The holidays can be emotionally difficult for many people. Here is a 'prescription' to help navigate the season ahead.

Teens and older adults are more likely to
face holiday loneliness. (Unsplash photo)

The holidays can be a source of good family times and celebration, but for many people the season is marked by severe loneliness and depression. With some inspiration from the U.S. Surgeon General's 5-for-5 connection challenge, Dr. Trisha Pasricha gives her 5-step "prescription to combat loneliness during the holidays" in her medical opinion for The Washington Post. "Even if you don’t feel lonely, try this challenge. You may be surprised by how much closer to others these small acts bring you over the next five days." To get readers started, the first three are shared below.

Day 1: Reach out to a former teacher or mentor and thank them.
I was recently at a wedding reflecting with others about all the teachers, friends and colleagues who have no idea how much they meant to us. Would they find it strange that we messaged them simply to express gratitude? I called my high school French teacher. She was as delighted as she was delightful. I found out she had retired but still loved to volunteer at my old school. She couldn't believe I was a physician. Today, thank someone. . . .and tell them how they influenced your life for the better.

Day 2: Join a group activity.
Whether you go into it with a friend or alone, sign up for a group activity to do for a few weeks. Get a ClassPass for aqua aerobics, plan a month of yoga in the park, or find a neighborhood book club. Choose something that gets you outside the house for part of your day. And if you're debating what to give someone this holiday, consider gifting an activity you'll do with them. It opens the door to a new community and is more valuable than any pair of cozy socks.

Day 3: Call a relative or friend you haven't spoken to in a while.
On my last birthday, a widowed uncle I've honestly never had much contact with called out of the blue to wish me happy birthday. It became one of the loveliest conversations I had that day as he asked all about my kids, and I learned he had an adorable new dog. Now, he and I text every month. Today, think about someone you've drifted away from and wish them a happy holiday season. 

Read Dr. Pasricha's full prescription here.

Another item to keep in mind: The people at greatest risk of loneliness are adolescents and older adults, those with poor physical or mental health, people living alone and single parents. Seek help if you are struggling during the holiday season and talk to a trusted friend, family member or physician, or call or text the 988 crisis line, which provides 24/7, free and confidential support for people in distress.

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.”

A look at the little-known, but critical, work of Depression-era Black workers in the Civilian Conservation Corps

Black CCC workers built a bridge at White River National Wildlife Refuge in Arkansas. (CCC photo)

Just in time for Black History Month, Dan Chapman of the U.S. Fish and Wildlife Service provides a look at the little-known history of Black workers—many of them from rural areas and working in rural areas—in the Depression-era Civilian Conservation Corps.

FWS archaeologist Richard Kanaksi is compiling information about their role in creating national wildlife refuges across the South, hoping to highlight the "major, yet largely hidden role played by African-Americans in rebuilding this country from the depths of the Great Depression," Chapman reports. Read more here.

Pandemic roundup: anxiety and depression skyrocketing, why reopening restaurants is a terrible idea, and more

Here's a roundup of some of the pandemic and vaccine-related news stories we've seen this week:

Millions of counterfeit N95 masks have been distributed to health-care workers. Read more here.

A sluggish vaccination program could delay a return to normal and invite vaccine-resistant coronavirus variants to emerge. Read more here.

Many rural clinics are having a hard time coping with the increased demands of mass vaccinations. Read more here.

What if we never reach herd immunity? Vaccines can still help. Read more here.

Why re-opening restaurants is a terrible idea. Read more here.

South Texas lawmakers want a vaccine hub for underserved rural border communities. Read more here.

Online vaccination signups cater to the tech-savvy, leaving out many. Read more here.

Depression and anxiety have skyrocketed during the pandemic. Read more here.

Snug-fitting and double-layered masks can help reduce coronavirus transmission. Read more here.

Pandemic stress could prompt spike in rural mental health problems and suicides; see county-level estimates

Estimated additional deaths of despair between 2020-2029 (Click the image to enlarge it)

Mental health issues and deaths of despair, or those caused by depression-related suicide or substance abuse, have been increasing over the past decade, but stress from the pandemic could cause a spike in such deaths, according to a recent paper by the Well Being Trust, a mental health and substance abuse research nonprofit, and the Robert Graham Center, a primary care research organization affiliated with the American Academy of Family Physicians.

