Even in essentially the most depressed county in America, stigma around mental illness persists

Sitting on a bench laughing with a co-worker during a morning smoke break, Debra Orcutt quickly raises her hand when asked if she knows anyone coping with depression.

“I’m,” she tells a visitor to the roadside market where she bakes brownies and peanut butter fudge.

Orcutt, 63, has used medication to administer her depression for greater than twenty years since her son, Kyle, died at age 4 from a congenital illness. “There have been days I could not leave the home,” she said.

After an extended marriage that resulted in divorce, she said, she lives happily together with her “hillbilly” partner near this small town in the guts of Appalachia, an hour’s drive south of the state capital, Charleston. But certain things, equivalent to the sound of an ambulance siren or the death of her potbellied pig, can trigger lingering feelings of sadness.

Orcutt is hardly alone on this county, where almost everyone knows someone with depression — or experiences it themselves. And that is not an exaggeration.

An estimated 32% of adults in Logan County, West Virginia, have been diagnosed with depression — the very best rate in america and nearly double the national rate, in keeping with a report released in June by the Centers for Disease Control and Prevention.

The study, which provided estimates by county based on a national survey of nearly 400,000 people conducted in 2020, showed depression rates varied widely by region and even inside states. Most counties with the very best rates were in a 13-state swath of Appalachia; the southern Mississippi River Valley, particularly Arkansas, Louisiana, and Tennessee; and Missouri, Oklahoma, and Washington.

The states with the bottom rates included California, Illinois, Alaska, and Hawaii.

West Virginia, which also has a few of the nation’s highest rates of poverty and poor health, is home to eight of the ten counties with the very best estimated rates of adult depression, the CDC survey found.

Overall, 18% of adults in america reported having been diagnosed with depression of their lifetimes, the CDC survey found.

Health experts say depression has risen to epidemic levels within the U.S. in recent many years, and the covid-19 pandemic exacerbated the issue with its isolating public health measures, threat of great illness, lingering health effects, and sobering death toll.

With heightened awareness of rising depression rates, the Biden administration has announced plans to expand access to mental health care.

The CDC findings correlate with those from other surveys that show depression rates at alarming levels.

Greater than a straightforward case of the blues, depression is a mood disorder that causes a persistent feeling of sadness and a lack of interest in things once enjoyed. It affects eating, sleeping, and concentrating, in addition to activities equivalent to working or going to highschool.

“Depression is usually a chronic illness, and in case you stop treatment, it will definitely comes back,” said Mark Miller, a psychiatry professor at West Virginia University in Morgantown.

He said his state’s combination of poor overall health, low education levels, and poverty — in addition to the opioid epidemic, which has hit West Virginia particularly hard — takes a punishing toll on residents’ mental health.

In Logan County, nearly 1 / 4 of whose 31,000 residents live in poverty, few expressed surprise in interviews with KFF Health News when told their home tops the list of most depressed counties.

“You’ve got come to the fitting place for depression,” said Marie Tomblin as she worked the front desk of the Holiday Inn Express & Suites in Logan, noting her sister, daughter, and other relations have faced it. “I see it an entire lot, and other people think it’s a standard feeling and don’t desire to confess they’ve an issue,” she said.

Logan County is within the Appalachian coal-mining region, now a shadow of its former self, because the industry has buckled under economic and regulatory pressures, taking many roles with it. In Logan, the county seat, the downtown has quite a few closed stores and office buildings, and few people were out walking its sidewalks on a recent weekday morning.

The county’s high rates of chronic diseases like diabetes and obesity also make it a breeding ground for depression, health experts say.

While depression rates have risen nationally, Medicare claims data shows treatment for depression has increased more in West Virginia and particularly in Logan County in recent times. Nationwide, 18% of enrollees in original Medicare received care related to depression in 2020, up from 16% in 2012 — despite an overall drop in care because the pandemic struck.

In Logan County, it was 28% of Medicare enrollees in 2020, up from 21% in 2012. As within the CDC study, Logan County’s numbers were amongst the very best within the country.

Yet, health professionals here say they usually are not overwhelmed by people looking for help for the condition.

Robert Perez, an internist in Logan, estimates greater than half of his patients have depression. But he said few wish to discuss it or accept a referral to a psychiatrist and he is proscribed in what he can do for them.

“It’s hard to persuade individuals who don’t desire to be helped,” he said. “I do not have that much time to treat their depression.”

David Brash, the chief executive of Logan Regional Medical Center, which sits on a hill overlooking the town, said he isn’t surprised by the realm’s high depression rates.

The medical center doesn’t have psychiatrists on staff, but its primary care doctors attempt to treat depression as a part of their practice, he said. The middle recently began offering telepsychiatric consultations for its physicians to assist treat patients in its emergency room.

“While you come from this area, you already know what the challenges are,” Brash said. “And the economic challenges affect the depression — it isn’t a brand new phenomenon.”

Diana Barnette, the county’s top elected official as president of the Logan County Commission, said doctors are sometimes too quick to present patients medicine after they are feeling down. “I’m not saying we don’t have lots of depression in the realm, but culturally it’s turn out to be so accepted to have a physician offer you a pill to make you’re feeling higher.”

Barnette, who owns several businesses within the county, including a movie show, also blames the region’s rainy, cloudy weather and the way its mountains limit residents’ sun exposure.

“There’s still lots of stigma around it,” said Michael Baker, a pharmacist at Aracoma Drug Company, a pharmacy in Chapmanville, the county’s largest town after Logan.

Indeed, Chris Palmer, an assistant professor of psychiatry at Harvard Medical School, said the notion that overprescribing or cloudy weather explains high depression rates doesn’t help the issue.

That viewpoint “strikes me as a hopeless and nihilistic attitude, that we’re drowning and there’s nothing we are able to do about it,” he said.

There are glimmers of hope here.

The pandemic is taken into account over by most residents; the state has leaned into its tourism motto, “Almost Heaven,” inspired by a widely known John Denver tune; and the region’s economy is slowly shifting from coal because the county markets its wooded trails to all-terrain vehicle enthusiasts.

In June, the identical month the CDC released its findings, Coalfield Health Center, a federally funded clinic within the county, announced it had hired its first psychiatrist, David Lewis.

Lewis, who grew up in Logan County and taught highschool math here, said he has seen about 50 patients up to now and knows he has room to see more.

“People usually are not used to having the choice of going to a psychiatrist here, and doctors still refer out to greater institutions, which might be in Charleston,” he said.

Coalfield is struggling to beat the stigma and other treatment obstacles around depression. On this region, Lewis said, people often view going for mental health help as being “weak in faith.”

“Only a small percentage of people that need assistance for depression are getting it,” said Kristin Dial, the chief director of Coalfield Health Center. “What we’ve got found is that we are able to refer them to Dr. Lewis, but we’ve got a high no-show rate.”

“We now have to be here after they are ready,” she said.

Lewis said the most effective treatment for depression includes improving weight loss program and exercise and avoiding drugs and alcohol. But when patients are asked how they wish to manage their illness, they have an inclination simply to want pills, he said.

Coalfield also has a nurse practitioner, Elice Hinkle, who recently finished training to supply counseling on the clinic.

Because patients know Hinkle from her having treated their physical ailments, she said, they usually tend to come for counseling, and she will coordinate efforts with a patient’s other providers on the clinic.

Back on the market, Orcutt says it has been a few years since she went to counseling. Nowadays, she copes together with her depression and anxiety by keeping busy with hobbies equivalent to sculpting and painting.

“It helps to not dwell on it,” she said.

This text was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is certainly one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.