Born in the USA? A scoping review of deaths of despair research beyond the United States

Background: The concept of ‘deaths of despair’, initially developed to explain rising midlife mortality among non-Hispanic white Americans, has gained traction globally. However, its applicability and conceptual relevance beyond the United States, where it originated, remain emerging areas of research. This scoping review maps the international use of the concept, examining its geographical reach, methodological approaches, and conceptual adaptations.
Methods: A comprehensive search of six electronic databases (PubMed, Web of Science, Scopus, CINAHL, PsycINFO, and PsycArticles) yielded 5,595 records. Following screening and eligibility checks, 56 articles published between 2018 and 2024 were selected. Data were extracted using a standardised framework and synthesised through a descriptive-analytical approach.
Results: Research on deaths of despair is concentrated in high-income, English-speaking countries, particularly the United Kingdom and Canada. Most studies utilise mortality-based, quantitative designs, although some incorporate non-fatal indicators such as mental health distress. The literature is characterised by geographical concentration, variable outcome definitions, and gaps in data coverage, which present challenges for cross-national comparison.
Conclusions: These findings highlight the necessity for greater geographical diversity, conceptual reflexivity, and methodological innovation. A critical examination of the concept's theoretical foundations and cultural fit is essential as it extends beyond the US.