The stigma of mental illness persists in America’s most depressed county Health news from the healthiest communities


The stigma of mental illness persists in America’s most depressed county Health news from the healthiest communities

By Phil Galewitz | KFF health news

LOGAN, W.Va. – Debra Orcutt laughs as she sits on a bench with a colleague during a morning smoke break and quickly raises her hand when asked if she knows anyone with depression.

“That’s me,” she tells a visitor to the street market where she bakes brownies and peanut butter fudge.

Orcutt, 63, has been taking medication to treat her depression for more than two decades since her son Kyle died of a congenital disease at the age of four. “There were days when I couldn’t leave the house,” she said.

After a long marriage that ended in divorce, she said she lives happily with her “hillbilly” partner near this small town in the heart of the Appalachian Mountains, an hour’s drive south of the state capital, Charleston. But certain things, like the sound of an ambulance siren or the death of their pot-bellied pig, can trigger lingering feelings of sadness.

Orcutt is hardly alone in this county, where almost everyone knows someone who suffers from depression – or suffers from it themselves. And that’s no exaggeration.

An estimated 32% of adults in Logan County, West Virginia, have been diagnosed with depression — the highest rate in the United States and nearly double the national rate, according to a study Report published in June from the Centers for Disease Control and Prevention.

The study, which provided estimates by county based on a 2020 nationwide survey of nearly 400,000 people, showed that depression rates vary widely by region and even within states. Most of the counties with the highest rates were in a 13-state portion of the Appalachian Mountains; the southern Mississippi River Valley, particularly Arkansas, Louisiana, and Tennessee; and Missouri, Oklahoma and Washington.

West Virginia, which also has some of the highest in the country poverty rates And bad healthis home to eight of the 10 counties with the highest estimated rates of adult depression, according to the CDC survey.

Overall, 18% of adults in the United States said they had been diagnosed with depression at some point in their lives, the CDC survey found.

Health experts say depression has reached epidemic proportions in the US in recent decades, and the COVID-19 pandemic is troubling the problem with its isolating public health measures, threat of serious illness, lingering health effects and a sobering death toll has tightened.

In the face of increased awareness of rising depression rates, the Biden administration has announced plans expand access to mental health care.

More than a simple case of the blues, depression is a mood disorder that leads to a persistent feeling of sadness and a loss of interest in things you once enjoyed. It affects eating, sleeping and concentrating as well as activities such as working or going to school.

“Depression is often a chronic illness, and if you stop treatment, it will eventually come back,” said Mark Miller, professor of psychiatry at West Virginia University in Morgantown.

In Logan County, where nearly a quarter of its 31,000 residents live in poverty, few expressed surprise when interviewed by KFF Health News to be told that their home tops the list of the most depressed counties.

“If you’re dealing with depression, you’ve come to the right place,” Marie Tomblin said of working the front desk at the Holiday Inn Express & Suites in Logan, noting that it affected her sister, daughter and other family members. “I see it a lot and people take it as a normal feeling and don’t want to admit they have a problem,” she said.

Located in the coal-mining region of the Appalachian Mountains, Logan County is today, like the industry, only a shadow of its former self bent down economic and regulatory pressures that bring with them many jobs. The downtown area of ​​Logan, the county seat, is full of closed businesses and office buildings, and few people were out on the sidewalks on a weekday morning.

While depression rates have been rising nationwide, data from Medicare shows that treatment for depression in West Virginia, and Logan County in particular, has increased at a faster rate in recent years. Nationally, 18% of original Medicare plan participants were receiving depression-related treatment in 2020, up from 16% in 2012 — despite an overall decline in care amid the pandemic.

In Logan County, it was 28% of Medicare enrollments in 2020, up from 21% in 2012. As in the CDC study, Logan County’s numbers were among the highest in the country.

Still, health professionals here say they are not overwhelmed by people seeking help for their condition.

Robert Perez, an internist at Logan, estimates that more than half of his patients suffer from depression. But he said few were willing to talk about it or accept a referral to a psychiatrist and there was only so much he could do for them.

“It’s hard to convince people who don’t want to be helped,” he said. “I don’t have that much time to treat her depression.”

David Brash, executive director of Logan Regional Medical Center, which sits on a hill overlooking the city, said he wasn’t surprised by the area’s high rate of depression.

The medical center does not have psychiatrists on staff, but its GPs try to treat depression as part of their practice, he said. The center recently began offering telepsychiatric consultations to its physicians to assist them in treating patients in the emergency room.

“Coming from this area, you know the challenges,” Brash said. “And the economic challenges are having an impact on the Depression — it’s not a new phenomenon.”

Diana Barnette, the county’s top elected official as president of the Logan County Commission, said doctors are often too quick to administer medication to patients when they’re feeling down. “I’m not saying we don’t have a lot of depression in the area, but culturally it’s so common for a doctor to give you a pill to make you feel better.”

Barnette, who owns several businesses in the county, including a cinema, also blames the area’s rainy and cloudy weather, and the fact that the mountains limit residents’ exposure to the sun.

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

In fact, Chris Palmer, an assistant professor of psychiatry at Harvard Medical School, said that the notion that overprescribing or cloudy weather explains the high rates of depression does not alleviate the problem.

That stance “strikes me like a hopeless and nihilistic attitude, that we’re drowning and there’s nothing we can do about it,” he said.

There is a glimmer of hope here.

The pandemic is considered over for most residents; The state has adopted its tourism motto, “Almost Heaven,” which is inspired by this a well-known song by John Denver; and the region’s economy is slowly shifting from coal as a circle markets its forest trails for off-road vehicle enthusiasts.

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

Lewis, who grew up in Logan County and taught high school math here, said he has treated about 50 patients so far and knows he has room for more patients.

“People aren’t used to having the ability to see a psychiatrist here, and doctors are still pointing to larger facilities that could be in Charleston,” he said.

Coalfield is struggling to break down the stigma and other treatment barriers associated with depression. In this region, Lewis says, people often find seeking mental health help “weak in faith.”

“Only a small percentage of people who need help for depression get it,” said Kristin Dial, executive director of the Coalfield Health Center. “We found that we would send her to Dr. Lewis can refer, but we have a high no-show rate.”

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

Lewis said the best treatment for depression is to improve diet, exercise, and avoid drugs and alcohol. But when patients were asked how they wanted to manage their illness, all they wanted was pills, he said.

Coalfield also has a registered nurse, Elice Hinkle, who recently completed her counseling service provider training at the clinic.

Because patients know Hinkle through treating their physical ailments, they are more likely to come for counseling and she can coordinate efforts with a patient’s other providers at the clinic, she said.

Back at the market, Orcutt says it’s been many years since she went for counseling. These days, she copes with her depression and anxiety by pursuing hobbies such as sculpting and painting.

“It helps not to think about it,” she said.

This article was created by KFF health newsa national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF. It is published with permission.

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