"They're not mentally ill, their lives are just shit": Stakeholders' understanding of deaths of despair in a deindustrialised community in North East England.

The rise in mortality in high-income countries from drug, suicide, and alcohol specific causes, referred to collectively as 'deaths of despair', has received growing interest from researchers. In both the US and UK, mortality rates from deaths of despair are higher in deprived, deindustrialised communities. In this qualitative study, we sought to learn how stakeholders working with vulnerable populations in Middlesbrough, a deindustrialised town in North East England with above average mortality from deaths of despair, understand and explain the prevalence of deaths from these causes in their area. Participants identified a number of structural and socio-cultural determinants that they believe drive deaths of despair in their community, including the effects of austerity, deindustrialisation, communal identity, and collective trauma; we argue that these determinants are themselves a product of structural violence.