Deaths of despair were climbing before opioids, and the decline of churchgoing may have helped set the stage.
A new study suggests that falling involvement in organized religion among middle-aged white Americans with less education may have contributed to the rise in what are known as “deaths of despair.” These deaths include fatalities linked to drug overdoses, suicide, and alcoholic liver disease.
Researchers found that states experiencing the sharpest declines in church attendance between 1985 and 2000 later saw the largest increases in these types of deaths.
The Rise Began Before the Opioid Crisis
Deaths of despair are often associated with the arrival of OxyContin and other opioid medications in the late 1990s. However, the study indicates that the upward trend started years earlier, coinciding with a drop in religious participation.
“What we see in this study is the beginning of the story, before opioids became a major issue, and it shows rises in deaths of despair were already beginning to happen when the opioid crisis hit,” said Tamar Oostrom, a co-author of the study and an assistant professor of economics at The Ohio State University.
Oostrom conducted the research with Tyler Giles of Wellsley College and Daniel Hungerman of the University of Notre Dame. The study was published online in the Journal of the European Economic Association.
Data Sources and Who Was Most Affected
The researchers relied on data measuring religious participation from the General Social Surveys and mortality records from the Centers for Disease Control and Prevention.
Their analysis showed that the decline in religious participation was largely driven by white, middle-aged Americans without a college degree. This same group experienced the largest increases in deaths of despair, according to Oostrom.
The association between reduced church attendance and higher mortality was observed among both men and women, and it appeared in rural and urban areas across the United States.
Blue Laws and Church Attendance
To strengthen their findings, the researchers examined the repeal of “blue laws,” which had restricted many businesses from operating on Sundays. These laws reduced alternatives to churchgoing by limiting commercial activity.
The most significant repeal occurred in 1985, when Minnesota, South Carolina, and Texas eliminated their blue laws. The researchers compared trends in those states with others that did not repeal similar laws at the time.
The results showed that repealing blue laws led to a 5- to 10-percentage-point decline in weekly attendance at religious services. In later years, those states also experienced increases in deaths of despair.
Mortality Trends Before and After OxyContin
Oostrom said deaths of despair among middle-aged white Americans had been steadily declining from the late 1970s through the early 1990s. That downward trend eventually stalled, a shift that aligns with both declining religious participation and the repeal of blue laws.
After OxyContin was introduced in 1996, mortality rates rose sharply.
“OxyContin and the opioid crisis made a bad situation worse, but the deaths of despair were already on the rise,” Oostrom said.
Why Churchgoing May Matter for Health
The findings raise an important question about how declining church attendance might be linked to higher death rates.
Oostrom explained that when people stop attending church, they often lose social connections that previous research has shown are important for health. However, the study suggests the effect goes beyond simple social interaction.
Researchers did not find declines in other forms of social activity during the same period when church attendance was falling.
“Religion may provide some way of making sense of the world, some sense of identity in relation to others, that can’t easily be replaced by other forms of socialization,” Oostrom said.
She also noted that belief in God did not decline during the years covered by the study.
“What changed is whether people identified as religious and whether they go to church. Those are the things that matter when it comes to deaths of despair,” she said.
Can Community Engagement Reverse the Trend?
The results raise the question of whether renewed participation in organized religion, or possibly secular community organizations, could help reverse these mortality trends.
“To our knowledge, findings on this point have so far been pessimistic,” the authors wrote.
Oostrom added that there is no evidence that overall declines in community participation are reversing. She also noted that the positive effects of religious involvement on life satisfaction are difficult to replicate through other forms of social engagement.
The growing influence of social media in the 21st century may make such a reversal even less likely, she said.
“People are less religious now, and there hasn’t been a substitute that provides what religion provided to many people. And our paper suggests this could have long-term impacts on health and mortality,” Oostrom said.
Reference: “Deaths of Despair and The Decline of American Religion,” by Tyler Giles, Daniel Hungerman and Tamar Oostrom, 28 November 2025, Journal of the European Economic Association.
DOI: 10.1093/jeea/jvaf048
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11 Comments
A silly conclusion. Church is never gonna really help you. Desperate people know that.
So, a much better conclusion is that desperation contributed both to reduction in churchgoing and to increase in suicide rates.
I suspect that is is a spurious correlation born of a desire to assign blame.
Exactly!
And to think this is a “science” magazine…
The statistics on opioid-related deaths are usually characterized as “accidental fentanyl overdoses.” While sometimes they are truly accidental, as when poor quality control results in an unintended overdose. However, I have suspected for some time that depression and despair lead to intended overdoses. That is, suicide without a note to confirm it. Thus, suicides are a greater problem than commonly acknowledged.
People point to the high number of suicides using a firearm, and simplistically propose that it be made more difficult to acquire a firearm. They overlook how easy it is to substitute other methods for a gun. Thus, Japan has a suicide rate higher than the USA, but NONE are committed with a gun.
