Associations of Despair With Suicidality and Substance Misuse Among Young Adults.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study assessing lagged predictive associations over time.
PubMed 32573708 · doi:10.1001/jamanetworkopen.2020.8627
What was done
Researchers analyzed data from the Great Smoky Mountains Study, a population-based cohort in the Southeastern United States of 1420 participants enrolled at ages 9, 11, and 13 and followed up across 11 assessment waves up to age 30. Structured psychiatric interviews (Child and Adolescent Psychiatric Assessment and Young Adult Psychiatric Assessment) measured despair (hopelessness, helplessness, low self-worth, feeling unloved) and outcomes at ages 25 and 30 (2424 observations across 1266 individuals). Longitudinal, lagged regression models tested whether despair scores (range, 0–3) predicted subsequent suicidal thoughts and behaviors, DSM-5 alcohol use disorder, illicit drug use, and opioid misuse, controlling for sociodemographics, lagged outcome status, and lagged depression.
What was found
The 3-month weighted prevalence of any despair at ages 25 to 30 was 19.5% (476 of 2424 observations), with 7.6% (201 observations) reporting two or more indicators. In lagged multivariable models, each step increase in despair score was associated with higher odds of suicidal thoughts and behaviors (OR 1.5; 95% CI, 1.1–2.0), illicit drug use (OR 1.7; 95% CI, 1.2–2.5), and opioid misuse (OR 1.9; 95% CI, 1.1–3.3). Despair was not significantly associated with alcohol use disorder (OR 0.8; 95% CI, 0.6–1.2). Associations persisted after adjusting for sociodemographics and prior depression, and strengthened when incorporating cumulative despair measures extending back to childhood.
Why it matters
This study provides empirical support for the psychological construct of despair as a distinct prospective risk factor for components of "deaths of despair" (specifically suicidality and opioid/illicit drug misuse), independent of clinical depression, while finding no association with alcohol use disorder.
Limits
The sample is restricted to a single regional population in rural/mixed Southeastern United States (Appalachia), limiting generalizability to other geographic or demographic groups. Mortality itself was not evaluated as an endpoint (only non-fatal precursors). Alcohol use disorder showed no association, indicating despair does not account for all hypothesized "deaths of despair" domains.
Cited by
- supports Deaths of despair are one of the primary causes of death in people under the age of 30.