West Virginians are experiencing mental illness at rates higher than the national average, and it’s even worse in southern West Virginia.
According to multiple studies, Boone and Logan counties have the highest rates of depression in the nation.
Data from the Centers For Disease Control and Prevention show that in 2020 more than 18 percent of U.S. adults reported having ever been diagnosed with depression. In that same period, 27.5 percent of West Virginians reported being diagnosed with depression, the highest in the nation.
The CDC analyzed 2020 Behavioral Risk Factor Surveillance System data to estimate the national, state-level, and county-level prevalence of U.S. adults aged older than 18 years self-reporting a lifetime diagnosis of depression.
In the report, the CDC found that most of the states with the highest prevalence of depression were in the Appalachian and Mississippi Valley regions.
Jessica Bradley is a psychologist at Marshall Health. She said the rates of depression revealed in the June 2023 CDC report were concerning to her as a mental health provider and a citizen.
“The data showed that an estimated 32 percent of adults in Logan County have been diagnosed with depression, which is the highest in the nation,” Bradley said. “And that number for West Virginia was 27.5 percent. But that’s opposed to, I believe,18 percent of adults nationwide. So clearly, we are at a much higher rate. That’s concerning as a provider. It’s also concerning as a citizen because these are, these are our family members. These are my friends. These are people that I care about. And it’s not just numbers, these are humans with stories.”
While the CDC report revealed Logan County as the most depressed county in West Virginia, and the nation, Christina Mullins, commissioner for the West Virginia Department of Health and Human Resources’ Bureau for Behavioral Health, said the CDC’s data was compiled from 2014 to 2020 and cited the newly released West Virginia MATCH Survey as the research her department relies on.
“So what I think is happening, what I think has happened to some degree, is that we’ve all gotten a little worse through the pandemic and but I don’t know that Logan County has gotten as worse as some, as bad, you know, has worsened as much as other areas, because my data is right now is not supporting what’s shown in and that data is valid for the time period that it was collected,” Mullins said.
MATCH is a biennial survey – meaning data is collected every two years. One out of 14 adult West Virginians are randomly chosen to participate using a large database of West Virginia residential addresses. The first survey period was August 2021 to February 2022.
“The data indicators are not exactly the same,” Mullins said. “But I had Logan County as 12th, actually in the state for depression, anxiety or PTSD, PTSD in the last 12 months, at 27 percent. And the state average being 24.3. So they weren’t, they weren’t the worst when I was really looking at the stats.”
According to the West Virginia Match Survey, 27.4 percent of Logan County residents said they had experienced depression, anxiety or post-traumatic stress disorder in the past 12 months.
The highest rate, according to the West Virginia MATCH Survey, was in Boone County, just over the county line, with 32 percent of residents reporting experiencing depression, anxiety, or post-traumatic stress disorder in the past 12 months.
Researchers for the CDC found that rates of depression in West Virginia might reflect the influence of social determinants of health or patterns of other chronic diseases.
“Social determinants are a really broad concept,” Bradley said. “And they start out as anything from food insecurity to parental involvement. Whenever you’re a kid, to job security, and family stressors. on a community level, it looks like the economy and what’s going on the world around you. And that can be extended to just nationwide. So, if you take all of that into consideration, everything is playing apart, and where you are, how you’re feeling about things.”
Boone and Logan counties were coal-producing powerhouses until the nation moved away from coal-powered electricity and the mines began to close.
“One of the symptoms of depression is hopelessness,” Bradley said. “And it’s so much easier to feel hopeless about things, whenever the voices that you hear are telling you that there’s no hope.”
In response to these challenges, Logan County residents are banding together for better health.
The Coalfield Health Center in Chapmanville is part of a group that hopes to address southern West Virginia’s health outcomes. Next to the clinic, Wild, Wonderful and Healthy Logan County (WWHLC) is developing a public greenspace for all Logan County residents.
“We have relationships across our state to try to meet the need in these rural populations because it’s so difficult for it’s so difficult for people to get access to quality services are really just to get access to services period, in the rural settings they have to travel or maybe they don’t have the finances to be able to travel to the big city,” Bradley said. “That’s one of the things that’s so difficult so telehealth has really helped improve that access. And then also people are just willing to do the work to get to these places. And I think that’s a really wonderful thing.”
Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.
**Editor’s Note: A previous version of this story incorrectly said Jessica Bradley is a physiatrist. She is a psychologist.
Debut novelist William Brewer teaches creative writing at Stanford University, but his Morgantown roots have deeply influenced his writing, and even the main character of his new book — "The Red Arrow" — is also a West Virginia native.
Debut novelist William Brewer currently teaches creative writing at Stanford University, but his Morgantown roots have deeply influenced his writing, and even the main character of his new book — “The Red Arrow” — is also a West Virginia native.
