Declining mental health among disadvantaged Americans

Lifetime healthcare expenditures across socioeconomic groups

BACKGROUND

A socioeconomic gradient affects healthcare expenditures and longevity in opposite directions as less affluent individuals have higher current healthcare expenditures but simultaneously enjoy shorter lives. Yet, it is unclear whether this cross-sectional healthcare expenditure gradient persists from a lifetime perspective. This paper analyzes lifetime healthcare expenditures across socioeconomic groups using detailed individual-level healthcare expenditure data for the entire Danish population.

METHOD

Using full population healthcare expenditures from Danish registries, we estimate lifetime healthcare expenditures as age-specific mean healthcare expenditures times the probability of being alive at each age. Our data enables the estimation of lifetime healthcare expenditures by sex, socioeconomic status, and by various types of healthcare expenditure.

RESULTS

Once we account for mortality differences and all types of healthcare expenditures, all socioeconomic groups spend an almost equal amount on healthcare throughout a lifetime. Lower socioeconomic groups incur the lowest lifetime hospital expenditures, whereas higher socioeconomic groups experience the highest lifetime expenditures on long-term care services. Our findings remain robust across various socioeconomic measures and alternative estimation methodologies.

CONCLUSION

Improving the health status of lower socioeconomic groups to align with that of higher socioeconomic groups is costly but may ultimately reduce current healthcare expenditures. Enhanced health outcomes likely increase lifespan, leading to extended periods of healthcare consumption. However, since all socioeconomic groups tend to have similar lifetime healthcare expenditures, this prolonged consumption has limited impact on overall lifetime healthcare costs. Additionally, a significant benefit is the deferment of healthcare expenditures into the future. Overall, our results diminish concerns about socially inequitable utilization of healthcare resources while socioeconomic differences in health and longevity persist, even in a universal healthcare system.

Enduring Heroism in the Face of Inequality and Injustice: Who Steps Up and Why?

Enduring heroism defined as persistent efforts to confront inequality and injustice is the focus of this article. Six exemplars are considered: Harriet Tubman, Crazy Horse, Jane Addams, Mohandas Gandhi, Nelson Mandela, Malcolm X. Similarities and differences in their pursuits are considered and linked to the larger literature on heroism. They are also contrasted with enduring anti-heroes to elevate roles of virtue and benevolence in long-term efforts to correct societal ills. What motivates enduring heroism is a central question. A hypothesis put forth is that distinct dimensions of eudaimonic well-being - especially, purpose in life, autonomy, environmental mastery, and personal growth - may be key elements that fuel efforts of enduring heroes. A final section underscores the need for such individuals in our era, drawing on wide-ranging evidence that inequality and injustice are worsening and have been exacerbated by major historical events (Great Recession, COVID-19 pandemic). Now more than ever enduring heroes are needed to help redress the enormous suffering around us.

Institutional Failures as Structural Determinants of Suicide: The Opioid Epidemic and the Great Recession in the United States

We investigate recent trends in U.S. suicide mortality using a "structural determinants of health" framework. We access restricted-use multiple cause of death files to track suicide rates among U.S. Black, White, American Indian/Alaska Native, and Latino/a men and women between 1990 and 2017. We examine suicide deaths separately by poisonings and nonpoisonings to illustrate that (1) women's suicide rates from poisonings track strongly with increases in prescription drug availability and (2) nonpoisoning suicide rates among all adult Americans track strongly with worsening economic conditions coinciding with the financial crash and Great Recession. These findings suggest that institutional failures elevated U.S. suicide risk between 1990 and 2017 by increasing access to more lethal means of self-harm and by increasing both exposure and vulnerability to economic downturns. Together, these results support calls to scale up to focus on the structural determinants of U.S. suicide.

Mental Health and U.S. Attitudes Toward Social Determinants of Health Policies

INTRODUCTION

Research has suggested that individual health may influence policy attitudes, yet the relationship between mental health and policy support is understudied. Clarifying this relationship may help inform policies that can improve the population mental health. To address this gap, this study measures national support for 5 social determinants of health policy priorities and their relation to mental health and political affiliation.

METHODS

This study assessed support for 5 policy priorities related to the social determinants of health using a nationally representative survey of US adults (n=2,430) conducted in March-April 2023. Logistic regression was used to estimate the predicted probability of identifying each priority as important, test differences in support by self-rated mental health, and evaluate whether partisanship modified these relationships. Analyses were conducted in 2023.

RESULTS

The majority of US adults, across partisan identities, supported 5 policy priorities related to improving the economy (84%), healthcare affordability (77%), improving K-12 education (76%), housing affordability (68%), and childcare affordability (61%). Worse mental health predicted significantly greater support for addressing housing affordability (73.9% vs 66.2%), and partisanship modified the relationship between mental health and support for improving the economy, improving K-12 education, and housing affordability.

CONCLUSIONS

In 2023, there was substantial bipartisan support for federal policy action to address the social determinants of health, and worse mental health was related to greater policy support, particularly among Democrats. Federal policymakers have a broad consensus to take action to address the social determinants of health, which may improve the population mental health.

Racial/ethnic and nativity differences in adversity profiles among middle-aged and older adults

OBJECTIVES

Focusing on the nexus of race/ethnicity and nativity, this study examined profiles of adversity and their mental health implications in five groups of middle-aged and older adults: native-born whites, native-born blacks, native-born Hispanics, foreign-born whites, and foreign-born Hispanics.

METHODS

Data were from the 2018 psychosocial assessment of the HRS (N = 5,223). Latent class analysis (LCA) was employed to identify patterns of eleven adversity indicators and to compare the latent structures and class prevalence across the race/ethnicity and nativity groups. Regressions were used to examine the associations between adversity profiles and depression and life satisfaction, respectively.

RESULTS

Four adversity profiles emerged: low adversity (59.84%), low human capital (15.27%), socially marginalized (15.26%), and neighborhood adversity (9.63%). Regardless of nativity status, white older adults were most likely to have the low adversity profile (74 ∼ 75%). In contrast, all the racial/ethnic minority groups were more likely to have the other three adversity profiles. The adversity experienced by racial/ethnic minorities was further cofounded by their immigration status. Overall, having low adversity was associated with the best mental health outcomes and socially marginalized had the poorest outcomes. Even with the low adversity profile, native-born blacks had significantly more depressive symptoms than native-born whites.

CONCLUSION

Findings revealed heterogeneity in adversity profiles and their mental health implications in disadvantaged aging populations. Tailored programs are needed to address unique needs of different minority populations.

