In the midst of a morning smoke break, Debra Orcutt, seated on a bench, shares laughter with a colleague. When queried about knowing individuals grappling with depression, Orcutt promptly raises her hand. “I am,” she discloses to a visitor at the roadside market where she crafts brownies and peanut butter fudge.
Aged 63, Orcutt has harnessed medication to navigate her depression for over twenty years, a journey that commenced after her son, Kyle, passed away at age 4 due to a congenital ailment. Reflecting on those challenging times, she reveals, “There were days I couldn’t leave the house.”
Having concluded a long marriage that culminated in divorce, Orcutt reveals that her current contentment derives from her life with her “hillbilly” partner, residing near a small town at the core of Appalachia, positioned an hour’s drive to the south of Charleston, the state capital. Yet, certain triggers, such as the wail of an ambulance siren or the loss of her potbellied pig, retain the capacity to kindle persistent feelings of sorrow.
Orcutt’s experience is far from isolated within her county, where nearly everyone encounters either personal experience or acquaintances confronting depression. This assertion stands as no exaggeration.
A recent report released by the Centers for Disease Control and Prevention (CDC) in June indicated that Logan County, West Virginia, the subject of this exploration, boasts the highest rate of diagnosed depression among adults in the United States. An estimated 32% of adults in the county have received a depression diagnosis, nearly twice the national average, reflecting the results of a survey encompassing nearly 400,000 participants conducted in 2020.
The data underscored significant geographical disparities, revealing variations in depression rates across regions and even within states. Most counties registering the highest rates are situated within a 13-state belt enveloping Appalachia, the southern Mississippi River Valley (including Arkansas, Louisiana, and Tennessee), along with Missouri, Oklahoma, and Washington. In stark contrast, states such as California, Illinois, Alaska, and Hawaii reported the lowest rates.
Of note, West Virginia, a state confronted with elevated poverty and subpar health indicators, lays claim to eight out of the top ten counties with the highest estimated rates of adult depression as delineated by the CDC survey.
Nationwide, 18% of adults in the United States have disclosed lifetime diagnoses of depression, as affirmed by the CDC survey. Health professionals assert that the prevalence of depression in the U.S. has surged to epidemic proportions over recent decades, an issue exacerbated by the COVID-19 pandemic, characterized by isolating public health measures, a looming threat of severe illness, enduring health ramifications, and a sobering death toll.
Acknowledging the escalating depression rates, the Biden administration has unveiled plans to expand access to mental health care.
Parallel surveys substantiate the CDC findings, accentuating the alarming prevalence of depression.
Beyond Merely Feeling Blue
Depression transcends mere emotional despondency, embodying a mood disorder marked by sustained feelings of melancholy and the erosion of interest in activities once cherished. It resonates across eating habits, sleep patterns, concentration, and everyday pursuits such as professional work or academic engagement.
Dr. Mark Miller, a professor specializing in psychiatry at West Virginia University in Morgantown, underscores depression’s propensity to manifest as a chronic ailment. He attributes the state’s low health standings, suboptimal education levels, pervasive poverty, and the acutely damaging opioid crisis that has disproportionately affected West Virginia to the substantial impact on residents’ mental well-being.
In the context of Logan County, where nearly one-quarter of its 31,000 inhabitants grapple with poverty, residents display little surprise upon learning that their community claims the top spot in terms of depression rates. Marie Tomblin, stationed at the front desk of a local Holiday Inn Express & Suites, asserts, “You’ve come to the right place for depression.” She adds that acknowledging the issue remains a challenge, citing both personal and familial encounters with it.
Logan County, nestled in the Appalachian coal-mining sphere, has witnessed the coal industry’s dwindling stature due to economic and regulatory pressures, resulting in the loss of numerous jobs. In the county seat of Logan, a downtrodden ambiance is palpable, with numerous closed establishments and scant pedestrian activity even on a weekday morning.
The county’s pronounced prevalence of chronic conditions such as diabetes and obesity exacerbates its susceptibility to depression, according to health experts.
