The trend of increasing U.S. working-age (25–64) mortality is well-documented. Yet, our understanding of its causes is incomplete, and analyses are often limited to using population data with little information on individual behaviors and characteristics.

One characterization of this trend centers on the role of despair as a catalyst for self-destructive behaviors that ultimately manifest in mortality from suicide and substance use. The role of despair in predicting mortality at the individual level has received limited empirical interrogation.

Using Cox proportional hazards models with behavioral risk factors and latent variable measures of despair in young adulthood (ages 24–32 in 2008–2009) as focal predictors, we estimate subsequent mortality risk through 2022 (298 deaths among 12,277 individuals; 177,628 person-years of exposure).

We find that suicidal ideation, suicide attempts, illegal drug use, and prescription drug abuse in young adulthood predict all-cause, suicide, and drug poisoning mortality. Notably, all four domains of despair (cognitive, emotional, biosomatic, and behavioral) and overall despair predict all-cause mortality and mortality from drug poisoning and suicide.

This research note provides new empirical evidence regarding the relationship between individual despair and mortality, improving our understanding of the life course contributors to working-age mortality.