Social Infrastructure Availability and Suicide Rates among Working-Age Adults in the United States

Social infrastructure (SI) may buffer against suicide risk by improving social cohesion, social support, and information and resource sharing. This study uses an ecological approach to examine the relationship between county-level SI availability and suicide rates among working-age adults (ages 25-64) in the United States, a population for whom suicide rates are high, rising, and geographically unequal. Mortality data are from the National Vital Statistics System for 2016-2019. SI data are from the National Neighborhood Data Archive for 2013-2015 and capture the availability of typically free SI (e.g. libraries, community centers) and commercial SI (e.g. coffee shops, diners, entertainment venues). Results from negative binomial models show that suicide rates are significantly lower in counties with more SI availability, net of county demographic, socioeconomic, and health care factors. This relationship held for both typically free and commercial SI. Policymakers should consider strengthening existing and developing new social infrastructure, particularly in counties with less educated populations, as part of a broader strategy to reduce suicide rates in the United States.

Contributions of Eudaimonic Well-Being to Mental Health Practice

Purpose

Synergies between a eudaimonic model of psychological well-being (Ryff, 1989) and mental health practice are examined. The model grew out of clinical, developmental, existential, and humanistic perspectives that emphasized psychological strengths and capacities, in contrast to the focus on emotional distress and dysfunction in clinical psychology.

Design/Approach

Conceptual foundations of the eudaimonic approach are described, along with the six components positive functioning that are used to measure well-being. These qualities may be important in facilitating the recovery experiences, which are of interest in Mental Health and Social Inclusion.

Findings

Four categories of empirical evidence about eudaimonia are reviewed: (1) how it changes with aging, (2) how it matters for health, (3) what are its biological and neurological underpinnings, and (4) whether it can be promoted. Major contemporary forces against eudaimonia are also considered, including ever-widening inequality, the enduring pandemic, and world-wide strife. In contrast, encounters with the arts and nature are put forth as forces for eudaimonia. The relevance of these ideas for mental health research and practice is considered.

Originality

Mental health is often defined as the absence of mental illness. The novelty of the eudaimonic approach is to define mental health as the presence of well-being, assessed with different components of positive functioning.

Practical Implications

Enormous suffering defines our contemporary world. Such realities call for greater attention to factors that undermine as well as nurture the realization of human potential, the core of eudaimonic well-being.

Effects of Mental Illness Amongst Adults in the United States Living With Diabetes Mellitus on Hospital Admissions

OBJECTIVE

To examine the influence of comorbid mental illness on hospitalization among adults reporting diabetes mellitus.

METHODS

This cross-sectional observational study used National Health Interview Survey (NHIS) data from 2000-2018 to examine hospitalization. Mental illness was defined as no to low psychological distress (NLPD), moderate psychological distress (MPD), and serious psychological distress (SPD) as per the Kessler-6 scale. Socio-demographic factors and health status were added as covariates in binary logistic regression.

RESULTS

This study involved 48,807 survey participants and reflected an estimated population of 17,524,418 adults with diabetes in the United States, of whom 19.9% were hospitalized in the year prior to the survey. Among those who were hospitalized, 71.5% exhibited None to Low Psychological Distress (NLPD), 17.7% reported Moderate Psychological Distress (MPD), and 10.8% reported Serious Psychological Distress (SPD). Conversely, among non-hospitalized individuals, the percentages were as follows: 83.2% had NLPD, 11.4% had MPD, and 5.3% had SPD. The odds ratio (OR) for hospitalization was found to be OR=1.31 (95% CI: 1.20, 1.43, p<0.0001) for MPD and OR=1.42 (95% CI: 1.28, 1.58, p<0.0001) for SPD, in comparison to those with no or low psychological distress.

CONCLUSION

Among adults with diabetes mellitus, those with mental illness were more likely to be hospitalized than those without mental illness. Programs and policies to improve care among adults with both mental illness and diabetes may help to reduce hospitalizations.

Social class discrimination during adolescence as a mediator of socioeconomic disparities in actigraphy-assessed and self-reported sleep

OBJECTIVE

To examine social class discrimination as a mediator of socioeconomic disparities in sleep outcomes in an adolescent sample.

METHODS

Sleep was assessed from established actigraphy (efficiency, long wake episodes, duration) and self-report (sleep/wake problems, daytime sleepiness) measures among 272 high school students in the Southeastern region of the United States (35% low income; 59% White, 41% Black, 49% female, Mean age = 17.3, SD = 0.8). Social class discrimination was assessed using a new measure, the Social Class Discrimination Scale (SCDS; 22-items), and an established measure, the Experiences of Discrimination Scale (EODS; 7-items). Socioeconomic disadvantage (SED) was measured as an aggregate of six indicators.

RESULTS

The SCDS was associated with sleep efficiency, long wake episodes, sleep/wake problems and daytime sleepiness (but not sleep duration), and significantly mediated the socioeconomic gradient in each sleep outcome. Black males experienced higher levels of social class discrimination than Black females, White males, or White females. A race by gender moderation effect was evident for two of the five sleep outcomes (sleep efficiency and long wake episodes) suggesting a stronger association between social class discrimination and sleep problems for Black females than White females but no clear race differences among males. The EODS was not associated with objective sleep outcomes or SED but was associated with self-reported sleep and showed a similar pattern of moderation effects.

CONCLUSIONS

Findings suggest that social class discrimination may contribute to socioeconomic disparities in sleep problems, with some variability across measures and demographic groups. Results are discussed in light of evolving trends in socioeconomic health disparities.

Unpacking Psychological Vulnerabilities in Deaths of Despair

Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.

Earmarked Taxes for Mental Health Services in the United States: A Local and State Legal Mapping Study

Policy Points Local governments are increasingly adopting policies that earmark taxes for mental health services, and approximately 30% of the US population lives in a jurisdiction with such a policy. Policies earmarking taxes for mental health services are heterogenous in their design, spending requirements, and oversight. In many jurisdictions, the annual per capita revenue generated by these taxes exceeds that of some major federal funding sources for mental health.

CONTEXT

State and local governments have been adopting taxes that earmark (i.e., dedicate) revenue for mental health. However, this emergent financing model has not been systematically assessed. We sought to identify all jurisdictions in the United States with policies earmarking taxes for mental health services and characterize attributes of these taxes.

METHODS

A legal mapping study was conducted. Literature reviews and 11 key informant interviews informed search strings. We then searched legal databases (HeinOnline, Cheetah tax repository) and municipal data sources. We collected information on the year the tax went into effect, passage by ballot initiative (yes/no), tax base, tax rate, and revenue generated annually (gross and per capita).

FINDINGS

We identified 207 policies earmarking taxes for mental health services (95.7% local, 4.3% state, 95.7% passed via ballot initiative). Property taxes (73.9%) and sales taxes/fees (25.1%) were most common. There was substantial heterogeneity in tax design, spending requirements, and oversight. Approximately 30% of the US population lives in a jurisdiction with a tax earmarked for mental health, and these taxes generate over $3.57 billion annually. The median per capita annual revenue generated by these taxes was $18.59 (range = $0.04-$197.09). Per capita annual revenue exceeded $25.00 in 63 jurisdictions (about five times annual per capita spending for mental health provided by the US Substance Abuse and Mental Health Services Administration).

CONCLUSIONS

Policies earmarking taxes for mental health services are diverse in design and are an increasingly common local financing strategy. The revenue generated by these taxes is substantial in many jurisdictions.

