Diseases of Despair in Young Adulthood: Risk, Resilience, and Prevention

After decades of improvement, premature mortality is uniquely on the rise in the U.S. among White non-Hispanic adults with low education. Suicide, drug poisoning (particularly from opiates), and alcoholic liver disease appear to be the culprits and have been coined “deaths of despair.” Suicidal thoughts and behaviors, illicit drug use, and alcohol problems (or “diseases of despair,” DoD)—the conditions that likely precede these deaths—are the focus of this project, as are the pathways to these DoD.

The first aim of this project is to look longitudinally at the developmental epidemiology of DoD across the early lifespan in the nationally-representative National Longitudinal Study of Adolescent to Adult Health database (Add Health) and in the rural-Appalachian Great Smoky Mountains Study (GSMS) with a large American Indian subsample.

The second aim is to test a childhood/adolescent strain -> young adult social/economic disengagement -> despair -> DoD pathways model and also to test protective factors that could intervene on each pathway. We will also use discovery-focused machine learning algorithms to uncover new pathways to DoD in Add Health and GSMS.

The third aim is to assess the impact of childhood interventions on DoD in the Great Smoky Mountains Study and Fast Track, a comprehensive 10-year randomized clinical intervention trial with 15 years of follow-up data that targeted mechanisms that are key in recent models of pathways to DoD.