Since the turn of this century, the mortality rate among white middle-aged Americans has been rising, as this Wall Street Journal article reports, and two Princeton University economists have a sobering idea of what’s driving the trend: “death by despair.”

That term, coined by the economists Anne Case and Angus Deaton in 2015, refers to death from causes like suicide, drugs and alcohol-related liver disease, as the WSJ reports.

A follow-up to their 2015 research on the same subject, the new findings — released Thursday by the Brookings Institution — point to a bleak continuation of the same trend: Mortality rates are rising among middle-aged, white, working-class Americans (often with a high-school education or less) while other demographics like black and Hispanic populations are seeing decreases in mortality.

Part of what’s driving this trend is fewer job opportunities for this specific demographic, marking the “collapse of the white, high-school educated working class after it’s heydey in the early 1970s,” as Case and Deaton tell WSJ. This group may also be experiencing more social isolation, potentially leading to poorer mental and physical health, according to the researchers. This is in addition to slowing progress in battling heart disease and cancer and the ongoing opioid epidemic.

While more research is needed, the “death by despair” theory is plausible, according to Case and Deaton. What it clear is that this problem is uniquely American — no where else around the world shows similar trends, as these graphs make startlingly clear. Add this to the fact that the U.S. already has one of the lowest lifespans among developed countries (not having comprehensive health care might have just a tad to do with it) and you get a pretty grim outcome. As Case and Deaton tell WSJ, it may take years — and a lot of policy changes — to reverse this trend.

Read more on WSJ.

Originally published at