Deaths of Despair and Population Aging in Missouri

Recent declines in life expectancy in the US, especially for middle-aged White persons, have called attention to mortality from deaths of despair - deaths due to alcohol, drugs, and suicide. Using data from the Centers for Disease Control and the U.S. Census Bureau, this paper examined deaths of despair by race/ethnicity, age, cause of death, birth cohort, and sex in Missouri. We focused on Area Agencies on Aging as geographic units of interest to increase usefulness of our findings to public administrators. Deaths of despair began trending up for all age groups beginning in 2007-2009, with the sharpest increases occurring for Black or African American non-Hispanics beginning in 2013-2015. The most dramatic increases occurred for the population age 50-59 in St. Louis City and Area Agency on Aging regions in southern Missouri. For older adults, considerable variation in rates, trends, and cause of deaths of despair is evident across the state.

Chronic overlapping pain conditions and long-term opioid treatment

OBJECTIVES

One in 5 people in the United States lives with chronic pain. Many patients with chronic pain experience a subset of specific co-occurring pain conditions that may share a common pain mechanism and that have been designated as chronic overlapping pain conditions (COPCs). Little is known about chronic opioid prescribing patterns among patients with COPCs in primary care settings, especially among socioeconomically vulnerable patients. This study aims to evaluate opioid prescribing among patients with COPCs in US community health centers and to identify individual COPCs and their combinations that are associated with long-term opioid treatment (LOT).

STUDY DESIGN

Retrospective cohort study.

METHODS

We conducted analyses of more than 1 million patients 18 years and older based on electronic health record data from 449 US community health centers across 17 states between January 1, 2009, and December 31, 2018. Logistic regression models were used to assess the relationship between COPCs and LOT.

RESULTS

Individuals with COPCs were prescribed LOT 4 times more often than individuals without a COPC (16.9% vs 4.0%). The presence of chronic low back pain, migraine headache, fibromyalgia, or irritable bowel syndrome combined with any of the other COPCs increased the odds of LOT prescribing compared with the presence of a single COPC.

CONCLUSIONS

Although LOT prescribing has declined over time, it remains relatively high among patients with certain COPCs and for those with multiple COPCs. These study findings suggest target populations for future interventions to manage chronic pain among socioeconomically vulnerable patients.

Flotsam, Jetsam, and Forward-Moving Vessels on the Sea of Well-Being: Commentary on "Emotional Well-Being: What Is it and Why it Matters"

I dispute the characterization of psychological aspects of well-being as fragmented and a landscape of confusion in need of an organizing conceptual framework. After 30+ years of research in this area, I see progress toward a multi-faceted, ever more differentiated understanding of what well-being is. This richness reflects decades of painstaking empirical inquiry. I also challenge the view that emotion is the overarching theme of well-being research. Missing from the target article was much-needed emphasis on empirical assessment tools. A growing problem in contemporary research is the proliferation of thin, poorly validated measures, which should concern all of the newly funded Emotion Networks. I conclude with a call for greater emphasis on major historical challenges that are undermining the well-being and health of many.

The Roles of Adolescent Occupational Expectations and Preparation in Adult Suicide and Drug Poisoning Deaths within a Shifting Labor Market

Research suggests that economic declines contribute to mortality risks from suicide and drug poisoning, but how the economy impacts individuals' risks of these deaths has been challenging to specify. Building on recent theoretical advances, we investigate how adolescent occupational expectations and preparation contribute to suicide and drug poisoning deaths in a shifting economy. We use High School and Beyond data linked to adult mortality records for men that were exposed to a decline in labor market share and wages in predominantly blue-collar occupations during early adulthood. We find that adolescent men who expected these occupations had increased risks of suicide and drug poisoning death as adults net of educational and occupational attainment in early adulthood. Family background and occupational preparation are risk factors for death by drug poisoning but not suicide. Our findings improve our understanding of how labor market uncertainty shapes individuals' vulnerability to suicide and drug poisoning death.

Sociodemographic dynamics and age trajectories of depressive symptoms among adults in mid- and later life: a cohort perspective

OBJECTIVES

This study explored the age trajectories of depressive symptoms across multiple cohort groups who were in middle and late adulthood; examined sociodemographic differences in these trajectories; and investigated how relevant factors contributed to depressive symptoms trends of different cohorts.

METHODS

Drawing on data from the 1994-2016 Health and Retirement Study (HRS), we used growth curve models to examine the age patterns of depressive symptoms, changes in sociodemographic gaps in depressive symptoms trajectories, and predictors of changes in depressive symptoms.

RESULTS

In general, adults' depressive symptoms started high in middle-adulthood, declined in young-old life, increased moderately in mid-old life, and peaked in old-old life; In detail, more nuanced cohort-specific age trajectories of depressive symptoms were observed, challenging the prevailing assumption of a common age trajectory of depressive symptoms. Later-born cohorts displayed higher levels of depressive symptoms than earlier-born cohorts at observed ages. Second, we found intra-cohort sociodemographic differences in levels of depressive symptoms, but these differences' growth rates varied by specific factors. Regardless of the cohort group, as people age, the gender gap in depressive symptoms persisted but the partnership gap reduced. A widening educational gap across cohorts was observed, but it declined with age in some cohorts.

CONCLUSION

Results suggest more evidence for the persistent inequality and age-as-leveler hypotheses rather than the cumulative (dis-)advantage hypothesis.

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.2010182 .

Using Twitter Data to Estimate the Prevalence of Symptoms of Mental Disorders in the United States During the COVID-19 Pandemic: Ecological Cohort Study

BACKGROUND

Existing research and national surveillance data suggest an increase of the prevalence of mental disorders during the COVID-19 pandemic. Social media platforms, such as Twitter, could be a source of data for estimation owing to its real-time nature, high availability, and large geographical coverage. However, there is a dearth of studies validating the accuracy of the prevalence of mental disorders on Twitter compared to that reported by the Centers for Disease Control and Prevention (CDC).

OBJECTIVE

This study aims to verify the feasibility of Twitter-based prevalence of mental disorders symptoms being an instrument for prevalence estimation, where feasibility is gauged via correlations between Twitter-based prevalence of mental disorder symptoms (ie, anxiety and depressive symptoms) and that based on national surveillance data. In addition, this study aims to identify how the correlations changed over time (ie, the temporal trend).

METHODS

State-level prevalence of anxiety and depressive symptoms was retrieved from the national Household Pulse Survey (HPS) of the CDC from April 2020 to July 2021. Tweets were retrieved from the Twitter streaming application programming interface during the same period and were used to estimate the prevalence of symptoms of mental disorders for each state using keyword analysis. Stratified linear mixed models were used to evaluate the correlations between the Twitter-based prevalence of symptoms of mental disorders and those reported by the CDC. The magnitude and significance of model parameters were considered to evaluate the correlations. Temporal trends of correlations were tested after adding the time variable to the model. Geospatial differences were compared on the basis of random effects.

