What is happening to mid-life white Americans? “Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling,” reports Gina Kolata in a recent New York Times article. The original research was conducted by Princeton economists Anne Case and Angus Deaton and published in the Proceedings of the National Academy of Sciences. The research study documented “A marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013.” Case and Deaton noted that the change reversed decades of progress in mortality and was unique to the United States.

No other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics. Midlife Blacks and Hispanics, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. The study also found significant declines in overall health.

“Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population,” Case and Deaton concluded. The increased death rates were largely accounted for by increased suicide rates among middle-aged whites as well as increased overdose deaths due to drug and alcohol use and the effects of chronic alcohol use causing liver diseases such as cirrhosis. Although all education groups saw increases in mortality and poor health, those with less education saw the most marked increases.

Although the study didn’t focus on gender issues, it is well known that men experience higher rates of suicide, and have much higher rates of alcohol and drug use and related health problems than do women. For instance, In his book Dying to Be Men, Will Courtenay, Ph.D. reports that the suicide rate for males is 3-12 times higher than it is for females and increases with age. Reporting government statistics Courtenay notes the following:

• For ages 45-54, the suicide rate for males is 3 times the rate for females.

• For ages 55-64, the rate for males increases slightly to 3.1 times the rate for females.

• For ages 65-74, the rate for males jumps to 6.3 times the rate for females.

• For those 75 and over, the suicide rate for males is 12.3 times the rate for females. Think about these statistics because they translate to real people. Think of friends and family you know between the age of 45 and 54. For every woman who commits suicide, three men will take their own lives. And when men hit retirement age, suicides jump dramatically, while the suicide rate for females actually declines.

What’s Going on With Mid-Life Caucasian Americans?

Let’s be clear at the outset, there are still major health problems that are related to being non-white in America. However, when those who have greater privilege and position in society are getting sicker and taking their own lives in increasing numbers we have to ask, “Why?”

Clearly more and more of us are in pain, both psychological and physical. 116 million people suffer from chronic physical pain. Pain affects more Americans than diabetes, heart disease and cancer combined. More and more of us feel overwhelmed with our lives and the pain impacts us all. We sense that there are changes going on that we are not able to control—such as global climate change, economic dislocations, and increasing violence at home and abroad. I view men as the “canaries in the coal mine” alerting us to the increased stresses we are all feeling. The result is that more and more of us are becoming depressed. This problem hits home to me since my father tried to take his own life when I was five years old.

Although he survived physically, our lives were never the same. I grew up wondering if stresses that impacted him would impact my own life. Over the years I have struggled with depression myself and have sought to understand how it can be better recognized and treated. My father’s depression and suicide attempt was one of the reasons I became a mental health counselor and went on to receive my PhD in International Health. My dissertation research sought to answer the question, “If the suicide rate is so much higher in males, why do most studies indicate that women suffer from depression at twice the rate of males?” My research demonstrated that, contrary to accepted beliefs in the field, symptoms of depression expressed themselves differently in men than in women.

Here’s a summary of my findings:

Depressed men tend to “act out” their pain. They are often irritable, angry, and blaming. They often escape through the use of alcohol, drugs, or excessive use of media including the internet. They may overwork as a way of staying busy and disconnected from their inner feelings of sadness and desperation.

Depressed women tend to “act in” their pain. They are often sad and tearful. They are more likely to blame themselves than others. They may escape through food and shopping. They are more likely to talk to others and seek out help more often than do men. When they do reach out they often generate a more sympathetic response. My own research shows that the questions we are asking may be biased toward the way women experience depression. I developed a new questionnaire that seems more responsive to the way men experience depression.

In my own clinical practice I have found it to be quite useful in helping more men identify depression and get the help they need. I’m hopeful that as we better understand the gender differences in symptoms between men and women, both sexes will get earlier diagnoses and better treatment.