Surge in Depression Treatment
Amidst the nationwide increase in depression rates, Medicare claims data underscores a parallel surge in depression treatment in West Virginia, particularly in Logan County. Nationwide, original Medicare enrollment witnessed a rise in the proportion of recipients receiving depression-related care, from 16% in 2012 to 18% in 2020, despite an overall decline in healthcare utilization triggered by the pandemic.
Logan County recorded an even more pronounced rise, with 28% of Medicare enrollees receiving depression-related care in 2020, compared to 21% in 2012. In parallel, these figures align with the CDC study, solidifying the county’s status as a focal point of heightened depression care.
However, the prevalence of depression treatment in the region does not equate to a deluge of individuals seeking help. Dr. Robert Perez, an internist practicing in Logan, estimates that over half of his patients grapple with depression. Nevertheless, most are reticent to acknowledge the issue or accept referrals to psychiatrists, reflecting the limitations in treatment delivery.
David Brash, the CEO of Logan Regional Medical Center, notes that the area’s elevated depression rates don’t take healthcare professionals by surprise. While the medical center lacks an on-site team of psychiatrists, its primary care physicians incorporate depression treatment within their practice. The center has recently instituted telepsychiatric consultations to augment its emergency room services.
Challenges of Treatment and Acceptance
Diana Barnette, President of the Logan County Commission, attributes the rampant prescription of medications for depression to a lack of comprehensive treatment options. While acknowledging the prevalence of depression, she contends that patients are often too swiftly directed towards pharmaceutical solutions. Notably, Barnette, who possesses an array of businesses in the county including a movie theater, also highlights the region’s cloud-covered, rainy weather and its role in limiting residents’ exposure to sunlight.
Michael Baker, a pharmacist at Aracoma Drug Company, substantiates the persistence of stigma surrounding mental health issues. Chris Palmer, an assistant professor of psychiatry at Harvard Medical School, dismisses the assertion that overprescription or climatic conditions contribute to the area’s elevated depression rates.
Within this milieu, signs of progress are discernible. The pandemic’s cessation has been embraced by the majority of residents, and the state has harnessed its tourism motto, “Almost Heaven,” inspired by a renowned John Denver melody. Furthermore, the region’s economy is gradually transitioning away from coal, with an increased emphasis on marketing wooded trails to all-terrain vehicle enthusiasts.
In June, the month coinciding with the CDC’s findings release, Coalfield Health Center, a federally funded clinic, welcomed David Lewis, its first psychiatrist, to its ranks. Lewis, a native of Logan County, views the appointment as transformative, given the relative dearth of local psychiatric resources. Having attended to approximately 50 patients thus far, he recognizes the potential for broader impact.
Lewis underscores the novelty of accessing local psychiatric resources, indicating that patients have grown accustomed to seeking psychiatric assistance in larger locales such as Charleston. He acknowledges that in a region where mental health assistance is frequently perceived as indicative of weak faith, the stigma surrounding mental health care persists.
Kristin Dial, Executive Director of Coalfield Health Center, laments the high no-show rate for psychiatric appointments, underscoring the urgent need for support. Dial asserts that only a fraction of those in need of depression treatment are currently receiving it. Her perspective reflects the prevailing sentiment that readiness for help remains a critical determinant in effectively addressing depression.
The Multi-Faceted Approach to Treatment
Lewis advocates a holistic approach to depression treatment, emphasizing the significance of diet and exercise, while minimizing reliance on substances like drugs and alcohol. However, he acknowledges that patient preferences often prioritize medication over other strategies.
Coalfield Health Center has enlisted nurse practitioner Elice Hinkle, who recently concluded counseling training. Capitalizing on her established rapport with patients, Hinkle positions herself as a bridge to counseling services, a role accentuated by her capacity to collaborate with a patient’s existing care providers.
Meanwhile, Orcutt continues her own journey. Engaged in pursuits such as sculpting and painting, she adheres to her self-constructed coping mechanisms. She contends that her involvement in hobbies fosters resilience against depression and anxiety.
The persistent stigma surrounding mental health concerns is evident, particularly in the mountains of Logan County, where clouds obscure the sky, both literally and metaphorically.
