LAUSR

Since the turn of the 21st century, during which White mortality has been rising, there has been a sharp increase in only three causes of death, drug use, alcohol use, and suicide. Because all three of these causes conjure notions of anguish and hopelessness, they have been conceptualized as a collective "deaths of despair" phenomenon. Simons and Masters challenge this conceptualization, by asking if these three causes are empirically associated with each other. Their analyses produce small correlations, which lead them to call into question that the three causes are part of a unified phenomenon. We contest their work on several grounds. Their analyses suffer from several technical problems, including the fact that, for any given year and cause of death, 65.8-97.6% of counties have death counts under 10. More fundamentally, it is unclear that we should expect these causes of death to rise and fall together, even if they are connected to a singular phenomenon. Instead, 'despair' may manifest differently in different places (i.e. these causes may be substitutes for each other). We argue that the best answer to the authors' important question comes from assessing whether there is a common, despair-based causal mechanism underlying all three of them.