Psychiatric Annals

Editorial Free

Deaths of Despair: A Toxic Side Effect of Racism for Whites?

Andrew A. Nierenberg, MD

We live in trying times, but for some, these times are more trying. The global economic dislocations, which culminated in the great recession of 2008, disproportionally affected communities dependent on manufacturing professions (and other jobs that did not require a college degree) after many of those jobs moved outside of the United States or ceased operations altogether. With the loss of jobs came the loss of income and self-reliance, which led to loss of self-esteem and dignity and the rise of despair and humiliation. These powerful forces and emotions have turned deadly. Family structures broke down, religious attendance dropped, and communities dispersed. A key article by Case and Deaton1 in 2015 showed that middle-age White non-Hispanic people were dying from suicide, alcohol poisoning, cirrhosis, and opiate overdoses. In fact, so many people were dying that the overall life expectancy decreased.

These are issues and emotions we usually do not discuss in psychiatry—the dignity of work, the humiliation of joblessness, the loss of economic hope, the loss of cohesiveness of social networks, and the despair that one's life is getting worse with no end in sight. Case and Deaton1 found that people reported declines in their mental health and ability to conduct activities of daily living as well as their ability to work. They also found that from 1997 to 1999 and from 2011 to 2013 those who reported having serious mental illness increased from 3.9% to 4.8%.

It is not surprising to those of us who take care of people with psychiatric problems that large stressors have deleterious effects on people. Nor is it not surprising that loss of hope can lead to suicidal ideation and behavior and even death by suicide. What may be surprising is that the increased deaths by despair were not experienced by the Black population—and it is possible, but by no means proven, that part of the widespread despair is linked to White people perceiving that their dominant social status was threatened by the economic disruptions—whereas Black people who experienced similar economic disruptions did not have an increase in deaths by despair and actually had a decrease in mortality rates.2 If true, then these findings suggest that the false notion that White people are superior to Black people is not only toxic to Black people but fatal for White people.


  1. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015;112(49):15078–15083. doi:10.1073/pnas.1518393112 [CrossRef] PMID:26575631
  2. Siddiqi A, Sod-Erdene O, Hamilton D, Cottom TM, Darity W Jr, . Growing sense of social status threat and concomitant deaths of despair among whites. SSM Popul Health. 2019;9:100449. doi:10.1016/j.ssmph.2019.100449 [CrossRef] PMID:31993479

Andrew A. Nierenberg, MD

Andrew A. Nierenberg, MD, is the Thomas P. Hackett, MD, Endowed Chair in Psychiatry, the Director, Bipolar Clinic and Research Program, and the Director, Training and Education, MGH Research Institute, Massachusetts General Hospital; and a Professor of Psychiatry, Harvard Medical School.

Address correspondence to Andrew A. Nierenberg, MD, via email:


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