Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife

Abstract

Background Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. Methods Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains – suicidality, substance misuse, sleep problems, and pain – were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. Results We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [β = 0.23, 95% CI (0.16–0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [β = 0.26, 95% CI (0.19–0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. Conclusions Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.

Diseases of despair in early adulthood: The complex role of social relationships.

“…Seminal studies on deaths of despair have relied on data from death certificates, which informs about regional patterns and demographic groups most at risk but offers few clues as to underlying processes. Recent investigations have aimed at uncovering the developmental roots of diseases of despair (Brennan et al, 2023; Copeland et al, 2020). The present study adds to this literature by examining risk and resilience processes unfolding during a period of peak incidence and frequent onset for key diseases of despair, that is, early adulthood, in a demographic group particularly at risk, that is young adults with lower levels of education, with a focus on modifiable social factors amenable to intervention.…”

“…“Deaths of despair,” that is, mortality resulting from suicide, drug overdose, or alcohol-related liver disease, have caused reversals in long-standing trends toward improvement in life expectancy and have attracted considerable research and media attention in the United States and beyond (Benny et al, 2023; Brennan et al, 2023; Case & Deaton, 2020; King et al, 2022). Although despair mortality primarily affects middle-aged adults, deaths of despair are typically preceded by symptoms of diseases of despair, that is, of mood or substance-related disorders (Bohnert & Ilgen, 2019).…”

“…Because extant studies have not (with rare exceptions) considered the three types of relationships or included multiple assessments in early adulthood, shifts in the relative importance of different types of relationships remain elusive. The lack of longitudinal designs also means that extant studies do not factor in previous mental health outcomes, which is problematic, considering that mental health in adolescence is associated with the later emergence of symptoms of diseases of despair and with the quality of dyadic relationships in early adulthood (Brennan et al, 2023; Clayborne et al, 2019). Moreover, studies overwhelmingly focus on youth enrolled in university programs or who had college-educated parents; consequently, their results may not extend to their peers with lower levels of education, for whom informal support in close relationships might be especially critical (Hooker & Algoe, 2022; Sapiro & Ward, 2020).…”

Midlife diseases of despair and cardiometabolic risk: testing shared origins in adolescent psychopathology

“…These trends have generally been described separately, but they may be driven by similar mechanisms (National Academy of Medicine, 2022;Sterling & Platt, 2022). Here, we used data from a prospective, nationally representative cohort to characterize the co-occurrence of midlife diseases of despair and cardiometabolic risk and to test adolescent psychopathology as a common precursor to these outcomes.Diseases of despair comprise interrelated maladies (suicidality, substance misuse, pain, and sleep problems) that increase the risk of death from despair (Brennan et al, 2023). Cardiometabolic risk factors include a cluster of conditions (e.g.…”

“…Diseases of despair comprise interrelated maladies (suicidality, substance misuse, pain, and sleep problems) that increase the risk of death from despair (Brennan et al, 2023). Cardiometabolic risk factors include a cluster of conditions (e.g.…”