Geography of despair: where you live affects where you end up

The following article contains themes/content about suicide that some readers may find distressing.

A study keen to understand how much of a correlation exists between ‘deaths of despair,’ related to issues like substance abuse and poor mental health, and geographical area have found a strong connection.

Researchers discovered that people who spend more of their lives living in socioeconomically disadvantaged areas appear to face as much as a 60 percent higher risk of these deaths, which include suicide, drug overdoses and alcohol-related diseases.

These associations remained even after accounting for childhood vulnerabilities, family psychiatric history, adult stress, unemployment and financial hardship, says the University of Auckland’s Associate Professor Barry Milne, one of the principal investigators.

Milne, from the University’s COMPASS research centre, says the paper, published on 27 May in Clinical Psychological Science, found clear areas in New Zealand that were connected with higher deaths of despair.

“The research also uncovered evidence of an underlying ‘syndrome of despair,’ marked by chronic health circumstances including, but not limited to, substance misuse, chronic pain and sleep problems,” he says.

One study of the two involved in the wider research uses administrative data from the New Zealand population, via Statistics New Zealand’s ‘Integrated Data Infrastructure’ (IDI).

Milne was responsible for accessing and analysing these data.

The other came from the Dunedin Study, a well-known longitudinal project tracking the health, development and behaviour of 1,037 babies born in Dunedin between April 1972 and March 1973.

“These complementary nationwide datasets, which in the case of the IDI includes health and mortality records from 2.4 million people,” says Milne, “found that people living longer in disadvantaged neighborhoods were at greater risk for despair-related outcomes, even after accounting for income and education.”

He says the IDI work couldn’t take into account the childhood risk factors, which is where the Dunedin Study was useful.

Data from the Dunedin Study also suggests that life-long risks depend on a person’s exposure to deprived areas, says Milne.

“Individuals who began adulthood living in a disadvantaged neighborhood – or whose neighborhood conditions failed to improve over the first two decades of adulthood – experienced more severe despair-related symptoms by midlife.”

He says even with New Zealand’s public health system and comparatively strong social welfare programmes, where you grow up and continue to live still strongly shapes your life outcomes.
 

The authors say these findings support expanding public health approaches beyond individual treatment towards making deprived neighbourhoods better places to live.

These might include improving transport access, increasing green space, reducing proximity to alcohol and gambling outlets and improving access to healthy food and community amenities.

The research – from scholars at eight prominent universities – helps address some key gaps in researchers’ and society’s work to grapple with these sorts of deaths, which have been rising for several decades.

As well as Auckland, universities involved include study lead, the University of Virginia, the University of Otago, Duke University (North Carolina), Michigan State University, the University of Michigan, King’s College London and the University of Canterbury.

The research was supported by the US National Institute on Aging and the UK Medical Research Council, among others.

Longer residence in disadvantaged neighborhoods is associated with enhanced risk of death of despair and a midlife syndrome of despair: Multidecade geographic analyses in a prospective birth cohort by Reuben, A., Milne, B., Shah, D., Brennan, G., Pearson, A., Richmond-Rakerd, L., Guiney, H., Harrington, H., Hobbs, M., Houts, R., Ramakrishnan, M., Ramrakah, S., Theodore, M., Caspi, A., Moffitt, T.E. (2026) is published in Clinical Psychological Science.

Where to get help:

Call or text 1737 any time for support from a trained counsellor. You can also contact your GP, local mental health crisis team or one of the support services listed at Mental Health Foundation NZ.