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It is no surprise that COVID-19 has wreaked havoc on the wellbeing of individuals and families. Overall stress and worry for all Americans increased from 47% in 2019 to 59% in 2020. Two in five individuals reported an adverse mental or behavioral health condition in June 2020 with many linking their symptoms to COVID-19. The most stressed are young adults, followed by minorities and caregivers. The national suicide hotline reports an 800% increase in calls in 2020 compared to 2019, while domestic violence hotline calls increased by 76%.
These diseases of despair are behavior-related medical conditions that increase in groups of people who experience despair due to a sense of their long-term social and economic outlook as bleak. Sometimes they lead to deaths of despair as individuals succumb to overwhelming suicidal ideation or chemical overdose. A recent analysis found that by 2029, there may be 75,000 more deaths due to suicide and substance misuse as result of the pandemic and economic recession.
What helps protect our patients and ourselves from these problems? A new working paper by the National Bureau of Economic Research in Cambridge posits that the divide between those facing deaths of despair, morbidity, and emotional distress and those who do not is … a four-year college degree.
Our healthcare system cannot cure diseases of despair
The authors reviewed large datasets and concluded that ongoing riptides of pain and despair put Americans with no college degree at risk for suicide and opioid addiction, and contributed to large exoduses from a major political party. Their prediction is that this great divide will continue even if the opioid epidemic is brought under control. One of the main drivers is the economic decline that certain groups of Americans are experiencing more harshly than others.
This divide can feel overwhelming and slippery at the same time. Our healthcare delivery system has limitations. Yes, clinicians can ask patients to report if they have a college degree, create new patient registries, and increase efforts to engage patients at risk for diseases and deaths of despair. But this divide is bigger than healthcare, even though our health systems deal with the fallout of decisions made in other systems.
Innovations like population health management, integrated care, personalized medicine, and hot spotting are part of the future of healthcare. But our hospitals and clinics have limited resources and these innovations cannot adequately address chronic diseases like poverty, injustice, illiteracy, and violence. Our healthcare system cannot cure diseases of despair.
Don Berwick once said that healthcare is a weak tool, it’s nearly impotent if we want vitality in populations. The words “poverty is the worst disease of all” were seared into my mind at a CFHA conference plenary years ago. To really create health, the kind that mitigates diseases and deaths of despair, we need large-scale treatments and the political will to address the root causes of despair. If not, then healthcare will continue to pick up the broken pieces of a broken social system.
Luo, Yang; Chua, Cher Rui; Xiong, Zhonghui; Ho, Roger C.; Ho, Cyrus S. H. (23 November 2020). “A Systematic Review of the Impact of Viral Respiratory Epidemics on Mental Health: An Implication on the Coronavirus Disease 2019 Pandemic”. Frontiers in Psychiatry. 11: 565098. doi:10.3389/fpsyt.2020.565098
American Psychological Association (2020). Stress in America™ 2020: A National Mental Health Crisis. Retrieved from https://www.apa.org/news/press/releases/stress/2020/sia-mental-health-crisis.pdf
Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external
Brignone E, George DR, Sinoway L, et al. Trends in the diagnosis of diseases of despair in the United States, 2009–2018: a retrospective cohort study. BMJ Open 2020;10:e037679. doi: 10.1136/bmjopen-2020-037679
Petterson, Steve et al. “Projected Deaths of Despair During the Coronavirus Recession,” Well Being Trust. May 8, 2020. Retrieved from https://wellbeingtrust.org/areas-of-focus/policy-and-advocacy/reports/projected-deaths-of-despair-during-covid-19/
The Great Divide: Education, Despair and Death. Anne Case and Angus Deaton. NBER Working Paper No. 29241 September 2021. https://www.nber.org/system/files/working_papers/w29241/w29241.pdf
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