Brewer also wrote a highly acclaimed book of poetry that focused on the opioid crisis in West Virginia called “I Know Your Kind.” He will be speaking at Taylor Books in Charleston on Wednesday, Aug. 10.
News Director Eric Douglas spoke with Brewer about the book and growing up in the Mountain State.
This interview has been lightly edited for clarity.
Douglas: Tell me a little bit about the plot of the story in The Red Arrow.
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Poet William Brewer, whose debut novel ?The Red Arrow? will be published by Knopf in 2022. Brewer is also a Jones Lecturer at Stanford University.
Brewer: So the book begins with a narrator sitting on a train in Rome that’s about to depart for the north of Italy. He’s heading towards Modena, a town in the north, hoping to find a physicist that he works for as a ghost writer. He’s working to try to write this guy’s memoir to clear a huge debt he’s gotten himself into. He got into debt by taking a ton of money to write the ‘great West Virginia novel,’ which he sort of BS’d his way into and then quickly realized he had no business doing. So the book begins as the train is leaving the station. And he starts reflecting on how he got himself into this position. And in the meantime, what happens is he reflects on his failed career in the New York art world, a large chemical spill disaster in West Virginia, the phenomenon of psychedelic therapy in northern California. And then lastly, some experience of travel in Sicily and Italy.
Douglas: It’s interesting, you chose the chemical spill. Obviously, some of the facts have changed, but you set it about 20 years previous to the actual water crisis here in West Virginia. Why did you choose that as a seminal event?
Brewer: Something that’s really amazing about being from West Virginia, and then not living there and meeting other people, is they really struggle to believe the number of chemical and environmental disasters that have happened in the state and those disasters keep happening from a relationship with industry. People just don’t believe it’s possible.
They say that there’s no way you could do that. They’re like, I’ve never heard of it, so it couldn’t possibly be true. And so there’s two phenomena there. One is the scale of these events when they happen, and how often they’ve actually happened over the history of the state. If you look up the number of water crises that have happened, it’s quite a long list. But at the same time these things could be so big and so common, and yet people never know about them. And there’s something quite challenging about that in my mind.
The one that I fictionalize is, in some ways, cobbled together from any number of events; a detail from this one, a detail from that one. And the parameters sort of replay themselves over and over again.
I grew up in Morgantown, the river is sort of the central artery of the area. And it’s how you orient yourself. And I think that’s pretty much true throughout much of the state. There’s almost always a river where the towns are. And so when this sort of thing happens to the water, how quickly it has the ability to impact basically everybody’s lives in that town, and then how they each sort of struggle to deal with it in their own ways.
Douglas: I’m interested in your book of poetry as well. Tell me a little bit about that.
Brewer: The first book I wrote was a book of poems. And its main focus is the opioid epidemic in West Virginia. At the time, when I was going from undergrad up through grad school, and when I was writing my first book I was realizing this was happening all around. And I think people in West Virginia knew that this sort of epidemic was taking place, really before much of the nation caught on to it.
I think that was really by design, I think people who were moving these drugs through the state knew that the world wouldn’t notice right away. So I became really interested in that phenomenon and why it was happening. That’s sort of how these pharmaceutical companies treated people in the state in a way that was not unlike how timber treated people, and then how coal for much of its history treated people, which is more broadly to say the relationship between industry, these big industries with a great deal of power, and the people themselves that actually live in these places and have real lives.
Douglas: So what’s the name of the book?
Brewer: It’s “I Know Your Kind,” and it was published by the wonderful publisher called Milkweed Editions
Douglas: How does one make the transition from writing a book of poetry to teaching creative writing to your debut novel “The Red Arrow?”
Brewer: I started reading really seriously when I was about 15. And then I just sort of followed it wherever I went. One of the gifts of growing up in a place like West Virginia is that I was aware at a very early age that I was living somewhere that was vastly different than a lot of other places. And the times when my family would leave and travel to other parts of the Eastern Seaboard, it was very clear to me that where I lived was very different. And I mean that both in the landscape, the very distinct quality of the place, but also the quality of the people and the culture. And also how the state lives in relation to the rest of the country, that it’s this place that the country has been sort of built off the labor of, especially coal.
As a young person, when I would say, “I’m from West Virginia,” people would say, “I have cousins in Arlington.” And I don’t live in a state with Arlington. And so realizing that I was in this very specific part of the country, and yet, it was a part of the country that most of the country didn’t recognize, that piqued my attention at a really young age. And it sort of made me observe really heavily for much of my life. And if you’re going to write stuff, you have to be relatively good at paying attention and seeing the world around you. West Virginia was like a crash course on how to do that.