RESULTS

Pearson correlation coefficients between the overall prevalence reported by the CDC and that on Twitter for anxiety and depressive symptoms were 0.587 (P<.001) and 0.368 (P<.001), respectively. Stratified by 4 phases (ie, April 2020, August 2020, October 2020, and April 2021) defined by the HPS, linear mixed models showed that Twitter-based prevalence for anxiety symptoms had a positive and significant correlation with CDC-reported prevalence in phases 2 and 3, while a significant correlation for depressive symptoms was identified in phases 1 and 3.

CONCLUSIONS

Positive correlations were identified between Twitter-based and CDC-reported prevalence, and temporal trends of these correlations were found. Geospatial differences in the prevalence of symptoms of mental disorders were found between the northern and southern United States. Findings from this study could inform future investigation on leveraging social media platforms to estimate symptoms of mental disorders and the provision of immediate prevention measures to improve health outcomes.

COVID-19 impact on mental health, healthcare access and social wellbeing - a black community needs assessment

Background

The COVID-19 pandemic has had a disproportionate effect on the Black/African American population. In addition to the higher infection rates and the worse outcomes, there were other unintended consequences of the pandemic. The study objective was to determine the impact of COVID-19 on the Black/African American community.

Methods

A needs assessment was conducted using a mixed-methods approach. To address this specific study objective, an item included in the survey questionnaire asked respondents (n = 183) about their greatest worry related to CODID-19. Interviews and focus group discussions were conducted to further explore individual and community perceptions.

Results

The areas of greatest concern were Health (41.0%), Family (25.1%), Finances (8.2%), and Education (4.9%). The needs assessment revealed that the COVID-19 pandemic had a profound impact on the mental health and wellness, healthcare access and utilization, and social aspects of life the Black community. Emerging themes revealed that there was worsening mental health for many, limited healthcare access and under-utilization, and profound disruption of the social cohesive identity of the Black/African American community.

Conclusion

Pre-existing structural inequities are implicated in the mental health impact, as well as the under-utilization of and limited access to healthcare services in the Black/African American population. The impact on social well-being emphasizes the important role of culture in the population health of communities of color, further supporting the need for culturally-responsive public health interventions when targeting these communities.

Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999-2020

The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25-54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis.

The Great Divide: Education, Despair, and Death

Deaths of despair, morbidity and emotional distress continue to rise in the US, largely borne by those without a college degree, the majority of American adults, for many of whom the economy and society are no longer delivering. Concurrently, all-cause mortality in the US is diverging by education in a way not seen in other rich countries. We review the rising prevalence of pain, despair, and suicide among those without a BA. Pain and despair created a baseline demand for opioids, but the escalation of addiction came from pharma and its political enablers. We examine the "politics of despair," how less-educated people have abandoned and been abandoned by the Democratic Party. While healthier states once voted Republican in presidential elections, now the less-healthy states do. We review deaths during COVID, finding mortality in 2020 replicated existing relative mortality differences between those with and without college degrees.

The Nexus of Physical and Psychological Pain: Consequences for Mortality and Implications for Medical Sociology

Although physical pain lies at the intersection of biology and social conditions, a sociology of pain is still in its infancy. We seek to show how physical and psychological pain are jointly parts of a common expression of despair, particularly in relation to mortality. Using the 2002-2014 National Health Interview Survey Linked Mortality Files (N = 228,098), we explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the "pain-distress nexus") and its relationship to mortality among adults ages 25 to 64. Results from regression and event history models reveal that differences are large for the combination of the two, pointing to an overlooked aspect of health disparities. The combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic whites. These patterns have several implications that medical sociology is well positioned to address.

Meaning-Making in the Face of Intersecting Catastrophes: COVID-19 and the Plague of Inequality

Beyond the enormous toll in illness and death, the COVID-19 pandemic unleashed multiple additional problems (job loss, evictions, hunger) that are disproportionately borne by those who were already vulnerable. In this essay, I reflect about these intersecting catastrophes, which I see as undermining the capacities of many to live meaningful and fulfilling lives. Symptoms of these problems are growing "deaths of despair" due to suicide, drug and alcohol addictions. Drawing on multidisciplinary science, I suggest that these widespread problems cannot be ministered to by focusing only at the individual level. Structural factors, including unfair distributions of resources and opportunities demand attention as well because they are fueling growing disparities between the privileged and the disadvantaged segments of contemporary societies. I examine what meanings and emotions are relevant responses to these troubled times, giving emphasis to the legitimacy of anger and outrage in the face of suffering and injustice. Further insight is sought in historical accounts of longstanding tensions between self-interest and the social contract. Going forward, I suggest that these turbulent times call for greater engagement with and scientific understanding of the arts and humanities in activating the deepest corners of our humanity. Examples from past and current art dealing with human suffering, inequality, and plagues illustrate their possible role in nurturing human capacities to understand, to care, and to act.

Positive Psychology: Looking Back and Looking Forward

Envisioning the future of positive psychology (PP) requires looking at its past. To that end, I first review prior critiques of PP to underscore that certain early problems have persisted over time. I then selectively examine recent research to illustrate progress in certain areas as well as draw attention to recurrent problems. Key among them is promulgation of poorly constructed measures of well-being and reliance on homogeneous, privileged research samples. Another concern is the commercialization of PP, which points to the need for greater oversight and quality control in profit-seeking endeavors. Looking ahead, I advocate for future science tied to contemporary challenges, particularly ever-widening inequality and the pandemic. These constitute intersecting catastrophes that need scientific attention. Such problems bring into focus "neglected negatives" that may be fueling current difficulties, including greed, indifference, and stupidity. Anger, which defies easy characterization as positive or negative, also warrants greater scientific study. Going forward I advocate for greater study of domains that likely nurture good lives and just societies - namely, participation in the arts and encounters with nature, both currently under study. Overall, my entreaty to PP is to reckon with persistent problems from its past, while striving toward a future that is societally relevant and virtuous.

A descriptive analysis of concomitant opioid and benzodiazepine medication use and associated adverse drug events in United States adults between 2009 and 2018

Background

In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines for prescribing opioids for chronic pain in response to the opioid epidemic and recommended avoiding concomitant use of opioid and benzodiazepine medications whenever possible. However, based on a recent report, 16% of overdose deaths involving opioids also involved benzodiazepines.

Objective

The objectives of this study were to examine 1) trends in concomitant opioid and benzodiazepine usage and factors associated with utilization 2) and related adverse event reporting before and after the publication of CDC chronic pain prescribing guidelines.

Methods

This study employed a retrospective data analysis of the National Health and Nutrition Examination Survey (NHANES) and FDA Adverse Event Reporting System (FAERS) databases between 2009 and 2018. Descriptive statistics and logistic regression were used to examine characteristics and temporal trends in people taking or reporting adverse events with opioid, benzodiazepine, and both medications.

