Deaths Of Despair: A Silent Interconnected Health Challenge In Europe

Conceptualising the term

The COVID-19 pandemic, apart from one of the most severe pandemics in recent times, exacerbated existing deficiencies within our societies and widened the gaps in healthcare systems. As for what accounts for mental health, studies have shown a global aggravation of depression and anxiety, following the beginning of the COVID-19 emergency. This is paired up with a rise in drug overdose and the idea of suicide in the population. These factors contribute to the development of what’s known as “deaths of despair”.

A “death of despair” is the outcome of what’s known as “disease of despair”. This kind of disease responds to three types of behaviour-related medical condition suffered by people who experience despair due to long-term socioeconomic reasons. These diseases are drug overdose, suicide, and alcoholic liver disease. The despair can be experienced in four different ways: cognitive (thoughts of defeat, pessimism), emotional (sadness, loneliness, apathy), behavioural (reckless or self-destructive behaviour) and biological (dysregulation of the body’s stress reactive system).

The contributing factors for developing a disease of despair can be varied and not necessarily tied to economic conditions. However, research outcomes explain that social connections, level of education, medical condition, working opportunities or perception of one’s own future could play a contributing role.

Findings from the European Drug Report 2023

Deaths of despair pose a significant threat to society, especially if attention is paid to the recent data from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). In the European Drug Report 2023, published recently, the EMCDDA identified that the mortality rate due to drug overdoses in the European Union (EU) in 2021 was estimated at 18.3 deaths per million population aged 15 to 64. Opioids, including heroin and its metabolites, were present in about three-quarters of the reported fatal overdoses in the EU. The number of overdose deaths among those aged 50 to 64 has grown significantly since 2012, with a 69% increase between 2012 and 2021.

When having a look into the substances, methadone, often combined with other opioids, alcohol, or benzodiazepines, was involved in a considerable number of drug-induced deaths in several EU countries. Stimulants, particularly amphetamines and methamphetamines, were also frequently involved in many deaths. As for heroin, there is a significant variation with higher proportions reported in countries like Austria, Italy, Ireland, Poland, and Romania.

According to the EMCCDA, the situation in Europe shows a diversified market, with high availability of illicit drugs and a wider range of options with higher potency or purity. This increased diversity in the drug offer exposes consumers to substances with limited knowledge regarding health risks or chemical composition. Nevertheless, this situation not only endangers public health but also poses a significant threat from the regulatory perspective since they might fall into legal loopholes and gaps in definitions of more traditional drugs.

Due to the interconnection between drug abuse and other mental health issues, this data only confirms the worrying trend of deaths of despair, which are on the rise. The impact of the COVID-19 pandemic, the multi-crisis affecting Europe, the war in Ukraine and the inflationary phenomenon have severely affected the population that was already in distress before the pandemic hits. The EMCDDA’s report also confirms that cohort studies revealed a much higher overall mortality risk among people who use drugs, with excess mortality being 17 times higher than the general population. Benzodiazepines, a well-known drug for treating insomnia, anxiety or depression, are now also a common drug responsible for overdose deaths in several countries.

What’s new in the comprehensive approach to mental health

As a response to the urgent deterioration of the mental health of EU citizens, the European Commission published its “comprehensive approach to mental health” on 7 June 2023. This initiative aimed to lay the foundation for a holistic approach to mental health through three guiding principles: adequate and effective prevention, access to high quality and affordable mental healthcare and treatment and reintegration into society after recovery. Moreover, a plan with 20 flagship initiatives was also presented that includes a “mental health in all policies” approach along with other actions such as the creation of a European Code for Mental Health. Furthermore, the strategy places a strong emphasis on prevention and improving access to care and treatment.

However, despite the existing connection between mental health and substance abuse, the official communication offers a minimal link of these two phenomenons. The strategy briefly mentions that “The special care needs of people with comorbidities should also be addressed to facilitate access to effective treatments, in particular for people with drug-use disorders, in line with the EU Drugs Strategy 2021-2025 and the related Action Plan”. This statement outlines the possibility of comorbidities, which in a mental health context refers to coexisting disorders, but does not provide an in-depth analysis as to the circumstances that prompt people to such states. Consequently, it isolates mental health disorders and does not acknowledge their impact in substance abuse patients nor considers other contriubting factors outlined above, such as socioeconomic conditions or hopelesness.

Conclusion

The COVID-19 pandemic and the following crises that Europe has had to face have brought to light the pressing need to address mental health issues and the concerning diseases of despair. Data from the European Drug Report 2023 only confirms the worrying trends in drug overdoses and mental health problems, highlighting the interconnected nature of these issues. While the European Commission’s initiative for a holistic approach to mental health is a step in the right direction, with its focus on prevention and access to high-quality care, it is nonetheless crucial to acknowledge the multifaceted nature of these issues and recognize the various socioeconomic contributing factors.

Mental health and drug abuse are intricately linked, with a two-sided relationship. Individuals dealing with mental health issues are often more susceptible to developing drug or alcohol disorders. Conversely, those struggling with drug use regularly face additional challenges such as unemployment, homelessness, and lack of access to healthcare, which can exacerbate their mental health difficulties. This interconnection underscores the importance of addressing both mental health and substance abuse issues in a holistic and integrated manner, recognizing that effective treatment and support must consider the complex interplay between these two aspects of individuals’ well-being.

Future efforts should emphasize a more inclusive and nuanced approach that addresses these root causes and provides tailored care to vulnerable populations. This could include long-term policy approaches to employment, education, and social infrastructures while providing short- and medium-term solutions that can ease the lives of people that already find themselves in these circumstances.

What will be the long-term consequences on mental health from the current crisis?

Will the comprehensive approach to mental health lead to tangible improvements?

What best practices can society implement in the meantime?

Suggested readings:

Case, Anne and Deaton, Angus. “Deaths of despair and the future of capitalism“. 17 March 2020.

King, Lawrence, Nosrati, Elias, Scheiring, Gábor. “Deaths of Despair in Comparative Perspective“. July 2022.

Robinson, Lawrence, Smith, Melinda, Segal, Jeanne. “Dual Diagnosis: Substance Abuse and Mental Health“. 5 June 2023.