Douglas: It’s an interesting perspective that forced you mentally to pay attention, to be an observer. And then that extends into your writing.
Brewer: It shows you the relationship between people and where they live. And that’s something that you don’t necessarily get everywhere you go. I’ve certainly been to parts of the country where there’s these vast, sprawling suburbs, and you really could be anywhere. That’s never the case in West Virginia. When you are there, there is no doubt about where you are. And that’s something that I really became interested in.
Douglas: I thought it was interesting you chose a narrator, so the book is in first person, rather than a more traditional third person for a novel. Why did you choose that perspective?
Brewer: For this book, specifically, one of its concerns is how people lose track of reality in their minds. That their perceptions can get the better of them. And specifically, in the case of mental illness. I think the book is definitely interested in depression, but even sort of a kind of hyper awareness and a pressure of anxiety. And these are situations that I think are running rampant in America at the moment. I think the last two years of the pandemic made that all the worse with people being isolated, and strange for their jobs and just their own health.
The book is really interested in how mental illness functions in the mind. One of the ways to do that, to explore that in a book is to really sit squarely in a person’s mind. But the speaker has found freedom from this sort of oppressive depression that he’s lived with for much of his life. One of the ways to do that in the book is have this person speaking from the other side of the sort of burden of depression, which then allows him to reflect on his own mind from within his own mind. It sort of gives the reader the closest examination they can hope for.
Douglas: What haven’t we talked about?
Brewer: One of the blockbuster topics in the book that people are probably starting to learn about is the subject of psychedelic therapy. A documentary that just came out on Netflix called “How to Change Your Mind,” which is based off of the book by Michael Pollan. That book recounts the use of psychedelics towards how they function in the human mind demystifying them as these really, really dangerous drugs, but also showing how they can help people that are undergoing serious suffering.
I’m always interested in how humans change their minds, how they change consciousness. My poetry book relating to the opioid epidemic is part of that. If we look at something like the opioid epidemic, it doesn’t suggest to me that West Virginia has a problem with a lot of people that just want to use drugs. It has a problem with a lot of pain, and it’s a place that’s had a lot of pain put on it. If one drug gives people the power to numb that pain, and those drugs being opiates, the alternative then is these psychedelics, which used in a therapeutic context, are being shown time and time again, at places like Johns Hopkins University, for example, that are running huge studies and have now opened an institute for the study of these chemicals, that they offer immense potential in helping people be alleviated from that suffering.
People want to tiptoe around it as a subject, but my job as a writer is to dive headfirst into it. I based the book off my own experience. It completely changed my life. I encountered it here in northern California, but it’s something that I believe would offer immense help to places like West Virginia, for example, where I think people want help.
Douglas: In the book, you referred to the mist, which is a euphemism for depression, for feeling like you’re kind of walking through a cloud. Tell me a little bit about that.
Brewer: I experienced depression pretty severely for much of my life, and I’d read a lot about it. But in a lot of books, they talk about it in the abstract. Something I wanted to do is make it sort of a presence. That’s certainly how it felt. For me, it felt like this thing that was with me at all times, but was not me. I hoped that it could show people the kind of physical power of it, how it really becomes this thing that interrupts your experience of reality, that anyone who has been around someone who has a really hard walk with depression.
It can be really hard to even get your words to them. By making it this cloud, this misty figure really articulates the physicality, the sort of derangement of it. I live here where there’s the famous Bay Area fog all the time. That’s often a quite common component of life. And in the mountains of West Virginia, there are these foggy, misty mornings that hang on for much of the year. Those always stayed with me. I have very visceral memories of walking to the bus stop through these foggy mornings, and I think I’ve never stopped thinking about them.
Douglas: You went through this psychedelic therapy, and by all accounts, it has changed your own mind.
Brewer: It completely changed my life. It liberated me from the disease of depression. And it taught me a lot about how the human mind works. It sounds to some people very hippie dippie. But it’s the most immense experience I’ve ever had. Besides meeting my wife, easily the most important thing that’s ever happened to me. But it also made the most sense in terms of mental health care of anything I’ve ever experienced. It’s like having open heart surgery on your mind.
West Virginia college counselors are overwhelmed and asking for support from the state legislature. “The counseling center staff are weary, there's no question about it,” Dr. Hawkins said. “Because we’re operating as if we are in a psychiatric emergency room.”
West Virginia college counselors are overwhelmed and asking for support from the state legislature.
Dr. T. Anne Hawkins, director of the West Virginia University (WVU) Carruth Counseling Center, gave a presentation Sunday on mental health in higher education to the Joint Standing Committee on Education.
“College counseling centers, around the state and around the country, are one of the most popular places on the campus,” Hawkins told lawmakers. “And they have been for the last 10 years. We increasingly are seeing more and more students.”
