# Diseases of Despair in Young Adulthood: Risk, Resilience, and Prevention

> **NIH NIH R01** · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · 2020 · $371,411

## Abstract

ABSTRACT
After decades of improvement, premature mortality is uniquely on the rise in the U.S. among White non-
Hispanic adults with low education. Suicide, drug poisoning (particularly from opiates), and alcoholic liver
disease appear to be the culprits and have been coined “deaths of despair.” Suicidal thoughts and behaviors,
illicit drug use, and alcohol problems (or “diseases of despair,” DoD)—the conditions that likely precede
these deaths—are the focus of this application, as are the pathways to these DoD. Despite many years of
research and in the face of rising suicides and a nationwide opiates public health emergency, we lack accurate
and appreciable predictions of who will succumb to DoD and who will be shielded from them. Speedy new
insights on the development of DoD are needed to inform efforts to reverse the rising tide of DoD. These can
only be generated with decades' worth of prospective-longitudinal data with rich coverage of multiple levels of
risk and protective factors—from community contexts to molecular mechanisms—with clinically-relevant
characterizations of DoD.
Realistically, no single extant dataset can fulfill these requirements. Secondary data analysis of multiple long-
term longitudinal studies of recent cohorts, with recent young adult assessments, can provide an
unprecedented opportunity here. We capitalize on three complementary, long-standing, prospective-
longitudinal data sets spanning childhood, adolescence, and young adulthood, with recent assessments in
young adulthood. (1) The nationally representative National Longitudinal Study of Adolescent to Adult
Health (Add Health) allows for fine-grained socio-structural characterizations of individuals and communities
affected by DoD. (2) The community-representative psychiatric-diagnostic Great Smoky Mountains Study
(GSMS) was collected in mostly impoverished rural communities in Appalachia—one of the epicenters of the
DoD epidemic. It features a quasi-experiment that allows testing for whether cash transfers—received by a
subgroup of participants for over 15 years—are protective against DoD. (3) Fast Track is a comprehensive 10-
year randomized clinical intervention trial with 15 years of follow-up data that targeted mechanisms that are
key in recent models of pathways to DoD. The first aim is to look longitudinally at the developmental
epidemiology of DoD across the early lifespan in the nationally-representative Add Health and in the rural-
Appalachian GSMS with a large American Indian subsample. The second aim is to test a
childhood/adolescent strain  young adult social/economic disengagement  despair  DoD
pathways model and also to test protective factors that could intervene on each pathway. We will also use
discovery-focused machine learning algorithms to uncover new pathways to DoD in Add Health and GSMS.
The third aim is to assess the impact of childhood interventions on DoD in GSMS and Fast Track.

## Key facts

- **NIH application ID:** 9917845
- **Project number:** 5R01MH117559-03
- **Recipient organization:** UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
- **Principal Investigator:** William Copeland
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $371,411
- **Award type:** 5
- **Project period:** 2018-08-15 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9917845

## Citation

> US National Institutes of Health, RePORTER application 9917845, Diseases of Despair in Young Adulthood: Risk, Resilience, and Prevention (5R01MH117559-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9917845. Licensed CC0.

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