Results

Among those taking an opioid medication, 19.7% were also taking a benzodiazepine within the same 30 days. Characteristics for those who reported taking both medications together include being female, non-Hispanic White, being middle aged, and having a lower household income. Concomitant medication use rose between 2009 and 2016 and declined in 2017-2018. Among FAERS reports examined with an opioid suspect medication, 17.9% also included a benzodiazepine suspect medication. Over time, there was an increase in identified FAERS reports involving concomitant opioid and benzodiazepine medications.

Conclusions

Concomitant opioid and benzodiazepine use was detected in a small but notable proportion of NHANES survey participants and FAERS reports between 2009 and 2018. Further research examining causal associations between opioids, benzodiazepines, and identified social risk factors are needed to inform prescribing and to best tailor public health interventions to address physical and mental illness safely and effectively across the population.

Widening Socioeconomic Disparities in Pain and Physical Function Among Americans Are Linked with Growing Obesity

Objectives: We investigate whether obesity accounts for widening socioeconomic disparities in pain. Methods: Based on nationally representative samples of Americans aged 25-74 in 1995-1996 and 2011-2014, we use logistic regression to model period change in headaches, backaches, and joint aches as well as physical limitations and to determine whether those changes vary by a multidimensional measure of socioeconomic status. Results: Prevalence of backaches, joint aches, physical limitations, and obesity increased between the mid-1990s and the early 2010s, particularly among more disadvantaged Americans. Socioeconomic disparities in frequent backaches, frequent joint pain, and physical limitations more than doubled over this period. We estimate that obesity and health conditions may account for nearly a quarter of the widening disparity in frequent backaches and about half of the widening disparity in frequent joint pain and physical limitations. Discussion: Widening disparities in backaches, joint pain, and physical limitations have coincided with growing obesity.

A Changing Landscape of Health Opportunity in the United States: Increases in the Strength of Association Between Childhood Socioeconomic Disadvantage and Adult Health Between the 1990s and the 2010s

Understanding the changing health consequences of childhood socioeconomic disadvantage (SED) is highly relevant to policy debates on inequality and national and state goals to improve population health. However, changes in the strength of association between childhood SED and adult health over historic time are largely unexamined in the United States. The present study begins to address this knowledge gap. Data were from 2 national samples of adults collected in 1995 (n = 7,108) and 2012 (n = 3,577) as part of the Midlife in the United States study. Three measures of childhood SED (parents' occupational prestige, childhood poverty exposure, and parents' education) were combined into an aggregate index and examined separately. The association between childhood SED (aggregate index) and 5 health outcomes (body mass index, waist circumference, chronic conditions, functional limitations, and self-rated health) was stronger in the 2012 sample than the 1995 sample, with the magnitude of associations being approximately twice as large in the more recent sample. Results persisted after adjusting for age, sex, race, marital status, and number of children, and were similar across all 3 measures of childhood SED. The findings suggest that the socioeconomic circumstances of childhood might have become a stronger predictor of adult health in recent decades.

Invited Commentary: Population Health in Peril-Needed US Science and Public Policy Action

With unprecedented increases, mortality trends in the United States have received significant attention in recent years. To date, research on this topic has emphasized specific causes of death and proximal behavioral or physiological determinants. In this commentary, I consider novel contributions of Zheng and Echave (Am J Epidemiol. 2021;190(11):2242-2255) in examining trends in mental health, health behaviors, and physiological dysregulation. I then discuss broader developments in related research and make a case for: 1) not allowing recent health trends among Whites to overshadow the urgent work that needs to be done to mitigate persistent racial inequities, 2) further investigation of what accounts for increases in income inequality and its life-span health consequences, and 3) broadening the scope of mechanisms considered to include underdiscussed topics such as the role of increases in social media use or environmental toxicant exposures. Underlying several potential explanations for observed trends in health and mortality is the fact that substantial change has occurred on multiple fronts in US society and that policy responses to these changes have been insufficient. An enhanced emphasis on innovative population health research will be essential to provide the evidence base needed for policy makers to rise to these urgent challenges.

THE US MIDLIFE MORTALITY CRISIS CONTINUES: EXCESS CAUSE-SPECIFIC MORTALITY DURING 2020

COVID-19 prematurely ended many lives, particularly among the oldest Americans, but the pandemic also had an indirect effect on health and non-COVID mortality among the working-age population, who suffered the brunt of the economic consequences. This analysis investigates whether monthly excess mortality in the US during 2020 varied by age and cause of death. Based on national-level death counts and population estimates for 1999-2020, negative binomial regression models-fit separately by sex-were used to estimate monthly cause-specific excess mortality by age group during 2020. Among males, 71% non-COVID excess deaths occurred at working ages (25-64), but those ages accounted for only 36% of non-COVID excess deaths in females. The results revealed substantial numbers of excess deaths from external causes (particularly among males), heart disease, diabetes, Alzheimer's disease (particularly among women), and cerebrovascular disease. For males, the largest share of non-COVID excess deaths resulted from external causes, nearly 80% of which occurred at working ages. Although incorrectly classified COVID-19 deaths may explain some excess non-COVID mortality, misclassification is unlikely to explain the increase in external causes of mortality. Auxiliary analyses suggested that drug-related mortality may be driving the rise in external mortality, but drug overdoses were already increasing for a full year prior to the pandemic. The oldest Americans bore the brunt of COVID-19 mortality, but working-age Americans, particularly men, suffered substantial numbers of excess non-COVID deaths, most commonly from external causes and heart disease.

State Policy and Mental Health Outcomes under COVID-19

CONTEXT

The COVID-19 pandemic has caused enormous damage to physiological health and economic security, especially among racial and ethnic minorities. We examined downstream effects on mental health, how effects vary by race and ethnicity, and the role of existing state-level social policies in softening the pandemic's impact.

METHODS

We analyze an online, multi-wave Census Bureau survey fielded to nearly a million respondents between late April and July 2020. The survey includes questions measuring psychological distress as well as indirect measures of experience with the pandemic. We combined these data with state-level measures of COVID-19 cases, lockdown orders, unemployment filings, and safety net policy.

FINDINGS

We find significant mental stress among all respondents and a sizeable gap between nonwhite and white respondents. Adjusting for pandemic experiences eliminates this gap. The effect of losing work as a result of the pandemic is slightly offset by state policies such as unemployment benefit size and Medicaid expansion. The magnitude of these offsetting effects is similar across racial/ethnic groups.

CONCLUSIONS

The racialized impacts of the pandemic are exacerbated by inequalities in state policy exemplifying structural racism. If the least generous states matched the policies of the most generous, inequalities caused by the pandemic would be diminished.

National religiosity eases the psychological burden of poverty

According to a fundamental assumption in the social sciences, the burden of lower socioeconomic status (SES) is more severe in developing nations. In contrast to this assumption, recent research has shown that the burden of lower SES is less—not more—severe in developing nations. In three large-scale global data sets, we show that national religiosity can explain this puzzling finding. Developing nations are more religious, and most world religions uphold norms that, in part, function to ease the burden of lower SES and to cast a bad light on higher SES. In times of declining religiosity, this finding is a call to scientists and policymakers to monitor the increasingly harmful effects of lower SES and its far-reaching social consequences.

