Deaths of despair were rising long before opioids
A new study suggests that falling participation in organized religion among middle-aged white Americans with lower levels of education
A new study suggests that falling participation in organized religion among middle-aged white Americans with lower levels of education may have contributed to the rise in so-called “deaths of despair.” These deaths include fatalities linked to drug overdoses, suicide, and alcoholic liver disease.
The researchers found a clear pattern at the state level. States that experienced the sharpest drops in church attendance between 1985 and 2000 also saw the largest increases in deaths from these causes during the same period.
A Trend That Began Before the Opioid Crisis
Deaths of despair are often associated with the arrival of OxyContin and other powerful opioids in the late 1990s. However, the new analysis indicates that the upward trend started earlier, at the same time religious participation began to decline.
“What we see in this study is the beginning of the story, before opioids became a major issue, and it shows rises in deaths of despair were already beginning to happen when the opioid crisis hit,” said Tamar Oostrom, co-author of the study and an assistant professor of economics at The Ohio State University.
Oostrom worked on the research with Tyler Giles of Wellsley College and Daniel Hungerman of the University of Notre Dame. The study was published online in the Journal of the European Economic Association.
Data Sources and Affected Populations
The research team combined survey data on religious involvement from the General Social Surveys with mortality records from the Centers for Disease Control and Prevention.
Their findings showed that the decline in religious participation was concentrated among white, middle-aged adults without a college degree. This was the same group that experienced the most pronounced increases in deaths of despair, Oostrom said.
The relationship between lower church attendance and higher mortality appeared consistently across genders and was seen in both rural and urban areas of the United States.
Blue Laws and Changes in Church Attendance
To strengthen their findings, the researchers examined the repeal of “blue laws,” which had previously restricted many businesses from operating on Sundays. These laws limited competition with church attendance by reducing alternative activities.
A major wave of repeals took place in 1985, when Minnesota, South Carolina, and Texas eliminated their blue laws. The researchers compared outcomes in those states with others that did not make similar changes at that time.
The analysis showed that repealing blue laws led to a 5- to 10-percentage-point drop in weekly attendance at religious services. In later years, those same states also experienced higher rates of deaths of despair.
Mortality Trends Before and After Opioids
Oostrom noted that deaths of despair among middle-aged white Americans had been steadily declining from the late 1970s through the early 1990s. That decline eventually stalled, a shift that aligns with both falling church attendance and the repeal of blue laws.
After OxyContin was introduced in 1996, mortality rates rose sharply.
“OxyContin and the opioid crisis made a bad situation worse, but the deaths of despair were already on the rise,” Oostrom said.
Why Churchgoing May Matter for Health
The study raises an important question: how could lower church attendance contribute to higher death rates?
Oostrom explained that people who stop attending religious services often lose social ties, which past research has shown play a crucial role in physical and mental health. However, the findings suggest that social connection alone does not fully explain the pattern.
The researchers did not observe similar declines in other types of social activities during the same period when church attendance was falling.
“Religion may provide some way of making sense of the world, some sense of identity in relation to others, that can’t easily be replaced by other forms of socialization,” Oostrom said.
She also emphasized that belief itself did not fade during the years studied.
“What changed is whether people identified as religious and whether they go to church. Those are the things that matter when it comes to deaths of despair,” she said.
Can Community Participation Reverse the Trend?
The findings raise the possibility that renewed involvement in religious organizations or even secular community groups might help counter rising mortality rates. However, the authors caution that existing evidence does not offer much optimism.
“To our knowledge, findings on this point have so far been pessimistic,” the researchers wrote.
Oostrom added that there is no clear sign that broader declines in community participation are reversing. She also noted that the positive effects of religious involvement on life satisfaction are difficult to reproduce through other forms of social engagement.
The growing role of social media in the 21st century may further reduce the likelihood of a meaningful reversal, she said.
“People are less religious now, and there hasn’t been a substitute that provides what religion provided to many people. And our paper suggests this could have long-term impacts on health and mortality,” Oostrom said.