An increase in deaths of despair could disproportionately affect rural residents, who are at a higher risk of such deaths. Racial and ethnic minorities and people with lower incomes are also at higher risk, especially those with more than one risk factor.

The paper considers nine possible future scenarios, including ones with quick economic recovery, slow economic recovery, and somewhere in between, along with other factors. The fastest recovery could result in an additional 27,644 deaths of despair, and the slowest recovery could lead to an additional 154,037 deaths of despair, according to the paper.

The authors suggest ways to mitigate the increase in deaths of despair, including finding ways to decrease social isolation. Read more here.

Iowa program to help farmers struggling with mental health in the pandemic; national resources listed

"Studies have found the rates of mental illness and suicide are higher for farmers. They work long hours, have limited social contact and are at the mercy of factors such as weather. Now the covid-19 pandemic is creating even greater challenges to their livelihood—and mental health," Natalie Krebs reports for Side Effects, a news collaborative that covers public health.

Iowa Concern, an Iowa State University extension program that helps farmers with financial, legal and mental-health concerns, is creating a state-funded initiative effort to help with pandemic stresses.

Many Midwestern farmers were already facing financial problems before the pandemic because of the trade war with China and more than a year of very wet weather. The pandemic has caused more problems, such as inability to sell crops or get livestock to slaughterhouses, and the stress of having to euthanize healthy animals. "In the Midwest, more than 300 family farms filed for bankruptcy in the 12-month period that ended in March. That was a 42 percent jump," Krebs notes.

One expert told Krebs that increased depression and stress could lead many farmers to experience post-traumatic stress disorder, and that more may abuse alcohol and/or try to harm themselves, but many find it hard to seek help because so many feel their identity is tied to endurance and hard work.

The new Iowa Concern initiative will direct farmers to mental-health resources. For those in other states, here are some farmer suicide prevention and mental-health resources:

• National Suicide Prevention Lifeline: 1-800-273-8255 (24 hours)
• Crisis Text Line: 741-741 (24 hours)
• Farm Aid farmer hotline: 1-800-327-6243 (Monday through Friday, 9 a.m.-5 p.m. Eastern)
• National Farmers Union Farm Crisis Center
• Suicide warning signs: American Foundation for Suicide Prevention

Poor, rural moms with chronic depression may face greater health problems, according to new study

For rural moms with low incomes, chronic depression may be correlated with an increased incidence of other health problems, according to a newly published study.

Researchers from Washington State University analyzed three years' worth of data about 23 mothers with clinical depression, gathered from the ongoing, multi-state Rural Families Speak project. "The findings, published in the Journal of Family Social Work, show that moms who were chronically depressed experienced more health problems, distrusted doctors and had a worse outlook on their lives, compared with moms whose symptoms improved. The mothers’ depression also affected those closest to them," Traci Pedersen reports for Psych Central.

Moms who were chronically depressed and moms who were depressed but improving faced similar struggles in parenting. "However, chronically depressed moms faced greater challenges in dealing with their children’s emotional and behavioral issues, which were often compounded by a lack of childcare options, employment, concerns for delinquent behaviors and day-to-day behavioral management issues," Pedersen reports.

Maternal depression affects the whole family, said Dr. Yoshi Sano, an associate professor at Washington State who leads the Rural Families Speak project and was also the lead author of the paper. "Mothers are one of the main supports of the family, Sano told Pedersen. "They’re raising children, paying bills, and organizing events. When they’re depressed, the entire family is impacted."

Though policymakers often focus on physical health as an obstacle to self-sufficiency for low-income people, mental health is the biggest obstacle for moms and affects everything from family life to employability. But stigma and distrust of health care professionals is a roadblock to treatment, Sano said.

However, mental health access can be limited in rural areas, Tyler Harris reports for Nebraska Farmer. And women who live on farms often face added mental health burdens, said Tina Chasek, associate psychology professor at the University of Nebraska.

"Women in agriculture are sometimes called third-shift workers," Chasek told Harris. "They work outside the home to provide a steady income and insurance benefits. Then they take care of the family and work on the farm, in addition to being social support. So, they have three jobs. If a male farmer is going to talk, it's usually to his wife. Women on the farm often take care of everybody's emotional needs. So, there's a huge burden on them as well."

