What changed? What would have caused America to suddenly become so much more despairing in the year 2000?

One of the answers to this question is deceptively simple: trade normalization with China—what MIT economist David Autor has labeled “China Shock.” The differential effect of offshoring on America’s blue-collar workers helps explain the initial rise. In a 2018 paper, economists Justin Pierce and Peter Schott showed a relationship between exposure to China Shock and increase in suicides (as well as drug overdose deaths). “These results,” they write, “are consistent with [exposed white’s] relatively high employment in manufacturing, the sector most affected by the change in trade policy.”

Today, suicides remain concentrated among whites and Native Americans (who are frequently ignored in conversations about deaths of despair despite their shocking rates of OD, suicide, and alcohol-associated death). But these groups have always had higher rates of suicide compared with other ethnicities—what explains this disparity is debated.

But whereas—per Pierce, Schott, Case, and Deaton—the suicide rise started among low-status, middle-aged whites, it appears to have spread.