Lower socioeconomic status (SES) harms psychological well-being, an effect responsible for widespread human suffering. This effect has long been assumed to weaken as nations develop economically. Recent evidence, however, has contradicted this fundamental assumption, finding instead that the psychological burden of lower SES is even greater in developed nations than in developing ones. That evidence has elicited consternation because it suggests that economic development is no cure for the psychological burden of lower SES. So, why is that burden greatest in developed nations? Here, we test whether national religiosity can explain this puzzle. National religiosity is particularly low in developed nations. Consequently, developed nations lack religious norms that may ease the burden of lower SES. Drawing on three different data sets of 1,567,204, 1,493,207, and 274,393 people across 156, 85, and 92 nations, we show that low levels of national religiosity can account for the greater burden of lower SES in developed nations. This finding suggests that, as national religiosity continues to decline, lower SES will become increasingly harmful for well-being—a societal change that is socially consequential and demands political attention.

Culture and Health: Recent Developments and Future Directions 1

Evidence of cultural differences in relationships and emotions has accumulated over the past few decades. As findings on cultural differences in psychological processes have accumulated, there has been growing interest in investigating whether they have implications for other phenomena such as health. Using scientific advances from the MIDUS and MIDJA studies, both publicly available, we examine links between culture and health. We first briefly review the accumulated evidence on cultural influences on health correlates of psychosocial factors. We then feature two recent developments - a more micro-level perspective on biological factors that may be involved in the culture and health linkage, and a more macro-level view of socioeconomic inequality, which also matters for health. Both perspectives inform the pathways through which health effects occur. Finally, we conclude our review by highlighting the changing historical contexts surrounding these cross-cultural investigations. Specifically, we draw attention to widening of economic inequality across cultures and the world-wide COVID-19 pandemic. These happenings bring notable implications for future research on health across cultural contexts.

Effects of the Great Recession on Educational Disparities in Cardiometabolic Health

BACKGROUND

Macroeconomic crises can exaggerate existing educational disparities in health. Few studies, however, have examined whether macroeconomic crises get under the skin to affect educational disparities in health-related biological processes.

PURPOSE

This study aimed to examine the effect of the economic recession of 2008 (i.e., Great Recession) on educational disparities in cardiometabolic risk and self-reported psychological distress.

METHODS

Data were drawn from two subsamples of the Midlife in the United States (MIDUS) study: the second wave of the MIDUS sample (pre-recession cohort, N = 985) and the refresher sample (post-recession cohort, N = 863). Educational attainment was categorized into high school education or less, some college, and bachelor's degree or higher. Outcomes included metabolic syndrome, C-reactive protein, and interleukin-6, as well as self-reported perceived stress, depressive symptoms, and financial distress.

RESULTS

Results showed that having a bachelor's degree or higher (compared to having a high school education or less) was more strongly associated with decreased metabolic syndrome symptoms in the post-recession cohort than the pre-recession cohort, above and beyond demographic, health, and behavioral covariates. These findings did not extend to systemic inflammation or psychological distress.

CONCLUSIONS

Our findings suggest that chronic macroeconomic stressors may widen the educational gap in physical health, particularly cardiometabolic health, by modifying biological and anthropometric risk factors implicated in metabolic syndrome.

Debts of despair: Education, financial losses, and precursors of deaths of despair

Recent deaths of despair literature hypothesizes that financial losses are a key mechanism through which education is associated with higher risk for drug use, alcohol abuse, and suicidal ideation. However, few studies have empirically assessed the significance of this harmful pathway or compared it to other hypothesized explanations. Drawing on data from over 8000 respondents in the National Longitudinal Study of Adolescent to Adult Health, this paper finds that lower education-levels are associated with heightened risk of drug use, painkiller use, frequent binge drinking, and suicidal ideation; in turn, decompositions reveal that financial losses mediate about 20 percent of the association between education with drug use and suicidal ideation. The results support a core assumption of the deaths of despair hypothesis-that financial losses among those with low education-levels drive the increase in harmful despair-associated behaviors, which often precede disease and mortality. Future research should extend this work by linking individual-level socioeconomic and health patterns with broader economic changes to better understand how individuals' educational attainment interacts with macro-level structural factors to shape their vulnerability to despair-associated disease and death.

Opioid misuse and family structure: Changes and continuities in the role of marriage and children over two decades

BACKGROUND

The opioid crisis is widely felt in the United States. Scholarly attention to the crisis focuses on macro-level processes and largely neglects meso-level explanations such as family structure for opioid use behaviors. We hypothesize that married adults and adults with coresident children are at lower risk of misusing prescription pain relievers (PPR), using heroin, and using needles to inject heroin relative to adults from other family structures.

METHOD

We used National Survey on Drug Use and Health data from 2002-2018 to test our hypotheses with multivariable logistic regression.

RESULTS

We found that married adults have a lower predicted probability of each opioid use behavior relative to nonmarried adults across the study period. We also found that the presence of children is associated with reductions in all three outcomes especially for never married adults.

CONCLUSION

Individuals from all family structures are vulnerable to the opioid crisis, but never married adults without coresident children ("disconnected adults") are especially susceptible to temporal fluctuations and drive the temporal trends in PPR misuse and heroin use. These findings suggest that ongoing demographic trends where disconnected adults are a growing population may result in future rises in opioid use disorders and mortality because of divestment from U.S. social safety nets. Future research should examine the role of U.S. policies that make disconnected adults especially vulnerable to developing opioid use disorders.

The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness

BACKGROUND

Social stratification is a well-documented determinant of mental health. Traditional measures of stratification (e.g., socioeconomic status) reduce dynamic social processes to individual attributes downstream of mechanisms that generate stratification. In this study, we measure one process theorized to generate and reproduce social stratification-economic exploitation-and explore its association with mental health.

METHODS

Data are from the 1983 to 2017 waves of the Panel Study of Income Dynamics, a nationally representative cohort study (baseline N = 3059). We operationalized "unconcealed exploitation" as the percentage of individuals' labor income they were hypothetically not paid for productive hours. We ascertained psychologic distress and mental illness with the Kessler-6 (K6) scale.

RESULTS

We fit inverse probability-weighted marginal structural models and found that for each unit increase in unconcealed exploitation, psychologic distress increased by 1.6 points (95% confidence interval = 0.71, 2.5) on the K6 scale and the odds of mental illness tripled (odds ratio = 3.0, 95% confidence interval = 1.5, 6.1). Results were not driven entirely by overwork and were robust to different inverse probability-weighted estimation strategies and sensitivity analyses.

CONCLUSIONS

Exploitation is associated with mental illness. Focusing on exploitation rather than its consequences (e.g., socioeconomic status), shifts attention to a structural process that may be a more appropriate explanatory mechanism, and a more pragmatic intervention target, for mental illness.

