Translation of Despair in Healthcare

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Penn State

In a seminal paper, Case and Deaton (2015) described a growing phenomenon, “diseases of despair” –namely drug overdose, suicide, and alcoholic liver disease--that underlies the first-ever decline in life expectancy in the U.S. and that disproportionately affects white non-Hispanic Americans and those living in rural communities.

Addressing conditions within the health system alone ignores that nearly 70% of early mortality is attributed to the social determinants of health—including lifestyle and health behaviors, social connectedness, and economic factors.

Effective population health initiatives rely on evidence-based solutions, implemented through community partnerships. Most of what we know about diseases of despair comes from epidemiologic studies, and there is a dearth of information regarding how local communities and health systems are responding to this public health challenge. There is a clear need for data that illuminate potentially malleable conditions in local, high-risk communities–or hot spots–that can be targeted for prevention and intervention efforts.

As a CTSA program located primarily within rural communities throughout the Commonwealth of Pennsylvania, Penn State CTSI researchers and clinicians in a number of its cores have begun to address some of the many components of diseases of despair. A collaboration between its Informatics Core and Highmark Inc., for example, has enabled identification of hot spots in rural PA communities and their distinctive contextual conditions. Its Community-Engaged Research Core is conducting qualitative research with health care professionals, community leaders, and social service providers to develop a natural history of diseases of despair and identify potential interventions. Further, the Community-Engaged Research Core collaborated with experts in health policy and economic analysis to develop a report to state attorney generals about the cost of prescription opioids epidemic crisis to states. Its Education Core sponsored a workshop during Association for Clinical and Translational Science 2019 as part of the Appalachian Translational Research Network to provide education and promote new research collaborations focused on diseases of despair. Also, supported by the work of Network Capacity and Hub Cores, research teams are involved in several new multi-site clinical research projects focused on pain management given the role of pain in the diseases of despair. Finally, the institute's most recent round of pilot project awards prioritized research on diseases of despair. These wide-ranging efforts are aimed at sparking novel, interdisciplinary and translational research at Penn State and new collaborations across the CTSA Consortium that can lead to effective approaches to preventing and treating diseases of despair.