According to a new study in the Journal of the American Medical Association, life expectancy at birth has stopped increasing since 2010 and decreased in the U.S. for three consecutive years.

The last time we saw three consecutive years of declining life expectancy was 100 years ago, coinciding with the flu epidemic of 1918.

In 1960, Americans had the highest life expectancy of any country in the world. But in the past couple of years, the U.S. has dropped to the bottom of the list of countries with a similar gross domestic product and high average income.

The U.S. is ranked in the mid-40s globally in terms of life expectancy, between countries like Lebanon, Cuba and Chile, which have gross domestic products that fall far short of ours.

Despite having the highest per capita health care spending in the world, Americans are more likely to die before age 65 than people in other countries. The authors also eerily added, ”Their children, too, are less likely to live as long.”

Perhaps surprisingly, increased mortality rates in midlife — defined rather broadly as 25 to 64 years old — are driving the decline.

Within this group, the largest increases in mortality rate occurred in the subset of people ages 25 to 34, and it was the increase in drug overdoses, suicides and alcohol-related diseases that were identified as three key causes of death. Between 1999 and 2017, midlife mortality from drug overdoses increased by nearly 400%, alcoholic liver disease increased by 40.6% and suicide rates increased by 38.3%.

This recent study is a sober reminder that morbidity and mortality take many forms and supports a point that we must be willing to accept. More than just a developing world problem, this specifically is an American problem.

The study demonstrates, in the U.S. at least, the deterioration of mental health often can be more deleterious than the decline of physical health when it comes to longevity.

Perhaps it’s time we invest our dollars into systems and organizations that specifically address mental health. Local organizations like Brain Health Iowa and Mindful Minutes are two examples that specifically address emotional regulation and mental health in adults and children.

Koneru is board certified in radiation oncology. He did his training at Northwestern University in Chicago and is an adjunct assistant professor at Loyola University Chicago Stritch School of Medicine. He sees patients at the Wendt Regional Cancer Center, the Helen G. Nassif Radiation Center and the Leonard C. Ferguson Cancer Center.