Given the range of alarming social indicators in the French overseas territories, we aimed to study “deaths of despair”, pooling deaths from suicide, alcohol, and drug-related deaths and to compare them with mainland France.

Standardized mortality rates obtained from death certificates between 2001 and 2022 were used for comparisons.

Deaths of despair were generally lower than in mainland France, with Reunion Island as an exception. Suicide rates were consistently lower across all territories. However, alcohol-related deaths were notably higher in the overseas territories, particularly among men. The study found that deaths of despair were predominantly driven by suicide in mainland France, while in the overseas territories, they were split nearly equally between suicide and alcohol-related deaths. Drug-related deaths were negligible in the overseas territories. Between 2001 and 2022 deaths of despair declined notably because alcohol-related deaths declined.

The counter-intuitive finding that, with the exception of Reunion Island, despite all the social difficulties deaths of despair tend to be less frequent than in mainland France suggests that these small territories may have complex resilient features that limit the impact of poverty. While affordable rhum is locally produced populations drink less alcohol when compared to mainland France. However, the risk of dying from it remains a public health problem.