’t a universal key. Its power to predict these dangerous behaviors really depends on which behavior we’re talking about. It seems to have a stronger link to drug-related behaviors than to suicidal thoughts or heavy drinking, at least when compared to other established predictors.

Not All Despair is Created Equal: Different Strokes for Different Folks (or Behaviors)

The plot thickens even more when we look at which aspects of despair seemed to matter most for each behavior. Remember those four domains? Emotional, cognitive, biosomatic, and behavioral? Well, they didn’t all carry the same weight across the board.

For example:

• When predicting suicidal ideation, features related to emotional despair (like diagnosed depression) and cognitive despair often ranked as highly important. This makes intuitive sense, right? Feelings of deep sadness and hopeless thoughts are often intertwined with suicidal thinking.
• For heavy drinking, it was more about behavioral despair features (like a history of arrests or even tobacco use) and some cognitive despair elements.
• Predicting illegal drug use also saw behavioral despair features shining, with some emotional despair indicators also popping up as important. Things like prior marijuana use (which they categorized under behavioral despair in a broader sense of risky behaviors if not the direct outcome) were significant.
• And for prescription drug misuse, it was a bit more of a mix, with features from behavioral, biosomatic (like poor self-rated health), and emotional despair all playing a role depending on the specific machine learning model used.

The big takeaway here is that the pathways from feeling crummy to engaging in specific self-destructive behaviors seem to be quite distinct. It’s not just ‘I feel despair, therefore I [insert risky behavior].’ It’s more like, ‘I feel this specific kind of despair, or my despair manifests in these particular ways, and that makes me more vulnerable to [a specific risky behavior].’

The Big Picture: Is Despair a Unifying Theory? Maybe Not So Much.

So, after all this, what does it mean for that grand ‘deaths of despair’ hypothesis? The one that suggests a common thread of despair ties together these rising rates of suicide, drug overdose, and alcohol-related deaths?

Well, these findings certainly throw a bit of a wrench in the works if we’re looking for a simple, one-size-fits-all explanation. The study quite directly says that the results ‘draw into question the relevance of despair as a unifying framework.’ Oof.

Here’s why:

• Different Predictive Power: If despair was the common root, you’d expect it to predict all these antecedent behaviors somewhat equally well. But, as we saw, it’s much better at predicting drug use (both illegal and prescription) than heavy drinking or suicidal ideation when compared to other strong predictors.
• Different Important Features: The specific aspects of despair that matter most also vary wildly from one behavior to another. Emotional despair might be key for suicidal thoughts, while behavioral despair indicators are more prominent for illegal drug use. This suggests different mechanisms are at play.

It seems the reality is far more nuanced. The pathways leading to these tragic outcomes are likely distinct, and lumping them all under a single ‘despair’ umbrella might actually obscure these important differences. It’s not that despair isn’t a factor – it clearly can be, especially for drug-related behaviors. But it’s probably not the singular, unifying factor for the entire crisis.

The researchers themselves put it beautifully: while the idea of despair as a catch-all is compelling, especially given the social and economic turmoil many have faced, it doesn’t mean it’s easy to pin down in data or that it provides an unambiguous answer. They suggest that while ‘overall despair’ might not be equally implicated everywhere, elements of despair are definitely at play. So, understanding its multi-dimensional nature is key.

Where Do We Go From Here?

It’s important to remember, as the researchers point out, that this study looked at behaviors, not actual deaths. And while these behaviors are strong precursors, the link isn’t always direct (not everyone with suicidal thoughts attempts suicide, for example). Also, the sample, due to data completeness, ended up being a bit more representative of White female adults, so we always need to be mindful of how these things play out across different groups.

But what this research does brilliantly is push us to think more critically. Instead of just accepting ‘despair’ as the answer, it encourages us to dig deeper into the specific risk factors and pathways for each of these devastating outcomes. This could be super important for designing better interventions. If emotional despair is a big driver for suicidal ideation, then interventions targeting those feelings are crucial. If behavioral patterns are more linked to illegal drug use, then that’s where the focus might need to be.

The study makes a strong case that while despair is a useful concept, we shouldn’t expect it to be a magic bullet explanation for complex population health trends. It’s a reminder that we need to look at these issues individually, especially if we want to find actionable solutions.

Ultimately, while the idea of a single cause for the ‘deaths of despair’ is tidy, the truth, as it often is, is a lot messier. And that’s okay! Recognizing this complexity is the first step towards truly understanding and, hopefully, addressing these critical public health challenges. It’s not about dismissing despair, but about refining our understanding of its many faces and its varied impacts.

Source: Springer