Individuals who are unable to meet their basic needs are more likely to respond reactively to their immediate social and financial hardships with behaviors that lead to “diseases of despair,” which include suicide, drug overdose, and alcohol-induced liver diseases. We sought to assess the feasibility of a community-to-clinic referral approach for diseases of despair-related behaviors.

Guided by the Model for Adaptation Design and Impact, we adapted existing clinical risk assessments into a six-item screener and integrated it into the PA 211 Southwest helpline’s workflow. The screener was created to identify helpline callers at risk for suicidal ideation/behavior, alcohol abuse, drug use, and those in need of seasonal flu vaccination. The screener was implemented from December 2020 to March 2021. We invited at-risk individuals who accepted a service referral to complete baseline and follow-up surveys to learn about their satisfaction with screening and use of referrals.

2,868 callers were invited to take the screener, with 37% (n = 1047) participation. Among screened callers, 19% (n = 196) were at risk of alcohol abuse, 11% (n = 118) for drug use, 9% (n = 98) for suicidal ideation/behavior, and 54% (n = 568) needed flu vaccination. Of those, 265 callers accepted at least one of the offered referrals. Forty-seven individuals took our surveys, with almost half of them (n = 22) reported engaging with a referral and 90% recommended the helpline for health referrals.

Our findings demonstrate the feasibility of using existing community infrastructure and social service systems to actively screen and link at-risk individuals to needed health referrals in their communities.

Rising midlife mortality in the United States is largely attributable to ‘deaths of despair’ (deaths from suicide, drug poisonings, and alcohol-related diseases) and deaths from cardiometabolic conditions. Although despair- and cardiometabolic-related mortality are increasing concurrently, it is unclear whether they share common developmental origins. We tested adolescent psychopathology as a potential common origin of midlife diseases of despair and cardiometabolic risk.

Participants (N = 4578) were from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort followed from adolescence to early midlife. Adolescent psychopathology included depression, anxiety, eating disorders, PTSD, conduct disorder, and ADHD at ages 11–18. Diseases of despair (suicidality, substance misuse, pain, and sleep problems) and cardiometabolic risk (hypertension, hyperlipidemia, high-risk waist circumference, diabetes, and cardiovascular conditions) were multi-modally measured at ages 33–43.

At midlife, adolescents who experienced psychopathology exhibited more indicators of despair-related diseases and cardiometabolic risk (IRRs = 1.67 [1.46–1.87] and 1.13 [1.04–1.21], respectively), even after accounting for demographics, adolescent SES, and adolescent cognitive ability. Associations were evident for internalizing and externalizing conditions, and in a dose–response fashion. In mediation analyses, low education explained little of these associations, but early-adult substance use explained 21.5% of psychopathology's association with despair-related diseases. Midlife despair-related diseases and cardiometabolic risk co-occurred within individuals (IRR = 1.12 [1.08–1.16]). Adolescent psychopathology accounted for 8.3% of this co-occurrence, and 16.7% together with adolescent SES and cognitive ability.

Adolescent psychopathology precedes both diseases of despair and cardiometabolic risk. Prevention and treatment of psychopathology may mitigate multiple causes of poor midlife health, reducing premature mortality.