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Why Deaths of Despair Are Increasing in the US and Not Other Industrial Nations—Insights From Neuroscience and Anthropology

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The US National Academy of Sciences reports rising mortality for US adults, most steeply for White adults with a secondary education or less. The rise is largely attributable to deaths of despair (suicide and poisoning by alcohol and drugs) with strong contributions from the cardiovascular effects of rising obesity. Although the report does acknowledge a crisis, it proposes mild measures to manage it, such as strengthening programs to support recovery, prevent relapse, increase resilience, and perform more research toward clinically useful definitions of despair. The US National Academy of Sciences report notes that mortality is decreasing in a control group of 16 wealthy nations (including countries in Western Europe, Canada, Australia, and Japan), but it does not ask what protects those nations from despair. It has been observed that human beings are constrained by evolutionary strategy (ie, huge brain, prolonged physical and emotional dependence, education beyond adolescence for professional skills, and extended adult learning) to require communal support at all stages of the life cycle. Without support, difficulties accumulate until there seems to be no way forward. The 16 wealthy nations provide communal assistance at every stage, thus facilitating diverse paths forward and protecting individuals and families from despair. The US could solve its health crisis by adopting the best practices of the 16-nation control group.

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Article Information

Accepted for Publication: November 16, 2021.

Published Online: February 2, 2022. doi:10.1001/jamapsychiatry.2021.4209

Corresponding Author: Peter Sterling, PhD, Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 (psterlin@gmail.com).

Author Contributions: Drs Sterling and Platt had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Both authors.

Administrative, technical, or material support: Sterling.

Supervision: Sterling.

Conflict of Interest Disclosures: Dr Platt reported receiving grant support from the National Institutes of Health (R37-MH10978, R01-MH108627, R01-MH118203, U01-MH121260, R21-AG073958, R56-MH122819, R56-AG071023), the National Science Foundation (NSF 21-10037), and the Charles E. Kaufman Foundation, and is cofounder of Cogwear LLC, and a scientific advisor to Neuroflow Inc, Amplio, Blue Horizon International, and Progenity. No other disclosures were reported.

Additional Contributions: We thank Felipe Parodi, BA, Department of Neuroscience, University of Pennsylvania, for preparing Figures 1, 2, and 4; Bart Borghuis, PhD, Department of Anatomical Sciences and Neurobiology, University of Louisville, for preparing Figure 2C; and Mary Reilly, MFA, for preparing Figure 3, all without financial compensation.

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