The Hidden Catalyst: How Declining Church Attendance Preceded the Rise of Deaths of Despair
A groundbreaking study reveals that the rise in 'deaths of despair'—including overdoses, suicide, and alcohol-related disease—began years before the opioid crisis, closely tracking a decline in religious participation among middle-aged, less-educated white Americans. Research from Ohio State University shows that states with the sharpest drops in church attendance between 1985 and 2000 experienced the largest increases in these mortality rates, suggesting that losing religious community may have removed crucial protective factors for mental and physical health. This analysis challenges conventional narratives about the opioid epidemic and highlights the complex social factors underlying America's public health crisis.
For decades, public health experts have sought to understand the roots of America's devastating 'deaths of despair' crisis—the alarming rise in mortality from drug overdoses, suicide, and alcohol-related diseases. While much attention has focused on the role of prescription opioids and economic distress, new research reveals a surprising precursor: the steady decline of religious participation. A comprehensive study published in the Journal of the European Economic Association demonstrates that falling church attendance among specific demographic groups preceded and potentially contributed to the rise in these tragic deaths, offering a more nuanced understanding of this complex public health challenge.
The Study's Key Findings: Connecting Religious Decline to Mortality
Researchers from Ohio State University, Wellesley College, and the University of Notre Dame conducted a meticulous analysis combining survey data from the General Social Surveys with mortality records from the Centers for Disease Control and Prevention. Their findings, published in December 2025, reveal a striking correlation at the state level: states that experienced the most significant declines in church attendance between 1985 and 2000 also saw the largest increases in deaths from overdoses, suicide, and alcoholic liver disease during the same period. This pattern emerged before OxyContin's introduction in 1996, suggesting the opioid epidemic intensified a problem already in motion.
The demographic most affected by this trend was middle-aged white Americans without college degrees—the same group that experienced the most pronounced increases in deaths of despair. According to study co-author Tamar Oostrom, an assistant professor of economics at Ohio State University, "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." The relationship between lower church attendance and higher mortality appeared consistently across genders and was observed in both rural and urban areas throughout the United States.
Blue Laws Repeal: A Natural Experiment
To strengthen their causal claims, the researchers examined the repeal of "blue laws"—regulations that previously restricted many businesses from operating on Sundays. These laws had effectively limited competition with church attendance by reducing alternative activities. A significant wave of repeals occurred in 1985 when Minnesota, South Carolina, and Texas eliminated their blue laws. By comparing outcomes in these states with others that maintained their restrictions, the researchers established a clearer connection between religious participation and mortality.
The analysis demonstrated that repealing blue laws led to a 5- to 10-percentage-point drop in weekly attendance at religious services. In subsequent years, those same states experienced higher rates of deaths of despair. This natural experiment provided compelling evidence that reduced religious participation wasn't merely correlated with increased mortality but may have contributed to it. Oostrom noted that deaths of despair among middle-aged white Americans had been steadily declining from the late 1970s through the early 1990s, but this decline eventually stalled—a shift that aligns with both falling church attendance and the repeal of blue laws.
Why Religious Participation Matters for Health
The study raises a crucial question: how could lower church attendance contribute to higher death rates? While social connection is an obvious factor—past research has consistently shown that social ties play a vital role in physical and mental health—the findings suggest this explanation is incomplete. The researchers did not observe similar declines in other types of social activities during the same period when church attendance was falling, indicating that religious participation offers something distinct from general socialization.
Oostrom explained, "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." Importantly, the study found that belief itself did not fade during the years examined. "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," Oostrom emphasized. This distinction highlights the importance of community practice and identity formation, not merely private belief, in providing protective factors against despair.
Implications and Future Directions
The findings have significant implications for public health policy and community intervention strategies. They suggest that addressing the deaths of despair crisis may require more than just medical or economic solutions—it may necessitate rebuilding the social and communal structures that provide meaning and identity. However, the researchers caution against excessive optimism about simply replacing religious participation with secular alternatives.
"To our knowledge, findings on this point have so far been pessimistic," the researchers wrote in their study. Oostrom added that there is no clear sign that broader declines in community participation are reversing, and the positive effects of religious involvement on life satisfaction appear difficult to reproduce through other forms of social engagement. The growing role of social media in the 21st century may further reduce the likelihood of a meaningful reversal, as online interactions often lack the depth and commitment of in-person religious communities.
As Oostrom summarized, "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." This research challenges us to think more broadly about the social determinants of health and the complex ways in which community, meaning, and identity intersect with physical and mental well-being in modern society.
