Fishman Samuel H, Gutin Iliya
Department of Sociology, Duke University, 276 Rueben-Cooke Building, 417 Chapel Dr., Durham, NC, 27708, USA.
Department of Sociology, University of North Carolina at Chapel Hill, 155 Pauli Murray Hall, Chapel Hill, NC, 27499, USA.
SSM Popul Health. 2021 Feb 28;14:100759. doi: 10.1016/j.ssmph.2021.100759. eCollection 2021 Jun.
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.
近期关于绝望致死的文献提出假说，认为经济损失是教育水平与药物使用、酗酒及自杀意念高风险之间产生关联的关键机制。然而，很少有研究从实证角度评估这一有害途径的重要性，或将其与其他假设性解释进行比较。本文利用“青少年到成人健康全国纵向研究”中8000多名受访者的数据，发现较低的教育水平与药物使用、止痛药使用、频繁酗酒及自杀意念的高风险相关；进一步分析表明，经济损失在教育水平与药物使用及自杀意念之间的关联中起到了约20%的中介作用。研究结果支持了绝望致死假说的一个核心假设，即低教育水平人群的经济损失导致了与绝望相关的有害行为增加，而这些行为往往先于疾病和死亡出现。未来的研究应通过将个体层面的社会经济和健康模式与更广泛的经济变化联系起来，拓展这项工作，以更好地理解个体的教育程度如何与宏观层面的结构因素相互作用，从而塑造他们对与绝望相关疾病和死亡的易感性。
