I was already living in the Netherlands when I came across the literature on DEATHS OF DESPAIR. For those unfamiliar with this macabre term, it was popularised by economists Case and Deaton, who identified massive upticks in Americans killing themselves— either quickly through suicide and drug overdoses, or slowly through alcohol and other addictions—concentrated among middle-aged non-Hispanic white men without a university degree. They hypothesised that the post-industrial deterioration of social, economic, and health-care structures was catalysing this phenomenon, and concluded that these shifts weren’t happening in other so-called “rich” countries. Could it be? Had American white men cornered the market on despair?

As an American living abroad, I thought back on my own experiences. More than a handful of close friends and family members have committed suicide, overdosed, or died due to liver disease. They were all young to middle aged men, some without even a high school diploma. I wondered, did a capitalist-fuelled dystopian American hellscape drive these men to premature death?

There is much debate regarding the deaths of despair literature. Some argue that the original oversimplistic analysis amplified trends among a specific subgroup. Others found that the deaths of despair phenomenon is largely explained through increases in opioid overdoses alone, which were concentrated among working class white men largely due to systematic racism inherent in the US healthcare system. It is also noteworthy that despite relative increases in premature death among white American males, other populations had already been dying earlier: Black Americans have consistently fared worse than white populations in measures of excess mortality, and deaths of despair were more common among Native Americans, with 10% of all deaths among women and girls attributed to suicide, drugs- or alcohol-related causes.

Recent studies have observed similar trends among middle-aged males in other countries, most notably in Scotland, and among other demographics—remarkable upsurges in deaths of despair, particularly overdoses, have been identified among minority groups and women. Adolescents and young people, also mostly males, have too seen an unexpected upsurge in preventable deaths related to interpersonal violence, self-harm, and drug misuse.

Reflecting on my own experiences, as a human being and as a researcher, what IS clear is that feelings of hopelessness and despair are not unique to a particular gender, ethnicity, age, sexual orientation, or physical location on this planet. However, some individuals may be less equipped to deal with feelings of not belonging.

Similar to the underlying concepts from the deaths of despair literature, in the Netherlands, low(er) educated, unmarried, and unemployed men are more likely to take their own life through suicide. Furthermore, despite a relatively low morbidity related to alcoholic liver cirrhosis, the number of drug overdoses have continued to rise, with poisoning by illicit drug use highest among young men.

While the neat and cohesive narrative proposed by Case and Deaton may not sufficiently address the complex and intertwining determinants of addiction and self-harm, their seminal book started a global conversation about unprecedented declines in population health. Considering the stagnating life expectancy here in the Netherlands, identifying groups at increased risk for preventable death can be critical for informing health systems regarding population-wide health threats.