Rates of depression in Appalachia are startling; persistent stigma keeps residents from asking for help

Logan, West Virginia, is the largest town in Logan County.
(Photo by Phil Galewitz, KFF Health News)

Depression is a painful mental health disease that can prevent people from participating in daily life. However, admitting to mental depression is still stigmatized even in places like West Virginia and its surrounding Appalachian states where the disease is most concentrated; asking for help is one of the biggest problems, Phil Galewitz of KFF Health News reports. “An estimated 32% of adults in Logan County, W.Va., have been diagnosed with depression — the highest rate in the United States and nearly double the national rate, according to a report released in June by the Centers for Disease Control and Prevention.”

Logan County, W.Va. (Wikipedia)

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 within states,” Galewitz writes. Almost all the counties with the highest rates were Appalachia. . . . “West Virginia, which also has some of the nation’s highest rates of poverty and poor health, is home to eight of the 10 counties with the highest estimated rates of adult depression, the CDC survey found.”

Depression is an insidious disease. “It’s a mood disorder that causes a persistent feeling of sadness and a loss of interest in things once enjoyed. It affects eating, sleeping, concentrating, and activities such as working or going to school.” Mark Miller, a psychiatry professor at West Virginia University, told Galewitz, “Depression is often a chronic illness, and if you stop treatment, it eventually comes back.” Galewitz adds, “He said his state’s combination of poor overall health, low education levels, and poverty — as well as the opioid epidemic, which has hit West Virginia particularly hard — takes a punishing toll on residents’ mental health.”

“In Logan County, nearly a quarter of whose 31,000 residents live in poverty, few expressed surprise when told their home tops the list of most depressed counties,” Galewitz adds. And yet, medical professionals in Logan County are not busy giving mental health referrals or treatment. “Robert Perez, an internist in Logan, estimates more than half of his patients have depression. But he said few want to talk about it or accept a referral to a psychiatrist, and he is limited in what he can do for them.” Perez told Galewitz, “It’s hard to convince people who don’t want to be helped. I don’t have that much time to treat their depression.”

People can also harbor beliefs that asking for help means they’re lacking faith in God or that persistent unhappiness can result from cloudy weather. Galewitz writes, “Indeed, Chris Palmer, an assistant professor of psychiatry at Harvard Medical School, said the notion that cloudy weather explains high depression rates does not help the problem. That viewpoint ‘strikes me as a hopeless and nihilistic attitude, that we are drowning and there is nothing we can do about it,’ he said.”

“In June, the same month the CDC released its findings, Coalfield Health Center, a federally funded clinic in the county, announced it had hired its first psychiatrist, David Lewis,” Galewitz reports. “Lewis, who grew up in Logan County and taught high school math here, said he has seen about 50 patients so far and knows he has room to see more. . . . Coalfield is struggling to overcome the stigma and other treatment obstacles around depression.”