Dennis and Gay Pond (WFPL photo)
“Rural America has some of the highest rates of chronic disease in the nation – the more remote a community, the more heart disease, cancer and diabetes. And there’s a side effect from having a chronic condition many people don’t think about – depression, anxiety and even suicide,” Lisa Gillespie reports for Louisville’s WFPL. “This is especially true for older adults, who’ve lived their entire lives in places with little access to places to exercise, with diets high in fat and sugar and in a culture that still hasn’t given up tobacco.”
Gillespie’s example is Dennis Pond, 67, of Casey County. “He often feels useless, in large part because his diabetes has caused terrible pain and numbness in his feet, and that affects his ability to drive, to help out around the house, to even go out in the yard,” she reports, quoting him: “The pain gets so bad that I actually feel like cutting my feet off or just taking care of myself, if you know what I mean Ending it.” But he doesn’t tell his psychiatrist about such thoughts: “When they ask me those questions, I got to try to watch what I’m saying because if I don’t I’ll end up in the psychiatric unit,” he said. “I try to say no, but I have thoughts.”
“His dark thoughts are in part an outgrowth of the toll chronic conditions have taken on him. Every day, he takes blood thinners for blood clots in his lungs, pain medication for his bad back, insulin for his diabetes,” Gillespie reports. “Then there’s the nerve damage from his diabetes – what he describes as thousands of needles piercing the bottoms of his feet when he walks.”
Pond lives 30 miles from the nearest town and hospital, Gillespie reports, adding, “Rural residents often have a hard time accessing medical care for their chronic conditions and psychiatric care for the attendant mental health issues. That contributes to the increased risk of suicide in rural areas, which are already at higher risk because of a lagging economy and substance abuse. For example, “suicide rates in 2017 were 30 percent higher in Appalachia than in the rest of the country.” Within the region, suicides were concentrated in Eastern Kentucky, West Virginia and East Tennessee, areas that struggle with high opioid-addiction rates and poverty.
Gina Piane, a professor at National University in San Diego, was one of the first researchers to link chronic disease and mental health. Giving rural youth more health and nutrition education is a key way to prevent such issues, she told Gillespie.
Psychologist John Fulton, who works in Casey County, said he tries to teach his patients coping skills and recommends that they develop a support system of friends and family if they don’t already have one. “I try to say, you know, you’re sitting there focusing on the bad things, and all that’s going to do is drag you down deeper,” Fulton told Gillespie. “[I] try to get them to, you know, turn around and start thinking about, ‘Well, I’ll go outside and look at dogs or I’ll watch wrestling on TV’ — get their mind off the illness and how bad they feel.”
“Fulton also recommends people try to develop a strong support system if they don’t already have one. That’s something Pond does have in his wife, Gay. They married in 2013 after he did work on her house,” Gillespie writes. “And there might be hope for Dennis’ pain and diabetes. He’s likely going to get surgery that could increase blood flow in his feet, helping avoid an amputation.”