The Rural Health Information Hub has a Rural Suicide Prevention Toolkit with links to resources that can help rural policymakers implement suicide prevention programs. Click here to access it.

Stringed-instrument school in southeastern Kentucky helps give recovering opioid addicts a sense of purpose

Doug Naselroad works on a dulcimer.
(Photo from Appalachian School of Luthiery)

"With the opioid epidemic spreading across the country, programs are coming up with unique ways to help recovering addicts. One program in Kentucky is using Appalachian music and culture to heal," Tomas Hoppough reports for Scripps Media.

Every week at the Appalachian School of Luthiery in Hindman, Doug Naselroad teaches students of all ages how to make traditional stringed instruments like banjos, mountain dulcimers, guitars and more. Some of those students come from a nearby drug rehabilitation center.

Naselroad believes that teaching a hands-on craft like luthiery can give people a purpose and help subvert the despair that often leads to opioid abuse. Opioid abuse "has to do with filling your hands with the wrong thing because the right thing hasn’t come along yet for you to do," he told Hoppough. "We offer these individuals a way to focus on something other than their drug problem."

Hindman, in Knott County. (Wikipedia map)

Recovering opioid addict Jeremy Henne agrees. He told Hoppough that he became addicted after a doctor prescribed him opioids for back pain. Learning luthiery "really gave me a sense of direction, a sense of purpose," he said.

Naselroad said he also hopes that learning luthiery will help recovering addicts to appreciate traditional local culture more and inspire a sense of pride in being Appalachian. "There’s a lot that’s precious and excellent about Appalachian culture and we need people to understand that’s what we’re working toward," he told Hoppough.

Study links auto-plant closures with upticks in opioid deaths

Counties included in this study; click the image to enlarge it.

A newly published study found a strong link between the closure of automotive factories and opioid-related deaths nearby, Nicole Karlis writes for Salon.

The researchers gathered data on opioid-overdose and related deaths in 112 counties near major auto manufacturing plants between 1999 and 2016. During the studied period, 29 counties had a nearby auto plant close. "Researchers found that in those counties where automotive assembly plants had closed five years earlier, opioid deaths were about 85 percent higher among people between the ages of 16 and 65 compared to counties where such plants remained open," Karlis reports.

The authors emphasize that the auto-plant closures, and the despair they bring to laid-off workers and their families, are not the only cause of opioid overdoses. The prevalence of prescription opioids is also a key factor, Karlis reports. The researchers write that they hope the study will raise awareness of some of the underlying causes of the opioid epidemic, and recommend policies that work to reduce both prescription and illicit opioid supply as well as increased diagnosis and treatment of substance-abuse disorders.

Extending Medicaid pregnancy coverage could save lives; 'We actually abandon women after delivery,' doctor says

States with extended Medicaid pregnancy coverage, categorized. California's
extension only covers women with mental-health needs, and Missouri's would
would only cover drug-addicted women. (Stateline map; click on it to enlarge)

Medicaid pregnancy coverage pays for nearly half of all births in the U.S., and rural women rely on it more than others. But it expires 60 days after childbirth, leaving many women without health insurance when they're at a higher risk of dying: about 700 American women died from pregnancy-related health issues in 2016. Rural women have a higher risk of poor birth outcomes.

"Nationwide, drug overdoses, suicides and pregnancy-related chronic illnesses such as diabetes, heart disease and high blood pressure are contributing to a rise in deaths among women during pregnancy, childbirth and the first 12 months after delivery," Christine Vestal reports for Stateline. "According to the U.S. Centers for Disease Control and Prevention, three out of five of those deaths could be prevented with adequate medical attention." Women can reapply for Medicaid as a parent after pregnancy coverage lapses, but the income limit is usually much lower, so many women don't qualify.

Some state and federal policymakers are trying to lengthen Medicaid pregnancy coverage. A bipartisan bill in Congress would give states incentives to extend such coverage to a full year after delivery by cutting red tape and increasing federal funding by 5 percent, Vestal reports. Lawmakers in at least six states (California, Illinois, Missouri, New Jersey, South Carolina and Tennessee) are considering extending Medicaid pregnancy coverage to a full year after delivery, and health agencies in Georgia, Texas, Utah and Washington and recommending similar changes.