Normative range parenting and the developing brain: A scoping review and recommendations for future research

Studies of early adversity such as trauma, abuse, and neglect highlight the critical importance of quality caregiving in brain development and mental health. However, the impact of normative range variability in caregiving on such biobehavioral processes remains poorly understood. Thus, we lack an essential foundation for understanding broader, population-representative developmental mechanisms of risk and resilience. Here, we conduct a scoping review of the extant literature centered on the question, "Is variability in normative range parenting associated with variability in brain structure and function?" After removing duplicates and screening by title, abstract, and full-text, 23 records were included in a qualitative review. The most striking outcome of this review was not only how few studies have explored associations between brain development and normative range parenting, but also how little methodological consistency exists across published studies. In light of these limitations, we propose recommendations for future research on normative range parenting and brain development. In doing so, we hope to facilitate evidence-based research that will help inform policies and practices that yield optimal developmental trajectories and mental health as well as extend the literature on the neurodevelopmental impact of early life stress.

Interactions Between Socioeconomic Status and Mental Health Outcomes in the Nigerian Context Amid COVID-19 Pandemic: A Comparative Study

This study examines the mental health outcomes among the healthcare personnel and the general population and the role of socioeconomic status. Eight hundred and eighty-four (884) residents in Nigeria comprising 382 healthcare personnel and 502 general residents aged between 18 to 78 years (M = 28.75, SD = 8.17) responded to an online survey with measures of Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index. Collected data were subjected to statistical analysis using the SPSS v.25. Results revealed significant difference in the prevalence of depressive symptoms (χ² = 14.26; df = 4; p < 0.01), insomnia symptoms (χ² = 40.21; df = 3; p < 0.01), posttraumatic stress symptoms (χ² = 08.34; df = 3; p < 0.05), and clinical anxiety symptoms (χ² = 06.71; df = 1; p < 0.05) among healthcare personnel and the general population, with a higher prevalence reported by the healthcare personnel. Further, socioeconomic status significantly influences prevalence of depressive symptoms (χ² = 04.5; df = 4; p < 0.05). The study concluded that the prevalence of poor mental health outcomes during the COVID-19 crisis among Nigerians is worrisome. Also, the socioeconomic status of the citizens has serious implications on depressive symptoms. The study recommends that the government and stakeholders should pay attention to policy that will favor tele-mental health services and adequate palliative measures to cushion the psycho-economic impacts of COVID-19 on residents. Also, healthcare workers should be considered for better remuneration and other welfare benefits to sustain their well-being during the present and future pandemic.

Mental health, pain, and risk of drug misuse: A nationwide cohort study

Evidence suggests that rising drug misuse, particularly of prescription painkillers, is more closely linked with period increases in reported pain among Americans of the same age range than with deterioration in mental health, but it is unclear whether those cross-sectional associations reflect causal effects of pain and mental health on drug misuse. Using data from the 1995-96, 2004-05, and 2013-14 waves of a nationwide cohort study, we evaluate the effects of pain and mental health on subsequent misuse of prescription painkillers and sedatives. Logistic regression is applied to model drug misuse (separately for painkillers and sedatives) as a function of predictors measured at the previous wave; respondents who reported misuse of that drug type at the prior wave are excluded from the analysis. Mental health is an important predictor of both painkiller and sedative misuse, whereas pain plays a much bigger role in painkiller misuse. Frequency of joint aches and stiffness has the strongest effect on subsequent painkiller misuse, although mental health yields substantial incremental predictive ability above and beyond pain. Negative affect, positive affect, and psychological well-being have notable effects on sedative misuse, while pain (particularly backache) makes only a small incremental contribution to sedative misuse. We suspect that increases over time in pain levels may have played a bigger role than mental health in explaining the rise in prescription painkiller misuse and may have contributed to growing misuse of sedatives. In contrast, deteriorating mental health was probably more important in explaining the rise of sedative misuse.

Adolescents' perceptions of family social status correlate with health and life chances: A twin difference longitudinal cohort study

Children from lower-income households are at increased risk for poor health, educational failure, and behavioral problems. This social gradient is one of the most reproduced findings in health and social science. How people view their position in social hierarchies also signals poor health. However, when adolescents' views of their social position begin to independently relate to well-being is currently unknown. A cotwin design was leveraged to test whether adolescents with identical family backgrounds, but who viewed their family's social status as higher than their same-aged and sex sibling, experienced better well-being in early and late adolescence. Participants were members of the Environmental Risk Longitudinal Twin Study, a representative cohort of British twins (n = 2,232) followed across the first 2 decades of life. By late adolescence, perceptions of subjective family social status (SFSS) robustly correlated with multiple indicators of health and well-being, including depression; anxiety; conduct problems; marijuana use; optimism; not in education, employment, or training (NEET) status; and crime. Findings held controlling for objective socioeconomic status both statistically and by cotwin design after accounting for measures of childhood intelligence (IQ), negative affect, and prior mental health risk and when self-report, informant report, and administrative data were used. Little support was found for the biological embedding of adolescents' perceptions of familial social status as indexed by inflammatory biomarkers or cognitive tests in late adolescence or for SFSS in early adolescence as a robust correlate of well-being or predictor of future problems. Future experimental studies are required to test whether altering adolescents' subjective social status will lead to improved well-being and social mobility.

Trends in Extreme Distress in the United States, 1993-2019

Objectives. To investigate changes from 1993 to 2019 in the percentage of US citizens suffering extreme distress.Methods. Using data on 8.1 million randomly sampled US citizens, we created a new proxy measure for exceptional distress (the percentage who reported major mental and emotional problems in all 30 of the last 30 days). We examined time trends for different groups and predictors of distress.Results. The proportion of the US population in extreme distress rose from 3.6% in 1993 to 6.4% in 2019. Among low-education midlife White persons, the percentage more than doubled, from 4.8% to 11.5%. Regression analysis revealed that (1) at the personal level, the strongest statistical predictor of extreme distress was "I am unable to work," and (2) at the state level, a decline in the share of manufacturing jobs was a predictor of greater distress.Conclusions. Increasing numbers of US citizens report extreme levels of mental distress. This links to poor labor-market prospects. Inequality of distress has also widened.Public Health Implications. Policymakers need to recognize the crisis of an ever-growing group of US citizens in extreme distress.

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20% of the upward trend in mild/moderate nonlimiting pain and 32% of the trend in severe and/or limiting pain for women, and 10% and 19% of the trends respectively for men.

•

We study the contribution of overweight and obesity to recent trends in pain among middle-aged adults.

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Overweight and obesity accounted for 32.1% of increases in severe or limiting pain among women and 19.0% among men.

•

Overweight and obesity explained a larger share of the increase in severe than mild/moderate pain.

•

The study highlights the importance of obesity prevention to decrease the prevalence of pain.

