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Appalachians have the highest levels of depression and mental illnesses in the United States. Currently, a great proportion of people report mental health problems; however, the incidences of depression and mental illnesses are not uniform in the region. Poorer counties reports of general mental health problems are considerable higher than in the rest of Appalachia. A research funded by the Appalachian Regional Commission (ARC) discovered that people from the poor mountain regions have more mental problems than other regions (Alford par. 1). They suffer the highest rate of depression and are thus more prone to abuse drugs (Alford par 2). From a holistic perspective, the depression and mental illness of the Appalachia people is higher than that of the nation as a whole. Depression and mental illness reinforce each other, especially in the impoverished regions in Appalachia.

The major depression and mental illnesses are associated with most of suicides in the region. Appalachian residents are at risk of suicide with the highest rates among men aged 35 and older; suicide rates were higher in the central and Southern sub regions than in the Northern sub-region (Halverson et al. 87). Variability was evident with relatively higher suicide rates among persons aged 65 years and above in counties in North Eastern Alabama and Western Virginia. Appalachian residents aged 12 years and older have a greater prevalence (13.5%) of grave psychological distress (SDP) compared with the same age group in non-Appalachian regions (11.6%) (Zhang et. al. 173). In addition, Appalachians reported considerably prevalence of major depressive episodes (MDEs) during a one-year period compared with non-Appalachian (8.2% versus 7.6%).

The high rates of depression among Appalachians relate to numerous economic stressors. In addition, concerns about stigma and confidentiality and acceptance of adversity limit people’s likelihood to seek professional assistance. Appalachians thus seek mental health assistance later in the course of their illness, and this result in more distress and impairment. In the region, major depression and mental illness are associated with the largest percentage of the suicides. Higher rates of depression and mental illness are risk factors for suicide among the Appalachians. There are greater mental health disparities in Appalachia between the urban and rural areas. The rural areas have considerably few mental health facilities than the urban areas. In addition, the medical personnel with superior specialization level in the realm of mental health and more proficiency are in short supply in the rural regions. Most of residents suffering from mental illnesses and living in the rural regions are also uninsured than other people in the rural areas. Lack of adequate access to health providers causes considerable under detection of the number of people suffering from depression and mental.

Depression is of particular concern when it comes to mental health difference between urban and rural areas, particularly among women. The pervasiveness of major depressive disorder among the rural women is very high with estimates that range from 24-41% pervasiveness in three studies regarding rural participants in different geographic areas (Behringer 4). The diagnostic criteria and methods were different among the three studies; however, the pervasiveness remained higher than the countrywide average every study. The high poverty levels in the rural regions in Appalachia compound the depression effects. Chronically impoverished people develop depression as an attribute and this call for improvement of health care delivery of mental health as well as culturally perceptive treatment approaches.

Poor economic conditions increase the incidences of depression and mental health problems in any population and this in turn gets in the way productivity. The Appalachian communities are predisposed to numerous economic and psychological depressions. The rural residents who experience prevalent poverty are prone to unending pressure, which leads to depression and which in turn causes economic productivity loss and which reinforces poverty further. People do not have good jobs to support their families; this generates anxiety and depression, and it leads to drug abuse (Alford par. 11). Mental illness results from lack of personal productivity. Depression leads to poor health and this keeps people from doing their everyday activities. Depression results from unhealthy condition than all the other particular health complications, such as diabetes, blood pressure, and asthma.

There is also a relationship between diabetes and depression. Diabetes results in depressed moods, loss of interest or pleasure, changes to sleep, weight loss or gain, loss of energy and persistent fatigue, feelings of worthlessness and suicidal attempts and difficulty in making decisions (Groot et. al.1). The high rates of depression and psychological distress are risk factors that cause some Appalachians to commit suicide. The changing socioeconomics, demographics, and use of health services later in the course of mental illness may explain the higher suicide rates in rural areas than in urban areas. Nonetheless, it is also possible that there are rural-urban differences in listing suicide in death reports. Lack of accessibility, availability, and acceptability of services also contribute to depression and mental illnesses. There are numerous barriers to mental health as well as substance abuse services in six Appalachian counties (Zhang et al 150). They identified concerns about privacy, stigma, transportation, confidentiality, limited payment options, and facility choices and cultural family or cultural barriers as some of the factors that interfere with utilization of mental health services.

To reduce depression and mental illness in Appalachia, sustainable poverty solutions are required. In addition, there is a need for community based research practices to establish local contributory aspects, which will advance the quantity as well as quality of research and allow for more cost effective and informed effective interventions, which has a basis on the needs of every community in Appalachia. Policies should take account political, social, economic, and cultural perspectives of rural Appalachia into account when attempting to eliminate depression and mental illness. In order to promote sustainable solutions for depression and mental illness problems, the government should involve the community in every level.

The government should address the Appalachian region economic situation by attracting new industries to the region because mining, forestry, and manufacturing jobs have dried up. The community leaders need to invest in initiatives that improve the residents’ psychological and physical well being to be in line with economic strategies. This is to turn the current negative state of mind around and establish a positive cycle of growth and optimism. These initiatives should include public health efforts to boost nutrition, increase physical activity outcomes, and consequently increase the residents’ psychological and physical health. In the rural areas with soaring rages of depression, public education strategies and campaign may come in handy to promote high levels of collaboration between mental health professionals, primary care givers, and substance abuse programs.

Mental illness is a health risk in Appalachia. There are also high rates of depression among residents in Appalachia, especially in the rural areas. Both depression and mental illness are risk factors of suicide in the region and this means that necessary measures for reducing the conditions are needed in the region. Stressors experienced by Appalachian contribute to higher risk for and higher rates of psychological distress and depression. These socio-economic stressors as well as other factors increase the risk of mental illness and decrease the access to treatment. There is a need for adequate plans and policies in Appalachia to address depression and mental illness in an efficient and continuous manner. Mental health services should be decentralized to deliver adequate services to rural areas giving greater attention to public mental health education and policies that address the economics of mental health. Appalachia region also required inexpensive insurance coverage for mental health services

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