Matthew Edwards, editor of the IFoA Longevity Bulletin, outlines some of the mortality implications of common aspects of poor mental health.
One of the saddest terms to have entered common parlance over the last 10 years is ‘deaths of despair’. It is a term coined by US economists Anne Case and Angus Deaton in their 2020 book Deaths of despair and the future of capitalism. This followed their ground-breaking 2015 paper which looked at the reversal from the late 1990s of the hitherto ‘taken for granted’ mortality decline in white middle-aged Americans.
Case and Deaton equated, for understandable reasons of objectivity and ease of categorisation, ‘deaths of despair’ with deaths due to suicide and drug and alcohol abuse. The numbers dying from such causes in the US alone have been staggering. The Economist recently put the 2022 figure at around 200,000, compared with total US deaths of 3.3 million in that year – so around 6%.
This problem has been observed elsewhere – for instance, such deaths in England accounted for around 3% of the total in 2019. As with the US phenomenon, such deaths were seen as varying strongly by socio-economic circumstances.
‘Despair’ is an interesting term, and rather more descriptive than the anodyne ‘mental health’ (which is often used to mean its own opposite). A layman might equate ‘despair’ to the lowest ebb of mental health. It is a far cry from such standard psychiatric labels as schizophrenia and bipolar disorder.
While epidemiological research dating from as far back as the 1930s has uncovered strong links between mortality and psychiatric conditions, I think it has come as a surprise to many to see high mortality linked to such a simple word as despair.
While despair itself may be an extreme of the spectrum, less apparently malign states are also associated with higher mortality. Stress is increasingly associated with poor health, from driving primary care visits to material numbers of deaths (circa 100,000 annually in the US, from one often-quoted study). Loneliness (generally ‘social isolation’ in the literature) is associated with many deaths. A common US estimate is around 150,000 annually (but with overlap with the above ‘deaths of despair’ likely).
What are the precise causes of death here? The core ‘deaths of despair’ relate to suicide and drug and alcohol abuse, as already mentioned. Research on stress-related mortality is poor but cardiovascular problems feature highly in literature on the subject. Cardiovascular deaths feature also with social isolation, but lack of care leads to a broader range of causes of death. Epidemiologically-minded readers will appreciate the challenges involved in conducting studies in these areas.
While the above might just read as thoroughly depressing, actuaries can see a positive aspect. To reduce mortality (or related aspects of morbidity), we would generally start by identifying and then quantifying causes or drivers. Once we have a reasonable understanding of those, there is then the possibility that we can collectively (at a societal and public health level) help to manage those causes, and reduce mortality.
The July 2024 Longevity Bulletin, which takes mental health as its theme, is now available, with an excellent range of articles aligned with the complex and multifaceted nature of the problem. The more I have thought about the topic over the last year or so, the more I see it as one of the big mortality drivers of our current times.
I remain pessimistic about mortality improvements in the UK, partly influenced by what I feel is a sense of ‘societal despair’ and a lack of motivating purpose in the elderly. However, if this despair could be transformed, if only in part, into its opposite – hope – we might be looking at another source of improvement. That itself is surely something to hope for!
The mental health issue of the Longevity Bulletin is now available on the IFoA website. References to source material in this blog piece are provided by the author on IFoA communities, where we would welcome discussion on any of the issues raised here and in the bulletin.
Read the mental health issue of the Longevity Bulletin
