Journal of Rural Community Psychology Volume E11 (1) Exploring Depression in Frontier Communities

Purpose: Frontier communities are exposed to unique communal norms which influence depression. The objectives of this study were to explore the experience of depression from the perspective of people living in Midwestern frontier counties. Methods: To elucidate how factors in frontier communities influence depression a mixed model of research methods was used: three focus groups (n=45) in two communities, a cross sectional community survey (n=59) and a cross sectional questionnaire from which we conducted a retrospective chart review and tabulated depression screening information and correlates of depressive symptoms from PHQ-9 data (n=67) in a primary care clinic. Qualitative analysis of transcribed audiotapes identified four pertinent themes: the double-edge sword of independence, minimal provider response, the reality of rural resources, and gender differences in depression. Results: Correlation analysis and analysis of variance (ANOVA) of the PHQ-9 questionnaires revealed three factors impacted depression: the number of medications taken, number of co-morbid illnesses and marital status. The community survey indicated: help for depression was sought from primary care providers, hospitalization was not needed however depression could not be overcome without help, there are few community resources, the majority of respondents have suffered from depression or have a friend or family member who has. Conclusions: Depressed persons in frontier communities face significant challenges that must be addressed. A model of improving access to resources in the health-care system and addressing community/social factors might be helpful for developing effective depression interventions in frontier communities