Qualitative evidence for the determinants of deaths of despair: a scoping review

Deaths from suicide, drug overdose, and alcohol-specific causes, collectively termed “deaths of despair” (DoD), represent a growing public health concern. Quantitative research has linked these deaths to adverse social and economic conditions but less is known about how their determinants are understood and articulated within qualitative research. This scoping review aimed to map the existing qualitative evidence on the perceived determinants of DoD. A scoping review was conducted in accordance with PRISMA-ScR guidelines. We searched CINAHL, Scopus, and Ovid Medline for qualitative studies published in English from 2015 onwards and conducted in OECD countries. Studies were included if they explored perceptions or beliefs related to the determinants of suicide, drug overdose, alcohol-specific mortality, or DoD collectively. Data were extracted and synthesised using a narrative thematic approach. Of 3292 unique records identified, nine papers representing six distinct qualitative studies met the inclusion criteria. Studies were conducted in the United States, the United Kingdom, and Canada. Three overarching themes were identified: structural determinants (including economic insecurity, deindustrialisation, and limited access to services), social determinants (including weakened community cohesion, gender norms, stigma, and discrimination), and individual-level experiences (including psychological distress, hopelessness, and barriers to help-seeking). The qualitative evidence base on the determinants of deaths of despair is sparse and uneven. Existing studies situate DoD within broader structural and social contexts, highlighting the role of economic decline, service withdrawal, and social fragmentation in shaping pathways to distress, substance use, and self-harm. Further qualitative research across more diverse populations and settings is urgently needed to strengthen understanding of the mechanisms underpinning these deaths and to inform effective, upstream public health policy responses.