Maternal mortality rates, which include deaths during and up to a year after pregnancy, are higher in the United States than in other developed nations. "And while pregnancy-related death rates have been dropping worldwide, they’ve more than doubled in the United States in the past 30 years, rising from 7 deaths per 100,000 live births in 1987 to 17 in 2016, according to the CDC," Vestal reports. "The opioid crisis is a contributing factor. Opioid addiction among pregnant women has quadrupled in the past 20 years, the CDC said."

Women with substance abuse disorders generally do well during pregnancy if they have access to social services and health care, but "Where things fall apart is postpartum," said Mishka Terplan, an obstetrician-gynecologist affiliated with the University of California at San Francisco. "We actually abandon women after delivery."

Telepsychiatry helps rural areas access mental health care, but lack of broadband can limit reach of telehealth in general

Telemedicine can help bring mental-health care to rural areas and improve doctor recruitment, as one company's adoption of the practice shows. Meridian Health Services in Indiana increased its investment in telepsychiatry over the past six months, partly because of the opioid addiction crisis, Yuki Noguchi reports for NPR. There's also a big financial incentive to expand to rural areas, since Medicare and Medicaid pay more for care in under-served areas.

Meridian patients drive to local offices where a nurse takes their vitals and establishes a secure video call to a psychiatrist in Indianapolis. According to one patient, interacting with the doctor via computer screen feels more comfortable and less confrontational: "It's easier because they're not there, so I feel like I can tell more, and speak more and truly just be fully real," the patient told Noguchi. "If they're sitting right there, I might not want to say everything or say as much."

Telehealth can expand access to mental-health care in rural areas, where the geographic isolation otherwise "exacerbates a vicious cycle," Noguchi reports. "A shortage of doctors means patients can't get timely care. The health system atrophies, and doctor recruitment gets even tougher."

Almost all states provide some type of Medicaid coverage and reimbursement for telehealth, and 39 states have some kind of private payer policy, according to a recent report from the National Conference of State Legislatures. However, many rural regions can't access telehealth services because they lack broadband infrastructure, Richard Craver reports for the Winston-Salem Journal.

Firearm suicide prevention efforts are tricky in rural Utah

Robin Hatch hands out gun socks with a suicide prevention
hotline printed on them. (KUER photo by Erik Neumann)

Firearms account for just over half of all suicide deaths, but trying to prevent use of guns for suicide can be difficult in rural areas, where firearms are part of the local culture.

Suicides by gun are much more common in rural areas, mostly because of easier access to firearms. It's a particular problem in Utah, which has one of the highest suicide rates in the nation, and especially in rural northeastern Utah, which has a suicide rate 58 percent higher than the rest of the state. Guns are a popular means of suicide in Utah: 85% of the state's firearm deaths are suicides, and suicide attempts with guns are far more likely to be successful, Erik Neumann reports for NPR.

Because guns are so popular in Utah, efforts to prevent suicide have mostly focused on increasing gun safety with devices such as free gun locks, expanding mental-health and crisis-response programs in rural areas, and promoting awareness among locals about when and how to intervene if they see someone at risk of suicide, Neumann reports. 

Dee Cairoli is a pastor who teaches concealed-carry classes on the side. "When hosting classes, Cairoli explains how gun owners can intervene if another gun owner shows signs of a mental-health crisis," Neumann reports. When Cairoli was 15, his father killed himself with a gun, but Cairoli says he never hated or blamed the gun; he focuses on the fact that his father could get a gun in a "desperate moment," and wants other gun owners to understand the importance of keeping an eye on friends.

Republican state Rep. Steve Eliason, who represents suburbs near Salt Lake City, has sponsored several bills focused on firearm safety, suicide prevention, and mental health. Eliason also has been touched by gun tragedy; three young male relatives have been firearm suicides. He told Neumann he has been careful to focus on safety and not restricting gun rights, since guns are so popular.

Counselors from Northeastern Counseling Center, in the northeast Utah community of Roosevelt, are more pointed. They have a table at a local gun-and-knife show to give out safety goodies meant to slow someone considering suicide in a moment of crisis: cable locks and gun socks with the National Suicide Prevention Lifeline phone number printed on them, Neumann reports. As they hand out the swag, they strike up conversations. One counselor, Robin Hatch, told an attendee: "Lethal access to lethal means makes a difference. Suicide attempts by any other means are less lethal."

