Suicidal thoughts, behavior in under 18-year-olds up by 287% in US and 210% among ages 18 to 34, finds study
“Diseases of despair”, such as substance abuse, alcohol dependency, and suicidal thoughts and behaviors, have soared in the US over the past decade, warns a research team. They now affect all ages, with suicidal thoughts and behaviors among those under 18 years rocketing by 287% between 2009 and 2018, and by 210% among 18 to 34-year-olds, their analysis shows.
“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 wellbeing. Thus, future research may build on these findings by quantifying treatment following disease identification and linking this treatment to longer-term morbidity and mortality,” recommends the team in their findings published in the journal BMJ Open. It includes experts from Highmark Health and Penn State College of Medicine.
According to researchers, from 2015 to 2017, there has been an annual downward trend in life expectancy in the US, the longest sustained decline since 1915-1918. They also observed a longer, more marked increase in deaths among middle-aged White non-Hispanic men and women in the US between 1999 and 2015, with premature deaths largely associated with “deaths of despair” such as suicides, accidental poisonings and alcohol-related liver disease.
The authors say this troubling observation has coincided with decades of economic decline for workers, particularly those with low levels of educational attainment, loss of social safety nets, and stagnant or falling wages and family incomes in the US, all of which are thought to have contributed to growing feelings of despair.
Despair may, in turn, trigger emotional, behavioral, and even biological changes, increasing the likelihood of diseases that can progress and ultimately culminate in deaths of despair, they explain.
Accordingly, to characterize trends in diseases of despair over the past decade and identify associated demographic risk factors, the team drew on detailed claims data extracted from Highmark, a large US-based health insurance company.
Highmark members are concentrated in states that have been disproportionately affected by deaths of despair: Pennsylvania, West Virginia, and Delaware. In all, the researchers analyzed information for 12 million people enrolled in a Highmark health insurance plan between 2007 and 2018, and who had valid details on file.
Diseases of despair were examined among the following age groups: under the age of 12 months, 1-17-year-olds, 18-34-year-olds, 35-54-year-olds, 55-75-year-olds, and those aged 75 and older.
“Increasing mortality and decreasing life expectancy in the US are largely attributable to accidental overdose, alcohol-related disease and suicide. These deaths of despair often follow years of morbidity, yet little is known about trends in the clinical recognition of diseases of despair. The objective of this study is to characterize rates of clinically documented diseases of despair over the last decade,” say investigators.
The annual diagnostic incidence of diseases of despair between 2009 and 2018 increased by 44%. Overall, 1 in 20 (515,830 or just over 4%) of those insured were diagnosed with at least one disease of despair at some point during the monitoring period. Some 58.5% were male, with an average age of 36. Of these, over half (54%) were diagnosed with an alcohol-related disorder, 44.2% with a substance-related disorder, and just over 16% with suicidal thoughts or behaviors. Just under 13% were diagnosed with more than one type of disease of despair.
Between 2009 and 2018, the rate of diseases of despair diagnoses increased by 68%. The rate of alcohol-related, substance-related and suicide-related diagnoses rose by 37%, 94% and 170%, respectively. The largest increase in alcohol and substance-related diagnoses was seen among 55 and 74-year-olds: 59% and 172% respectively.
“While the absolute numbers of suicide-related diagnoses were lower than for other types of diseases of despair, the relative increases were large. Among 1-17-year-olds, the rate increased by 287%, and by 210% among 18 to 34-year-olds. A relative increase of at least 70% occurred in all other age groups,” the authors write.
According to authors, diseases of despair diagnoses were also associated with significantly higher scores for coexisting conditions, higher rates of anxiety and mood disorders, and schizophrenia for both men and women across all age groups.
Among infants, substance-related diagnoses, which were attributable to neonatal abstinence syndrome (NAS) linked to maternal drug abuse (for example, opioid addiction) rose by 114%. NAS is a group of conditions that occurs when a baby withdraws from certain drugs he/she was exposed to in the mother’s womb.
“Among infants, the prevalence of substance-related diagnoses doubled over the course of follow-up. This increase was entirely attributable to neonatal abstinence syndrome and corresponds closely with increases in substance-related disorders among women of childbearing age. Neonatal abstinence syndrome could be argued to be the direct result of a disease of despair among mothers and was therefore included."
"In addition, the prevalence of suicide ideation and behaviors among youth and young adults at least tripled over the course of follow-up. These findings underscore the importance of targeting vulnerable subpopulations,” cautions the team.
The researchers acknowledge that it was not possible to find out about potentially influential social determinants of health from the claims data. Given that an estimated 87 million working adults in the US are uninsured or underinsured, it was hard to gauge the true scope of the diseases of despair, they add.
The investigators emphasize that these findings reinforce the notion that while the opioid crisis remains a top public health priority, parallel rises in alcohol-related diagnoses and suicidality must be concurrently addressed. “Findings suggest opportunities for healthcare systems and providers to deploy targeted prevention to mitigate the progression of morbidities towards mortality,” they recommend.