Life expectancy in the US has dropped once again, thanks in part to rising suicide and drug overdose rates, according to new government reports.
The Centers for Disease Control (CDC) found nearly 70,000 more Americans died in 2017 than 2016, with rising rates of death among 25- to 44-year-olds.
Thursday's reports revealed synthetic opioid-related overdose death rates rose by 45% on average, nationwide.
The suicide rate is also the highest it has been in decades.
Americans can expect to live just over 78 years and six months on average - a 0.1 year drop from 2016, according to the report released on Thursday.
"Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide," said CDC director Robert Redfield in a statement.
"Life expectancy gives us a snapshot of the nation's overall health and these sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable."
The top 10 leading causes of death - including heart disease, cancer, stroke, diabetes, and suicide - were the same as in 2016, accounting for the majority of deaths.
Only cancer death rates decreased by 2.1%, while the rates for most other causes increased.
US women continue to outlive men, and the death rate did decrease among 45- to 54-year-olds.
Between 2016 and 2017, mortality rates also decreased for black women, and there was no significant change in rates for black men and Hispanic Americans.
Life expectancy in the US began dropping in 2015.
Monaco and Japan currently have the longest life expectancies in the world at 89 and 85 years. The UK's life expectancy is around 80 years.
Drug death rate up 16% per year
As the US grapples with an opioid crisis, overdoses claim more and more lives, the CDC report found. The age-adjusted death rate has gone up 16% per year since 2014.
Drug overdose deaths accounted for 70,237 deaths last year - nearly 10% higher than in 2016 - with a significantly higher rate of death among men, compared to women.
The death rate from overdoses caused by synthetic opioids like fentanyl increased by 45% in one year.
West Virginia saw the highest overdose death rate in 2017 at 58 per 100,000 people; Ohio, Pennsylvania and the US capital also topped the list.
Steady increase in suicide
The CDC found suicide became the second leading cause of death for 10- to 34-year-olds in 2016, with rates increasing 33% between 1999 and 2017, according to the report.
Urban-area suicide rates were 16% higher in 2017 than 1999, and rural-area suicides increased by 53% over the same time period.
Dr Jerry Reed of the National Action Alliance for Suicide Prevention told the BBC that suicide is not always just a mental health challenge.
"Economic conditions or livelihood opportunities in decline could lead people to positions where they're at risk. We need to intervene in both mental and public health cases," Dr Reed says.
Where to get help
From Canada or US: If you're in an emergency, please call 911
You can contact the US National Suicide Prevention Lifeline on 1-800-273-8255 or the Crisis Test Line by texting HOME to 741741
Young people in need of help can call Kids Help Phone on 1-800-668-6868
If you are in the UK, you can call the Samaritans on 116123