Abstract
Deaths-of-despair have been difficult to predict while focusing solely on individual-level factors. In 2 complementary studies we tested whether individuals living in disadvantaged neighborhoods in a country with robust social-safety nets (New Zealand) were at greater risk for a despair-related death (suicides, drug overdoses, alcohol poisonings and liver-disease, Study 1) or a "premorbid" midlife syndrome of despair-related maladies (suicidality, substance misuse, sleep problems, and chronic pain, Study 2). In 2-decades of observation, New Zealanders residing in disadvantaged neighborhoods across adulthood were at greater risk for a despair-related death (N=2.4million analytic-sample using nationwide administrative data, population-RR per-quintile increase in cumulative disadvantage=1.27, 95%CI:1.23-1.30) and a more severe premorbid syndrome of despair-related maladies (N=907 analytic-sample using a population-representative birth-cohort, β=0.24, 95%CI:0.17-0.31). Findings held after adjustment for individual-level socioeconomic status and, in Study 2, adjustment for childhood antecedents and adult difficulties that could provoke despair. Neighborhoods could be intervention targets to reduce despair-related deaths.