From my reading, it appears that there are two groups that best represent the problem. Black, male teenagers, whose culture and living conditions lead to despair, and White, elderly males who have a terminal disease, and don’t want to burden their family with the medical expenses necessary to slightly increase their time before the inevitable. Religion is often a barrier to the solution preferred by those with a terminal condition.
This, Mr. Spencer, is another example where experience can make the difference between a study finding causation, correlation or just being anecdotal. Because the study was based on those CDC statistics, it fits almost perfectly with my own experience; mysteriously (to my doctor), seriously ill in early 1981 at age 37, following the FDA approval of the expanded use of added MSG in 1980. Statistically, the US obesity and diabetes epidemics presented by 1990 and 1994, respectively, CDC data. What amazes me is that, after all of this time, no one in authority is asking yet ‘what drove all of those people to seek relief, from what?’ I can attest from personal experience that FDA approved food poisoning can cause that much chronic pain.
There is little doubt that you have convinced yourself that MSG is responsible for your life-long health problems. However, other than presenting anecdotal evidence for your personal sensitivity, I have not seen any cited double-blind studies that corrected for the placebo effect, nor involved enough participants to establish just how common adverse effects to MSG are. MSG has been controversial for decades, and more recent studies suggest that the upper-limit of 3 grams ingested over a short time is sufficient to avoid undesirable side effects for most people.
Paracelsus is well known for his aphorism that “The poison is in the dose.” It is also well known that people vary in their response even to toxins, which is why the Lethal Dose (LD50) is defined as the amount that kills 50% of those that ingest it, for equal body weights. That means, some people will die at much smaller doses, and similarly, some people will experience unpleasant side-effects from foods and medicines, which don’t affect the majority. As Dirty Harry was famous for saying, “A man has to know his limits.” Act accordingly. But don’t assume that what is unpalatable for you affects everyone the same way unless you can present incontrovertible evidence that it does.
Mr. Spencer, if you are the “Clyde Spencer” of the “Trusted Community Engagement and Contributions” I found on the MSN network, how about looking me up so we can have some serious conversation on a very serious problem. I estimate another 5,000 to 6,000 unsuspecting Americans (mostly elderly and frail now) will succumb to FDA approved food poisoning again today, tomorrow and ad infinitum. Meanwhile, here’s a link to one of my online sources: http://www.holisticmed.com/msg/TheErbreportonMSGtotheWHO.pdf
As I observed above, Paracelsus remarked that “The poison is in the dose.” Virtually everything that can be ingested CAN be toxic, even common drinking water! The prudent man will determine what his limits are. The paper you linked talked about a 12-gram dose. Other things I have read suggest that is about 4X the safe limit over a short time; for some sensitive people, even 3-grams may produce symptoms. Demonstrating that MSG has undesirable side effects that vary with the specie of animal, its age, size, and interacting foods/chemicals doesn’t really add anything to the observation that all things can be toxic if one exceeds their personal tolerance.
MSG may be a problem for some people, but used in moderation, not for everyone. I’m older than you, and to the best of my knowledge, have never experienced any MSG side effects, despite never taking any special precautions.
Even 6,000 people, out of a population of 348 million, in the context of something like 400,000 accidental deaths annually resulting from routine medical procedures, and 70,000-100,000 fentanyl overdose deaths from recreational drug use, swamp the alleged losses from MSG.
Thank you for the invitation to extend this discussion. However, I am declining.
This “research” seems to struggle with the essential difference between correlation and causation. Just because blue laws were repealed does not show causation for decreased churchgoing; because churchgoing declined does not show causation for “deaths of despair,” etc.
Donald Trump was elected in 2016 and deaths of despair reached their peak in Appalachia in 2017. Was Donald Trump’s presidency the cause of this? Some biased observers will believe “yes” and other biased observers will reject the premise out of hand.
How does stuff like this get published? This is an opinion piece not science.
I don’t claim to know why church attendance has declined, nor why the use of opioid drugs became an issue in the 1990’s-but I do know that there has been a steady decline in manufacturing employment extending from New England west to Minnesota during the years between 1960 and 1990. We used to make computers, cameras, and photocopy machines in New York state. We used to make steel in Pennsylvania, and mine coal in West Virginia. We still manufacture cars & trucks in Michigan, but there have been many changes in how this is done, resulting in closed factories, and jobs lost. At one time, pots, pans, and kitchen appliances were manufactured in northern Wisconsin. Not any more. The paper mills are gone, and small engines are being manufactured elsewhere. I remember when General Electric was manufacturing air conditioners and refrigerators in Indiana. All of the jobs are not gone, and there are a few bright spots here and there. But overall, our current economy bears little resemblance to what we had in 1960.
People who have experienced a sense of separation from contact with others, as a consequence of their exposure to dependence on media for their everyday experience, which renders their sense of reality null, are at risk of feeling alone. The still have a need to feel some spiritual connection, and the use of opioids, in much the same way as an opium dream state does, provides them with relief and satisfies the need to feel that they have experienced a spiritual connection; it is a strategy to escape from the reality of despair, but it leads to dependency and the collapse of their physical system, and death. Dependence of media, and on the identification with physical accumulation of things, is a promoted delusion.