From 2010 to 2020, Hawkins said there was a “dramatic increase” in depression and anxiety amongst West Virginia college students. She noted, however, there was a decline in substance use during that time.
Hawkins said since the start of the pandemic, WVU’s crisis intervention went up by 36 percent. WVU, on average, provides almost 500 counseling sessions a week to students.
“This year, we will have served about 10.7 percent of the student population,” Hawkins said. “This is pretty tremendous. Thirty percent of our clients, our students, report self injury, 31 percent report suicidal thoughts, and 13 percent report a previous suicide attempt. Think about that – 13 percent.”
Hawkins told lawmakers she is “very concerned” about the nature of mental health in college students today.
“The counseling center staff are weary, there’s no question about it,” she said. “Because we’re operating as if we are in a psychiatric emergency room.”
Hawkins recently conducted a survey with some of the state’s college and university counseling centers. She said across the state, counseling center directors want to see more clinicians placed throughout the state.
She urged lawmakers to come up with incentive programs – similar to the state’s nursing and teaching programs – to get more clinicians to stay in West Virginia, receive good pay, and be placed in both K-12 and college institutions to help with the growing need.
“The focus should be decreasing stigma, enhancing and expanding digital and mental health services. We’ve got to work upstream. We’ve got to increase connection and a sense of belonging,” Hawkins said. “We’ve drifted off course, and that was beginning before the pandemic. We’ve got to create a culture that values well being.”
The Centers for Disease Control and Prevention (CDC) reports in 2020, suicide among people ages 10-14 and 25-34 was the second leading cause of death in the nation. That same year, for people ages 10-64, it was among the top nine leading causes of death.
The CDC also reports nationwide, the average anxiety severity scores increased 13 percent from Aug. to Dec. 2020 and then decreased 26.8 percent from Dec. 2020 to June 2021. Similar increases and decreases occurred in depression severity scores, according to the CDC.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 for help.
Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.
New research from West Virginia University suggests too much light, instead of too little, may cause depression in hospitalized individuals.
Researchers Randy Nelson and Courtney DeVries at the Department of Neuroscience in the WVU School of Medicine studied two groups of mice for three nights. One group was exposed to total darkness, while the other was exposed to dim light – the equivalent of a child’s night light.
The researchers found that the mice exposed to the dim light exhibited more “depressive-like” behaviors than the ones that spent their nights in the dark. The mice exposed to dim light showed smaller amounts of a molecule associated with blood-vessel growth in the hippocampus – a part of the brain that regulates emotions.
“We’re trying to mimic what happens in intensive care units,” said Nelson in a press release from the university. Nelson chairs the Department of Neuroscience.
The researchers hope the findings can be used to explore how light at night affects the mood of people who are hospitalized. People in intensive care units are often never exposed to a fully dark room while receiving treatment.
The researchers are investigating whether different lighting schemes, such as an ICU light that shifts from a bright, bluish white light during the day to a warmer tone at night, might prevent or reverse the depressive symptoms they observed in the mice. They also hope to expand their research to include human trials.
A new study from the West Virginia University School of Nursing suggests that loneliness may be making it harder for middle-aged Appalachians to manage chronic health conditions.
The study looked at 90 Appalachians ages 45-64, each with at least one chronic illness, such as diabetes, obesity and high blood pressure. Using surveys, researchers tracked how lonely or socially supported participants were and then measured levels of anger, depression and how those related to their physical and mental health.
They found that lonely participants scored consistently worse on markers of resiliency, including ability to maintain a positive state of mind and belief in their own abilities, than socially engaged participants. And middle-aged men reported being far lonelier than middle-aged women.
Middle-age is usually a time for raising kids, building a career and taking care of aging parents. In a press release, researchers said the study suggests that middle-aged patients may not have all the resources they need to juggle life tasks and caring for their own chronic diseases.
Lead researcher Laurie Theeke said that if health care providers can learn how to identify loneliness in patients, they might have a chance to stave off depression down the road.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.
A West Virginia University researcher has been awarded a $13.3 million from the Patient-Centered Outcomes Research Institute to compare three treatment strategies for rural depressed patients.
Rates of depression tend to be higher in rural areas, and accessing treatment is more difficult.
WVU professor Robert Bossarte will compare three treatment options: prescribing antidepressants alone, antidepressants combined with unguided online cognitive behavior therapy, and antidepressants combined with guided online cognitive behavior therapy.
Cognitive behavior therapy is a way of training your brain to react differently to stressful triggers, using tools like breathing and muscle relaxation.
Unguided therapy provides online instruction designed to determine what makes patient symptoms worse, and to change how they respond to those triggers.
During guided therapy patients will check-in with a cognitive behavior coach.
The study will include 8,000 West Virginia depression patients.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.