Hatch told Neumann, "Anything that we can do to get people off track a little bit, thinking something different. We believe that will help make a difference in our suicide rates."

Study finds that adverse childhood experiences increase risk of opioid addiction, relapse after treatment

A newly published study quantifies how trauma experienced during childhood, called adverse childhood experiences, can lead rural people to become addicted to opioids. Common ACEs include having an alcoholic or depressed parent, and being abused or neglected.

Researchers from the University of Tennessee and the University of Memphis conducted an in-depth study of 87 patients seeking opioid addiction treatment at a rural medical clinic. All the patients were white and 75 percent were male; almost half of them reported four or more adverse childhood events. A higher number of ACEs correlated to an increased risk of addiction relapse: every additional ACE increased the odds of relapse by 17%, according to the study.

On he other hand, each treatment visit reduced the odds of a relapse by 2%. Relapses occurred in 54% of patients, and the highest relapse rate happened after the first clinic.

Lead author Karen Derefinko said the study shows the lasting impact of ACEs, Jane Stevens reports for ACEs Connection.

"This study will help practitioners understand the importance of providing trauma-informed treatment," Derefinko told Stevens. "Because of the stigma associated with drug use, it’s hindered health care workers’ understanding of why people use drugs and has led to an assumption that they’re bad people. This shows that trauma-informed care and providing resources does impact how well people can do. It’s also validating for patients and gives them a lot of hope."

Study shows link between frequent exposure to insecticides and a higher risk of depression and anxiety in teenagers

Teenagers with frequent exposure to the most widely form of insecticide may have an increased risk of depression, according to a study published in the International Journal of Hygiene and Environmental Health.

The study was conducted in Ecuador by Dr. Jose Suarez-Lopez, an assistant professor at the University of California-San Diego. He and colleagues "have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008," a university press release said. "Ecuador is the world’s third-largest exporter of roses, with much of the flower production located near the homes of participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system."

Researchers measured blood levels in 11- to 17-year-olds of an enzyme that is inhibited by organophosphates. Studies in mice had shown that reduced levels of the enzyme were linked to "behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link," the release says. "However, pesticide exposure assessment in past studies had been only established by self-report of exposure and not using biological measures."

The study found that teens who had reduced enzyme levels, suggesting greater exposure to , showed higher-than-normal symptoms of depression. "The association was stronger for girls, who comprised half of all participants, and for teens younger than 14," the release says. It quotes Suarez-Lopez:  “Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies. This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study.”

Suicide and drug overdoses, of which rural people are at more risk, help decrease average life expectancy in the U.S.

Age-adjusted suicide rates by county urbanization level. (CDC chart; click on the image to enlarge it)

An increase in suicide and drug overdoses, of which rural areas have more than their share, has pulled down life expectancy in the United States. "Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the federal Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago," Mike Stobbe reports for The Associated Press.

The U.S. saw more than 47,000 suicides last year, making for the highest rate in at least 50 years, Stobbe reports. The rate was higher at all levels of urbanization in 2017 than it was in 1999, but it increased more in rural areas, and the more rural a person, the higher their risk for suicide. The age-adjusted suicide rate for the most rural counties in 2017 was 53 percent higher than the rate in 1999, according to the CDC figures. The age-adjusted suicide rate for the most rural counties was 1.4 times the rate for the most urban counties in 1999; in 2017 it increased to 1.8 times the rate.

What's causing the increase in suicides and drug overdoses? Dr. William Dietz, a disease prevention expert at George Washington University, told Stobbe that financial struggles, a widening income gap and divisive politics are driving Americans to despair: "I really do believe that people are increasingly hopeless . . . That leads to drug use; it leads potentially to suicide."

A survey of more than 115,000 voters conducted by AP buttresses Dietz's opinion: "About half of voters nationwide said they expect life in America for the next generation to be worse than it is today. Nearly a quarter said life would be better and about as many said it would be the same," Stobbe reports.

Disability benefits are nearly twice as common in rural areas, and they can deepen a cultural divide

From 1996 to 2015, "the number of working-age adults receiving federal disability payments increased significantly across the country — but nowhere more so than in rural America," The Washington Post reports in the latest piece of a series on "how disability is shaping the culture, economy and politics" of 102 rural counties "where, at minimum, about one in six working-age residents receive either Supplemental Security Income, a program for the disabled poor, or Social Security Disability Insurance for disabled workers. These are places — primarily white, rural and working-class — where once-dominant industries have collapsed or modernized and the number of people who are jobless or receiving public-assistance benefits has soared."

