{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T20:10:52Z","timestamp":1780344652853,"version":"3.54.1"},"reference-count":37,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P2C HD065563"],"award-info":[{"award-number":["P2C HD065563"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291723003495_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Deaths from suicides, drug poisonings, and alcohol-related diseases (\u2018deaths of despair\u2019) are well-documented among working-age Americans, and have been hypothesized to be largely specific to the U.S. However, support for this assertion\u2013and associated policies to reduce premature mortality\u2013requires tests concerning these deaths in other industrialized countries, with different institutional contexts. We tested whether the concentration and accumulation of health and social disadvantage forecasts deaths of despair, in New Zealand and Denmark.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723003495_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>We used nationwide administrative data. Our observation period was 10 years (NZ = July 2006\u2013June 2016, Denmark = January 2007\u2013December 2016). We identified all NZ-born and Danish-born individuals aged 25\u201364 in the last observation year (NZ = 1 555 902, Denmark = 2 541 758). We ascertained measures of disadvantage (public-hospital stays for physical- and mental-health difficulties, social-welfare benefit-use, and criminal convictions) across the first nine years. We ascertained deaths from suicide, drugs, alcohol, and all other causes in the last year.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723003495_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Deaths of despair clustered within a population segment that disproportionately experienced multiple disadvantages. In both countries, individuals in the top 5% of the population in multiple health- and social-service sectors were at elevated risk for deaths from suicide, drugs, and alcohol, and deaths from other causes. Associations were evident across sex and age.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723003495_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Deaths of despair are a marker of inequalities in countries beyond the U.S. with robust social-safety nets, nationwide healthcare, and strong pharmaceutical regulations. These deaths cluster within a highly disadvantaged population segment identifiable within health- and social-service systems.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291723003495","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T09:51:14Z","timestamp":1702979474000},"page":"1610-1619","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":6,"title":["Suicides, drug poisonings, and alcohol-related deaths cluster with health and social disadvantage in 4.1 million citizens from two nations"],"prefix":"10.1017","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-1026","authenticated-orcid":false,"given":"Leah S.","family":"Richmond-Rakerd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"D'Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0318-1201","authenticated-orcid":false,"given":"Barry J.","family":"Milne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0717-8878","authenticated-orcid":false,"given":"Signe Hald","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"S0033291723003495_ref25","doi-asserted-by":"crossref","first-page":"e2016217","DOI":"10.1001\/jamanetworkopen.2020.16217","article-title":"Trends in mortality from drug poisonings, suicide, and alcohol-induced deaths in the United States from 2000 to 2017","volume":"3","author":"Shiels","year":"2020","journal-title":"JAMA Network Open"},{"key":"S0033291723003495_ref30","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2105\/AJPH.2017.303941","article-title":"The epidemic of despair among white Americans: Trends in the leading causes of premature death, 1999\u20132015","volume":"107","author":"Stein","year":"2017","journal-title":"American Journal of Public Health"},{"key":"S0033291723003495_ref2","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1086\/711410","article-title":"Parent-child information frictions and human capital investment: Evidence from a field experiment","volume":"129","author":"Bergman","year":"2021","journal-title":"Journal of Political Economics"},{"key":"S0033291723003495_ref1","doi-asserted-by":"crossref","first-page":"e2103896118","DOI":"10.1073\/pnas.2103896118","article-title":"Nationwide evidence that education disrupts the intergenerational transmission of disadvantage","volume":"118","author":"Andersen","year":"2021","journal-title":"Proceedings of the National Academy of Sciences"},{"key":"S0033291723003495_ref22a","doi-asserted-by":"crossref","first-page":"e2033448","DOI":"10.1001\/jamanetworkopen.2020.33448","article-title":"Longitudinal associations of mental disorders with physical diseases and mortality among 2.3 million New Zealand citizens","volume":"4","author":"Richmond-Rakerd","year":"2021","journal-title":"JAMA Network Open"},{"key":"S0033291723003495_ref19a","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1016\/S0140-6736(19)32316-5","article-title":"A comprehensive analysis of mortality-related health metrics associated with mental disorders: A nationwide, register-based cohort study","volume":"394","author":"Plana-Ripoll","year":"2019","journal-title":"Lancet"},{"key":"S0033291723003495_ref28","unstructured":"Statistics New Zealand. 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}