Death rates from suicide, alcohol abuse, and drug overdoses—the “deaths of despair”—have reached an all-time high in the United States, according to a new report. The findings from the Commonwealth Fund were released Wednesday and showed that, although the death rates are up nationally, some states have been hit far worse than others. “When we look at what’s going on in Mid-Atlantic states—West Virginia, Ohio, Pennsylvania—those are the states that have the highest rates of drug-overdose deaths in the country,” said David Radley from the group. Drug-overdose rates in West Virginia rose more than fourfold between 2005 and 2017, according to the report, mainly due to opioid abuse. After West Virginia, the District of Columbia, Kentucky, Delaware, and New Hampshire had the next highest drug-overdose death rates in the country, the report found.

If you or a loved one are struggling with suicidal thoughts, please reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741