Tyler McGlothlin and his mother, Sheila
(Washington Post photo by Linda Davidson)

One of those places is Grundy, Va., near where the Old Dominion meets Kentucky and West Virginia, and one of those families is the McGlothlins: a father who became disabled in the coal mines, became addicted to painkillers and is now in jail for selling them; a mother whose disability check isn't enough for her household, which includes her son's fiance; and the son, who got fired from McDonald's for "missing a shift during a snowstorm," then totaled his car and had to drop out of community college, and now begs for money -- following in the footsteps of his father, who was confronted personally and on social media by a neighbor who was offended when the disabled miner wouldn't accept a job offer, Terrence McCoy reports.

McCoy gets into the head of Sheila McGlothlin: "She had wanted something more for him, something other than what she felt most days: shame. She knew how she must look, in her pajamas and mismatched socks, to people who work. She knew what they must say about her disability: It’s only anxiety, only depression. Why couldn’t she work? Why did she buy soda and cigarettes when they needed food? How could she afford the Internet and cable TV bills on a $500 monthly disability check? She would sometimes consider how she would answer. She would say that cigarettes and soda make hard days a little easier. That television is just about her only connection to a world that hasn’t seemed to want her anymore. But it’s simpler to say nothing at all, so she rarely leaves the house now."

Disability has become so prevalent that the federal government will spend more on it this year than food stamps, welfare, housing subsidies and unemployment, combined, and the programs are running out of money, the Post reports. In rural counties, 9.1 percent of working-age people are on disability — nearly twice the urban rate and 40 percent higher than the national average. In Buchanan County, where Grundy is the seat, one in four adults are on SSI or disability, but that doesn't mean it's a broadly popular pursuit. “There is a critical divide in the minds of low-income whites, between people who work, even if they struggle, and what has historically been called ‘white trash’,” University of California, Davis professor Lisa Pruitt, who researches rural poverty and grew up in Newton County, Arkansas, which has one of the nation’s highest disability rates, told McCoy. “The worst thing you can do in rural America among low-income whites is not work.” The a mentality, she told him, is that “only lazy white trash” accept “handouts.” A poll by the Post and the Kaiser Family Foundation confirmed that such feelings are more common in rural areas:

CDC study says rural suicide rates outpacing urban ones, suggests possible link to rise in opioid use

U.S. suicide rates are growing faster in rural areas than urban ones, says a study by the Centers for Disease Control and Prevention. The study, which used annual county-level mortality data from the National Vital Statistics System and U.S. Census Bureau to analyze suicide rate trends from 1999-2015, found that after declining since 1986, the U.S. suicide rate increased from 2000-15, with 600,000 suicides during the study period.

Researchers wrote: "Geographic disparities in suicide rates might be associated with suicide risk factors known to be highly prevalent in less urban areas, such as limited access to mental health care, made worse by shortages in behavioral health care providers in these areas, and greater social isolation. Such disparities might also reflect the influence of the opioid overdose epidemic. This epidemic is known to have disproportionately affected less urban areas during the earlier part of the study period and opioid misuse is associated with increased risk for suicide."

The study found that "it's also possible that economic pressures may have played a role," Margaret Farley Steele reports for HealthDay News. "The biggest increase in the suicide gap occurred beginning in 2007-2008, when the U.S. economy was experiencing a severe recession." Researchers also noted a lack of health care providers in rural areas. (CDC graphic: Suicide rates from 1999-2015)

Youth suicide is increasing in rural areas but declining in metros; Utah paper takes a look

Youth suicide rates are higher in rural areas, where young people often deal with isolation, limited transportation, a lack of mental-health providers, the stigma of undergoing mental-health care, more access to guns, and high rates of poverty and substance abuse, Lois M. Collins and Lauren Fields report as part of a series on teen suicide for the Deseret News in Salt Lake City.