Charting adult development through (historically changing) daily stress processes

This article views adult development through the lens of daily life experiences and recent historical changes in these experiences. In particular, it examines whether theories that postulate general linear increases in well-being throughout adulthood still hold during times of less prosperity and more uncertainty. Descriptive analyses of the National Study of Daily Experiences chart show how stress in the daily lives of Americans may have changed from the 1990s (N = 1,499) to the 2010s (N = 782). Results revealed that adults in the 2010s reported experiencing stressors on 2% more days than in the 1990s, which translates to an additional week of stressors across a year. Participants in the 2010s also reported that stressors were more severe and posed more risks to future plans and finances and that they experienced more distress. These historical changes were particularly pronounced among middle-aged adults (e.g., proportion of stressor days increased by 19%, and perceived risks to finances and to future plans rose by 61% and 52%, respectively). As a consequence, age-related linear increases in well-being observed from young adulthood to midlife in the 1990s were no longer observed in the 2010s. If further studies continue to replicate our findings, traditional theories of adult well-being that were developed and empirically tested during times of relative economic prosperity may need to be reevaluated in light of the changes in middle adulthood currently observed in this historic period. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Changes in mental health, pain, and drug misuse since the mid-1990s: Is there a link?

Drug-related mortality in the US grew dramatically in recent years, while mental health deteriorated among disadvantaged Americans and reported levels of pain increased over the same period. Here we investigate whether increased prevalence of drug misuse between the mid-1990s and early-2010s is associated with higher levels of mental distress and pain. Our results demonstrate higher drug misuse over this period, particularly for older and for socioeconomically disadvantaged Americans. After adjusting for sociodemographic characteristics, we estimate that the prevalence of drug misuse increased by 19 percentage points among those aged 50-76 in the bottom percentile of socioeconomic status (SES). Misuse increased much more at older than at younger ages for all drug types except sedatives, which increased to a similar degree in both age groups. Compared with measures of mental health, pain consistently accounted for a greater share of the period differential in drug misuse among both age groups and across all drug types. Misuse of prescription painkillers exhibited the largest difference in the contributions of pain versus mental health: among older individuals with the lowest SES, pain explained three times as much of the period trend as mental health (60% vs. 19%). Pain was more closely linked with the rise in misuse of prescription painkillers than other drugs. Mental health is a strong correlate of drug misuse (particularly sedative use), but growing drug misuse since the mid-1990s was more strongly linked with rising levels of reported pain than with deterioration in mental health. Pain could be a key factor underlying the association between trends in mental health and drug use: higher levels of pain may contribute to both mental distress and drug misuse. Given that pain, mental distress, and drug misuse are intertwined, successful intervention may require addressing all three factors.

Trends in Mental Well-Being of Non-Hispanic White Children of Midlife Parents With Low Education

Background

It is unknown whether recent increase in mortality and morbidity linked to mental despair (eg, suicide, opioid addiction, alcoholism) in midlife non-Hispanic whites (NHWs) was accompanied by declines in mental well-being of NHW children. The author examined aggregate trends in the mental well-being of NHW children between 2003 and 2018.

Methods

The author used linear (unadjusted) regression to generate estimates of long period (ie, between 2003-2005 and 2016-2018) and annual change in mental well-being and self-assessed health from the National Health Interview Survey data on 68 057 NHW children (aged 4-17 years).

Results

The NHW children showed no significant change in any of the tracked indicators (composite Strength and Difficulties Questionnaire [SDQ] 5-item score: long period: -0.03, 95% confidence interval [CI]: -0.09 to 0.02, annual: -0.00, 95% CI: -0.01 to 0.00; severe impairment in mental function: long period: 0.01, 95% CI: 0.00 to 0.02; subjective perception of overall health: long period: -0.01, 95% CI: -0.01 to -0.00). The author did not detect any gradient of worsening SDQ scores with parental midlife status and low parental education. However, the trends in SDQ scores in NHW children were slightly worse than those for children of other major race/ethnic groups.

Conclusion

The author did not find evidence of worsening mental distress in NHW children overall or whose parents were in their midlives and less educated.

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

Trends in Mental and Physical Health-Related Quality of Life in Low-Income Older Persons in the United States, 2003 to 2017

This cross-sectional study of respondents to the Behavioral Risk Factor Surveillance System survey assesses trends between 2003 and 2017 in mental and physical health-related quality of life in low-income US individuals 60 years or older.

Life Expectancy and Mortality Rates in the United States, 1959-2017

Importance

US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

Objective

To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.

Evidence

Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.

Findings

Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.

Conclusions and Relevance

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

The contribution of obesity to prescription opioid use in the United States

The prevalence of obesity has grown rapidly over the past several decades and has been accompanied by an increase in the prevalence of chronic pain and prescription opioid use. Obesity, through its association with pain, may represent an important contributor to opioid use. This cross-sectional study investigated the relationship between obesity and prescription opioid use among adults aged 35 to 79 years using data from the National Health and Nutrition Examination Survey (NHANES, 2003-2016). Relative to normal weight, body mass indices in the overweight {odds ratio (OR), 1.11 (confidence interval [CI], 0.88-1.39)}, obese I (OR, 1.26 [CI, 1.01-1.57]), obese II (OR, 1.69 [CI, 1.34-2.12]), and obese III (OR, 2.33 [CI, 1.76-3.08]) categories were associated with elevated odds of prescription opioid use. The association between excess weight and opioid use was stronger for chronic opioid use than for use with a duration of less than 90 days (P-value, <0.001). We estimated that 14% (CI, 9%-19%) of prescription opioid use at the population level was attributable to obesity, suggesting there might have been 1.5 million fewer opioid users per year under the hypothetical scenario where obese individuals were instead nonobese (CI, 0.9-2.0 million users). Back pain, joint pain, and muscle/nerve pain accounted for the largest differences in self-reported reasons for prescription opioid use across obesity status. Although interpretation is limited by the cross-sectional nature of the associations, our findings suggest that the obesity epidemic may be partially responsible for the high prevalence of prescription opioid use in the United States.

Fatal and Non-fatal Self-Injury in the USA: Critical Review of Current Trends and Innovations in Prevention

PURPOSE OF REVIEW

To examine current trends in suicide and self-injury in the USA, as well as potential contributors to their change over time, and to reflect on innovations in prevention and intervention that can guide policies and programs to reduce the burden of suicide and self-injury in the USA.

RECENT FINDINGS

Suicide and non-fatal self-injury are on the rise in the USA. Reasons for such trends over time remain speculative, although they seem linked to coincident increases in mood disorders and drug use and overdose. Promising innovative prevention and intervention programs that engage new technologies, such as machine learning-derived prediction tools and computerized ecologic momentary assessments, are currently in development and require additional evidence. Recent increases in fatal and non-fatal self-harm in the USA raise questions about the causes, interventions, and preventive measures that should be taken. Most innovative prevention efforts target individuals seeking to improve risk prediction and access to evidence-based care. However, as Durkheim pointed out over 100 years ago, suicide rates vary enormously between societal groups, suggesting that certain causal factors of suicide act and, hence, should be targeted at an ecological level. In the next generation of suicide research, it is critical to examine factors beyond the proximal and clinical to allow for a reimagining of prevention that is life course and socially focused.