Structural vulnerabilities? Trends in preventable deaths of despair in the Netherlands, 2013-2023.

OBJECTIVES: Deaths of despair - suicide, drug overdose, and alcohol-related mortality - have been widely studied in the U.S., where rising midlife mortality has been linked to institutional decline and cohort disadvantage. Far less is known about these dynamics in countries with stronger welfare regimes, particularly when disaggregated by cause, age, and socioeconomic position, and few studies examine these causes jointly. This study examines trends in despair-related and homicide mortality and associated socioeconomic factors in the Netherlands, expecting patterns that differ from those documented elsewhere and reflect context-specific institutional arrangements. STUDY DESIGN: Retrospective population-based observational study. METHODS: Using national mortality data (2013-2023) obtained from Statistics Netherlands, we analysed cause- and age-specific despair-related mortality alongside socioeconomic indicators to assess structural and socioeconomic influences. We uniquely examine these causes together - and explicitly include homicide alongside suicide, drug overdose, and alcohol-related mortality - on the premise that they represent different expressions of a shared set of despair-related processes. RESULTS: Suicide remains the leading cause of external mortality across the life course among the studied variables, with rates declining among middle-aged adults, but remaining stable among youth. In contrast, drug- and alcohol-related deaths have risen steadily, particularly among working-age and older adults. These patterns indicate a partial convergence with U.S. trajectories, while persistently low homicide rates and the absence of a midlife suicide surge differentiate the Dutch case. CONCLUSION: Despair-related mortality in the Netherlands reflects overlapping but distinct processes across the life course. The results suggest that the Netherlands' welfare institutions may buffer some of these dynamics compared with countries where social protections are weaker. These findings underscore the need for integrative, life-course models that combine epidemiological, socioeconomic, and ecological factors, and for policies that strengthen prevention, reduce inequalities, and foster resilience. Deaths of despair are not merely individual tragedies, but indicators of systemic vulnerability and institutional limits.