A Utah Department of Health report found that suicide is the leading cause of death among the state's residents 10 to 17. The state ranked eighth nationally in youth suicide in 2012-14, with rates tripling from 3 per 100,000 people in 2007 to 8.5 in 2014, says a separate health department report. "Fourteen percent of teens say they’ve thought about suicide, while nearly a thousand a year survive self-harm or suicide attempts (not necessarily the same thing), some living with varying degrees of damage." (Deseret News graphic)

The problem is greatest in rural areas, reports the Deseret News. "A 2015 study comparing teen and young adult suicides in all U.S. counties from 1996-2010 showed suicide rates in rural communities were nearly double those of urban areas—and the gap is increasing." (Deseret News graphic)

"Experts theorize that the same features that make rural life special can be both protective and risky: Wide-open space is great if you’re riding horses, but awful if you’re trying to reach a mental health specialist," reports the Deseret News. "A tight knit church community is life-affirming, unless you feel you aren’t included. And it’s nice to know everyone until you’d like some privacy."

A 2014 Pew Research Center report found in rural areas 51 percent of households own a gun, compared with 36 percent of suburban and 25 percent of urban homes, reports the Deseret News. An American Foundation for Suicide Prevention report found that "firearms were the most common suicide method in 2014, accounting for half of U.S. suicide deaths." Kimberly Myers, co-chair of the Utah Suicide Prevention Coalition and prevention coordinator in Utah’s Division of Substance Abuse and Mental Health, said "gun owners are not more likely to try to kill themselves, but guns are especially lethal so there’s less opportunity for rescue."

Experts warn of latent mental health concerns following fires like the ones in Smoky Mountains

Trevor Cates stood amid the ruins of the fellowship hall of Banner
Baptist Church, which he attends, at Gatlinburg. (Getty Images)

Survivors of fire, in addition to facing the long road to recovery from structural damage, are often in need of mental-health services, experts tell Jeff Martin of The Associated Press. "In some ways, escaping a fire-filled forest as thousands did recently in and around Gatlinburg, Tenn., can be more traumatic than hurricanes, floods or earthquakes," Martin reports. "One reason: Flames spread so rapidly that people had no time to prepare."

Becky Stoll, vice president of crisis and disaster management at Centerstone, one of the nation's largest behavioral health care providers, told Martin, "To have your life turned upside down is much more difficult than if you had time to brace for it, and in this case I don't think people had time to brace for it." Also, the visual image of seeing the flames causing damage can be hard to shake, said Valerie Cole of the American Red Cross.

Cole said that while some possessions can be salvaged from disasters such as earthquakes and tornadoes, a fire usually leaves nothing behind but ashes, Martin writes. She said after a fire survivors typically are thankful they are alive and focus on basic needs, but down the line, maybe six or nine months later, is when people begin to get frustrated or disillusioned. That can cause post-traumatic stress, leading to increased rates of suicide, depression, anger and substance abuse. (Read more)

Prescriptions for psychiatric drugs, most from non-psychiatrists, are partly blamed for rising suicide rate among white, middle-aged women

La Plata County, Colorado (Wikipedia map)

An increase in psychiatric drug prescriptions is being linked to an increase in suicide rates among white middle-age women 45 to 54 working blue-collar jobs, Amy Ellis Nutt reports for The Washington Post in the latest story in a series about the phenomenon. The suicide rate among middle-aged white women increased from 7 per 100,000 in 1999 to 12.6 in 2014. Psychiatric drug prescriptions increased 117 percent from 1999 to 2013.

Colorado ranks fourth nationally for suicide rates among middle-aged white women, Nutt writes. Rural La Plata County, with a population of 53,284, leads the state among counties with more than 30,000 residents. Fourteen middle-aged white women in the county have committed suicide since 2007. A Post analysis "found striking commonalities: Most worked physically demanding jobs. Most suffered from chronic pain. And most struggled with mental-health issues that, surviving friends and relatives say, were addressed through psychiatric medications that were ultimately ineffective."

"The number of prescriptions written by non-psychiatrists also has risen," Nutt writes. "As many as 80 percent of all antidepressant prescriptions are written by physicians who are not psychiatrists, multiple studies have found, and doctors often give the drugs to people who have received no psychiatric diagnosis. Studies also show that the drugs work only about half the time and can produce side effects, such as anxiety and sleeplessness, that mimic worsening symptoms."

"More than half of all counties in the U.S.—all of them rural—have no practicing psychiatrists, psychologists or social workers, according to a 2013 federal report," Nutt writes. "In La Plata County, only one mental-health clinic accepted Medicaid." (Read more)