Skip to main content

Depression and Anxiety

  • Living reference work entry
  • First Online:
Book cover Handbook of Rural, Remote, and very Remote Mental Health

Abstract

Depressive and anxiety disorders are among the most common mental health problems worldwide. They are associated with high rates of disability and poor physical health and often co-occur and go untreated. This may be particularly true for rural and remote communities given the lack of available providers, limited accessibility to services, and potentially unacceptable services (e.g., stigma, cultural competence). The present chapter first describes the standard diagnostic criteria for depressive and anxiety disorders as well as the importance of addressing unique cultural understandings when working in rural and remote communities. Next, treatment implications including the importance of evidence-based practice, consideration of adapting interventions, and the need for expanded models of care are discussed. Application of the chapter content is explicated in three case studies from Appalachia, and specific practice recommendations are made.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Aggarwal NK, DeSilva R, Nicasio NV, Boiler N, Lewis-Fernández R. Does the Cultural Formulation Interview (CFI) for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. Ethn Health. 2015;20:1–28. https://doi.org/10.1080/13557858.2013.857762.

    Article  PubMed  Google Scholar 

  • Alarcón RD. Culture, cultural factors and psychiatric diagnoses. World Psychiatry. 2009;8:131–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition: DSM-5. Washington, DC: Author; 2013.

    Book  Google Scholar 

  • Anderson M. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord. 2000;58:19–36. https://doi.org/10.1016/s0165-0327(99)00092-0.

  • Andrews G, Stewart G, Morris-Yates A, Holt P, Henderson S. Evidence for a general neurotic syndrome. Br J Psychiatry. 1990;157:6–12.

    Article  CAS  PubMed  Google Scholar 

  • Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders. JAMA Psychiat. 2017;74:875–84.

    Article  Google Scholar 

  • Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43:897–910. https://doi.org/10.1017/S003329171200147X.

    Article  CAS  PubMed  Google Scholar 

  • Caldwell T, Jorm A, Dear K. Suicide and mental health in rural, remote and metropolitan areas in Australia. Med J Aust. 2004;7:s10–4.

    Google Scholar 

  • Carey T. Beyond patient-centered care: enhancing the patient experience in mental health services through patient-perspective care. Patient Exp J. 2016;3:46–9.

    Article  Google Scholar 

  • Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, Saxena S. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3:415–24. https://doi.org/10.1016/S2215-0366(16)30024-4.

    Article  PubMed  Google Scholar 

  • Chowdhary N, Jotheeswaran AT, Nadkarni A, Hollon SD, King M, Jordans MJD, Rahman A, Verdeli H, Araya R, Patel V. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review. Psychol Med. 2014;44:1131–46.

    Article  CAS  PubMed  Google Scholar 

  • Conde A, Figueiredo B, Tendais I, Teixeira C, Costa R, Pacheco A, Nogueira R. Mother’s anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation. J Psychosom Obstet Gynecol. 2010;31:70–82.

    Article  Google Scholar 

  • Cuijpers P, Sijbrandij M, Kooke SL, Andersson G, Beekman AT, Reynolds CF. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. 2013;12:137–48.

    Article  PubMed  PubMed Central  Google Scholar 

  • Curtin L, Cohn T, Belhuemer J. Suicide in the rural population. In: Lamis DA, Kaslow NJ, editors. Advancing the science of suicide: understanding and intervention. Hauppauge: Nova Science Publishers; 2014.

    Google Scholar 

  • DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7. [Medline].

    Article  CAS  PubMed  Google Scholar 

  • Fox J, Merwin E, Blank M. De facto mental health services in the rural south. J Health Care Poor Underserved. 1995;6:434–68.

    Article  CAS  PubMed  Google Scholar 

  • Friedrich M. Depression is the leading cause of disability around the world. JAMA. 2017;317:1517. https://doi.org/10.1001/jama.2017.3826.

    Article  PubMed  Google Scholar 

  • Grist R, Cavanagh K. Computerised cognitive behavioural therapy for common mental health disorders, what works, for whom under what circumstances? A systematic review and meta-analysis. J Contemp Psychother. 2013;43:243–51. https://doi.org/10.1007/s10879-013-9243-y.

