[Skip to Content]
[Skip to Content Landing]

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
Abstract

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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.

References
1.
National Academies of Sciences, Engineering, and Medicine. High and Rising Mortality Rates Among Working-Age Adults. The National Academies Press; 2021. doi:10.17226/25976
2.
Eyer  J . Sterling  P .  Stress-related mortality and social organization.   Rev Radic Political. 1977;9(1):1-44. doi:10.1177/048661347700900103Google ScholarCrossref
3.
Case  A , Deaton  A .  Mortality and morbidity in the 21st century.   Brookings Pap Econ Act. 2017;2017:397-476. doi:10.1353/eca.2017.0005PubMedGoogle ScholarCrossref
4.
Sterling  P . What is Health? Allostasis and the Evolution of Human Design. MIT Press; 2020. doi:10.7551/mitpress/11472.001.0001
5.
The Violence Project. Mass shooter database. Accessed December 17, 2021. https://www.theviolenceproject.org/mass-shooter-database/
6.
Kenny  PJ .  The food addiction.   Sci Am. 2013;309(3):44-49.Google ScholarCrossref
7.
Eshel  N , Tian  J , Bukwich  M , Uchida  N .  Dopamine neurons share common response function for reward prediction error.   Nat Neurosci. 2016;19(3):479-486. doi:10.1038/nn.4239PubMedGoogle ScholarCrossref
8.
Harbaugh  WT , Mayr  U , Burghart  DR .  Neural responses to taxation and voluntary giving reveal motives for charitable donations.   Science. 2007;316(5831):1622-1625. doi:10.1126/science.1140738PubMedGoogle ScholarCrossref
9.
Kaplan  H , Gurven  M . The natural history of human food sharing and cooperation: a review and a new multi-individual approach to the negotiation of norms. In: Gintis  H , Bowles  S , Boyd  R , Fehr  E , eds.  Moral Sentiments and Material Interests. MIT Press; 2005:75-114.
10.
Boyd  R , Silk  JB .  How Humans Evolved. WW Norton & Co; 2018.
11.
Pontzer  H , Wood  BM , Raichlen  DA .  Hunter-gatherers as models in public health.   Obes Rev. 2018;19(suppl 1):24-35.Google ScholarCrossref
12.
Tobler  PN , Fiorillo  CD , Schultz  W .  Adaptive coding of reward value by dopamine neurons.   Science. 2005;307(5715):1642-1645. doi:10.1126/science.1105370PubMedGoogle ScholarCrossref
13.
Sutton  RS , Barto  AG .  Reinforcement Learning. 2nd ed. MIT Press; 2018.
14.
Steiner  P .  Brain fuel utilization in the developing brain.   Ann Nutr Metab. 2019;75(suppl 1):8-18. doi:10.1159/000508054PubMedGoogle ScholarCrossref
15.
Kaplan  HS , Robson  AJ .  The emergence of humans: the coevolution of intelligence and longevity with intergenerational transfers.   Proc Natl Acad Sci U S A. 2002;99(15):10221-10226. doi:10.1073/pnas.152502899PubMedGoogle ScholarCrossref
16.
Yeatman  JD , Wandell  BA , Mezer  AA .  Life-span maturation and degeneration of human brain white matter.   Nat Commun. 2014;5:4932. doi:10.1038/ncomms5932PubMedGoogle ScholarCrossref
17.
Livingston  G .  The Changing Profile of Unmarried Parents. Pew Research Center; 2018
18.
Kramer  S . US has world’s highest rate of children living in single-parent households. December 12, 2019. Accessed December 17, 2021. https://www.pewresearch.org/fact-tank/2019/12/12/u-s-children-more-likely-than-children-in-other-countries-to-live-with-just-one-parent/
19.
Driscoll  AK , Ely  DM .  Maternal characteristics and infant outcomes in Appalachia and the Delta.   Natl Vital Stat Rep. 2019;68(11):1-15.PubMedGoogle Scholar
20.
Maye  A . No-vacation nation, revised. May 22, 2019. Accessed December 17, 2021. https://cepr.net/report/no-vacation-nation-revised/
21.
Farah  MJ , Sternberg  S , Nichols  TA ,  et al.  Randomized manipulation of early cognitive experience impacts adult brain structure.   J Cogn Neurosci. 2021;33(6):1197-1209. doi:10.1162/jocn_a_01709PubMedGoogle ScholarCrossref
22.
Manning  WD .  Cohabitation and child well-being.   Future Child. 2015;25(2):51-66. doi:10.1353/foc.2015.0012PubMedGoogle ScholarCrossref
23.
Gray-Lobe  G , Pathak  P , Walters  C . The long-term effects of universal preschool in Boston. Accessed December 17, 2021. https://www.nber.org/system/files/working_papers/w28756/w28756.pdf
24.
Education Data Initiative. College enrollment and student demographics statistics. Updated November 22, 2021. Accessed December 17, 2021. https://educationdata.org/college-enrollment-statistics
25.
Song J. Average cost of college in America. Accessed December 17, 2021. https://www.valuepenguin.com/student-loans/average-cost-of-college
26.
Nieuwenhuis  R .  Directions of thought for single parents in the EU.   Community Work Fam. 2020;24(5):559-566.Google ScholarCrossref
27.
Kamal R, Hudman J, McDermott D. What do we know about infant mortality in the US and comparable countries? October 18, 2019. Accessed December 17, 2021. https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/
28.
Tikkanen R, Gunja MZ, FitzGerald M, Zephyrin L. Maternal mortality and maternity care in the United States compared to 10 other developed countries. November 18, 2020. Accessed December 17, 2021. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries
29.
World Population Review. Maternity leave by country 2021. Accessed December 17, 2021. https://worldpopulationreview.com/country-rankings/maternity-leave-by-country
30.
Chzhen  Y , Gromada  A , Rees  G .  Are the World’s Richest Countries Family Friendly? Policy in the OECD, and EU. UNICEF Office of Research; 2019.
31.
McDade  TW , Ryan  CP , Jones  MJ ,  et al.  Genome-wide analysis of DNA methylation in relation to socioeconomic status during development and early adulthood.   Am J Phys Anthropol. 2019;169(1):3-11. doi:10.1002/ajpa.23800PubMedGoogle ScholarCrossref
32.
Swartz  JR , Hariri  AR , Williamson  DE .  An epigenetic mechanism links socioeconomic status to changes in depression-related brain function in high-risk adolescents.   Mol Psychiatry. 2017;22(2):209-214. doi:10.1038/mp.2016.82PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close