Does the culture in the Appalachian Mountains lead to higher rates of suicide?

According to Dr. Lisa Curtin from Appalachian State University’s Department of Psychology, the answer is “yes,” as she shared the results of a study on suicide and depression in the high county with the Ashe Suicide/Depression Prevention Awareness (ASAP) task force on Tuesday, Jan. 8.

“Overall, each participant showed the symptoms that are normally associated with depression,” said Curtain. However, Curtin also said some unique aspects of the area like social isolation contribute to higher rates of suicide.

She also prefaced her presentation by acknowledging rural areas with low-income families tend to have an above average suicide rate.

To conduct the study, the participants each had a non-formal interview called an “illness narrative.” The average interview ranged from one to three hours in length. Curtain said her group just finished transcribing all of the material, and the study was completed by finding common themes mentioned by each participant.

One of the common themes was the feeling of social isolation and social withdrawal. According to Curtin, these feelings were tied to relationships.

Many of the participants in the study said they no longer enjoyed being with other people. More common among the participants was the feeling they were not loved by others.

For many of these participants, these feelings can become overwhelming and when they bubble to the surface, those participants embark on self-harming behaviors (cutting) and have suicidal thoughts.

Also, Curtin said members of the “mountain culture” have a greater collective sense of self than most Americans. This means members of the Appalachian culture build their self-perceptions based on how their peers view them.

“This culture dates back to the importance of kin for survival, an idea that’s been passed on through the generations,” said Curtin.

The conflict between social isolation and a sense of collective self plays a key factor in depression and suicide in the area, said Curtin.

Another major theme among the participants was their religious beliefs.

While many participants found a sense of meaning and comfort in the belief of a higher power, religion also became a “unique stresser” for others.

“For some people it was a source of helpful support and for others it was a source of conflict,” said Curtin.

According to Curtin, the main theme associated with religion was the feeling “if I was right with God, I wouldn’t feel this way.” Also, the concept that thinking about suicide is a potential sin was a conflict with the sample group.

Many of the participant left their church’s altogether, which caused more social isolation. Others felt inclined to stay in church only because of their families and peer group, creating another form of stress.

Many of the participants in the sample had experienced some form of trauma in their lives. Common trends included domestic violence, child abuse, and the feeling of loss.

According to Curtin, a key find in the study was how participants made sense of their problems. Many didn’t view the source of their depression in terms of chemical interactions in the brain, but instead, saw depression as a part of who they are, almost like depressive symptoms are genetic. This mindset is known as Appalachian fatalism.

The participants’ upbringing only feeds into that mindset. Many in the sample said they were raised to “pull themselves up by their boot straps” and they shouldn’t need external help for their depression.

“All of these findings match up with the literature,” said Curtin.

Many participants, even the younger members, have struggled with depression for a long time. One participant said she remembers feeling depressive symptoms as early as 12 years old, she said.

In spite of this, there are problems with the availability of mental health services in Ashe County, along with the rest of the Appalachian Mountains, said Curtin.

There is also a stigma against seeking professional help for depression and suicidal thoughts. This stigma, in part, caused a high turnover rate with participants and their service providers.

Many in the sample feared the negative consequences if a person in their social group, mostly in the workplace, discovered they were depressed.

Those in the sample who decided seek help reported positive results. Some found good results by taking antidepressants, while others felt more comfortable with alternatives like therapy, acupuncture, and practicing tai chi, said Curtin.

The study was based on a 23 person sample (9 males, 14 females) who were, on average, moderately depressed. The average age of the participants was 41 years old; the youngest participant was in his/her early 20’s while the oldest participant was over 70.

Each participant was either diagnosed with depression or taking antidepressant medication. The 23 participants were gathered after 450 fliers were distributed across the regions health facilities.

“The fact that we only got 23 participants after distributing 450 fliers speaks to the stigma of suicide and depression in the area,” said Curtin.

Curtin said these results were based on a relatively small sample, and the study may contain elements of selection bias. The participants who joined the study may feel less stigma about their depression than others who chose not to participate.