    Article  Google Scholar 

  • Hargrove DS, Curtin L, Kirschner B. Ruralism and regionalism: myths and misgivings regarding the homogeneity of rural populations. In: Michael KD, Jameson JP, editors. Handbook of rural school mental health. Cham: Springer International Publishers; 2017.

    Google Scholar 

  • Hilty DM, Ferrer DC, Parish MB, Jonston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed E Health. 2013:19: 444–54.

    Google Scholar 

  • Hranov LG. Comorbid anxiety and depression: illumination of a controversy. Int J Psychiatry Clin Pract. 2007;11:171–89. https://doi.org/10.1080/13651500601127180.

    Article  PubMed  Google Scholar 

  • Jackson HH, Judd F, Komiti A, Fraser C, Murray G, Robins G, et al. Mental health problems in rural contexts: what are the barriers to seeking help from professional providers? Aust Psychol. 2007;42:147–60. https://doi.org/10.1080/00050060701299532.

    Article  Google Scholar 

  • Jameson JP, Blank MB. Diagnosis and treatment of anxiety and depressive disorders by primary care providers in rural and urban practice: national survey results. Psychiatr Serv. 2010;61:620–3.

    Article  Google Scholar 

  • Jameson JP, Chambless DL, Blank MB. Empirically supported treatments in rural community mental health centers: a preliminary report on current utilization and attitudes toward adoption. Community Ment Health J. 2009;45:463–7.

    Article  PubMed  Google Scholar 

  • Judd FK, Jackson H, Davis J, Cockram A, Komiti A, Allen N, Murray G, Kyrios M, Hodgins G. Improving access for rural Australians to treatment for anxiety and depression: the University of Melbourne depression and anxiety research and treatment group-Bendigo health care group initiative. Aust J Rural Health. 2001;9:92–7.

    Article  Google Scholar 

  • Kazdin AE, Rabbitt SM. Novel models for delivering mental health services and reducing the burdens of mental illness. Clin Psychol Sci. 2013;1:170–91. https://doi.org/10.1177/2167702612463566.

    Article  Google Scholar 

  • Keefe SE, editor. Appalachian cultural competency: a guide for medical, mental health, and social service professionals. Knoxville: University of Tennessee Press; 2005.

    Google Scholar 

  • Keefe SE, editor. Participatory development in Appalachia: perspectives on identity, community, and sustainability. Knoxville: University of Tennessee Press; 2009.

    Google Scholar 

  • Kessler RC, Sampson NA, Berglund P, Gruber MJ, Al-Hamzawi A, Andrade L, … Wilcox MA. Anxious and non-anxious major depressive disorder in the World Health Organization world mental health surveys. Epidemiol Psychiatr Sci. 2015;24:210–226. https://doi.org/10.1017/S2045796015000189.

  • Kleinman A. Social origins of distress and disease: depression, neurasthenia, and pain in modern China. New Haven: Yale University Press; 1986.

    Google Scholar 

  • Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988.

    Google Scholar 

  • Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82:858–66. https://doi.org/10.1590/S0042-96862004001100011.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AM, … Penninx BH. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72:341–348. https://doi.org/10.4088/JCP.10m06176blu.

  • Mehta S, Farina A. Is being “sick” really better?: effect of the disease view of mental disorders on stigma. J Soc Clin Psychol. 1997;16:405–19.

    Article  Google Scholar 

  • Mendenhall E, DeSilva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M, Luitel N, Ssebunnya J, Fekadu A, Patel V, Tomlinson M, Lund C. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Afrida, and Uganda. Soc Sci Med. 2014;118:33–42.

    Article  PubMed  PubMed Central  Google Scholar 

  • Michael KD, Jameson JP, Capps E. Preface: making the case for rural school mental health. In: Michael KD, Jameson JP, editors. Handbook of rural school mental health. New York: Springer; 2017.

    Chapter  Google Scholar 

  • Mohatt DF, Bradley MM, Adams SJ, Morris CD. Mental health and rural America, 1994–2005. Rockfille: U.S. Department of Health and Human Services; 2005.

    Google Scholar 

  • Morrissey KM. An urban-rural exploration of depression, CVD, and their comorbidity in Ireland. Ir Geogr. 2014;47:77–94. https://doi.org/10.2014/igj.v47i1.450.

    Article  Google Scholar 

  • NAMI: National Alliance on Mental Illness. https://www.nami.org

  • Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev. 2015;40:91–110.

    Article  PubMed  Google Scholar 

  • Panagloti M, Scott C, Blakemore A, Coventry PA. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014;9:1289–309.

    Google Scholar 

  • Pesonen H, Vasala K. Congregations and rural development: the case of the evangelical Lutheran Church of Finland. Agric Econ Rev. 2006;7:5–14.

    Google Scholar 

  • Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect. 2005;3:13–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Richards D. Prevalence and clinical course of depression: a review. Clin Psychol Rev. 2011;31:1117–25. https://doi.org/10.1016/j.cpr.2011.07.004.

    Article  PubMed  Google Scholar 

  • Roseborough DJ, McLeod JT, Wright FI. Attrition in psychotherapy: a survival analysis. Res Soc Work Pract. Online First. 2015; https://doi.org/10.1177/1049731515569073.

  • Smith TB, Rodriguez MD, Bernal G. Culture. J Clin Psychol In Session. 2011;67:166–75.

    Article  PubMed  Google Scholar 

  • Spitzer RL, Kroenke K, Williams JBW, et al. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282:1737–44. https://doi.org/10.1001/jama.282.18.1737.

    Article  CAS  PubMed  Google Scholar 

  • Steel Z, Marnane C, Iranpour C, Silove D, Chey T, Jackson J, Patel V. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43:476–93.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stewart RE, Chambless DL. Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: a meta-analysis of effectiveness studies. J Consult Clin Psychol. 2009;77:595–606.

    Article  PubMed  Google Scholar 

  • Svennson B, Hansson L. Effectiveness of mental health first aid training in Sweden: a randomized controlled trial with a six-month and two-year follow-up. PLoS One. 2014;9:1–8.

    Google Scholar 

  • Tyrer P. The case for cothymia: mixed anxiety and depression as a single diagnosis. Br J Psychiatry. 2001;179:191–3.

    Article  CAS  PubMed  Google Scholar 

  • Vallury KD, Jones M, Oosterbroek C. Computerized cognitive behavior therapy for anxiety and depression in rural areas: a systematic review. J Med Internet Res. 2015;17:1. https://doi.org/10.2196/jmir.4145.

    Article  Google Scholar 

  • Van Schaik E. The social context of “nerves” in eastern Kentucky. In: Keefe SE, editor. Appalachian mental health. Lexington: University Press of Kentucky; 1988.

    Google Scholar 

  • Ventevogel P. Integration of mental health into primary healthcare in low-income countries: avoiding medicalization. Int Rev. Psychiatry. 2014;26:669–79.

    Article  PubMed  Google Scholar 

  • Vermaas JD, Green J, Haley M, Haddock L. Predicting the mental health literacy of clergy: an informational resource for counselors. J Ment Health Couns. 2017;39:225–41.

    Article  Google Scholar 

  • Watters E. Crazy like us: the globalization of the American psyche. New York: Simon and Schuster; 2010.

    Google Scholar 

  • World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: WHO; 1992.

    Google Scholar 

  • World Health Organization. The world health report 2001: mental health: new understanding, new hope. Geneva: WHO; 2001.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lisa Curtin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Curtin, L., Moss, S.E., Keefe, S.E. (2020). Depression and Anxiety. In: Carey, T.A., Gullifer, J. (eds) Handbook of Rural, Remote, and very Remote Mental Health. Springer, Singapore. https://doi.org/10.1007/978-981-10-5012-1_34-1

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-5012-1_34-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-5012-1

  • Online ISBN: 978-981-10-5012-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics