Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.
The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.
“Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.
The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.
The participants had up to 11 phone sessions between January 2011 and October, 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques. The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.
The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms.
The building that houses the post office on the other side of town could be owned by someone on the other side of the country. In central North and South Dakota, local landlords usually mean better property maintenance and lower costs for the Postal Service, a regional reporting project finds. But absentee owners are in the majority.
Photo by Sarah GackleThe post office in Kulm, North Dakota
EDITOR’S NOTE: The U.S. Postal Service leases most of the buildings it uses for post offices. The relationship of a local post office to its landlord – sometimes located in distant states – can affect the cost of the lease, the timeliness of repairs, and, in one case, even the existence of the local P.O. Dakotafire Media, a reporting collaborative serving parts of North and South Dakota, examines patterns of post-office ownership. This story originally appeared as part of a series on the Dakotafire website and in collaborating newspapers. Doug Card, Sarah Gackle, and Bill Krikac contributed reporting to this article.
A small-town post office serves as a recognizable face of the local community.
“It is an identity. Your ZIP code and your post office is your town,” said Brian Bauer, mayor of Mellette, South Dakota.
It’s also the face of the federal government in the community, where federal holidays are observed and the flag is sure to fly at half-staff if directed so by Washington.
But most of those buildings are not owned by the U.S. Postal Service—and relatively few of them are owned by entities with the same ZIP code as the one on the outside of the building.
The U.S. Postal Service owns just 8,583 of the 32,232 buildings currently in use, and leases 23,649—or 73 percent—of them from private entities. This model has been used for several decades, according to Pete Nowacki of USPS Corporate Communications, because federal ownership is “cost prohibitive.”
“We don’t have the capital to purchase” that many buildings, he said.
Although most of the postal employees interviewed for this story declined to comment on the partnerships they have with private building owners, much of the information—including owner identities, addresses, rental rates and who is responsible for building upkeep—is public record and can be found at https://about.usps.com/who-we-are/foia/leased-facilities/report.htm.
Whether a property is owned by a close neighbor or a distant landlord can have an effect on how much is charged for rent, as well as how easy it is to maintain the property, a Dakotafire Media analysis has found.
Most Post Office Landlords Are Not Local
Dakotafire Media looked at data for 201 eastern South Dakota post offices (ZIP codes 57001-57481) and 87 southeastern North Dakota post offices (ZIP codes 58001-58081 and 58401-58497). About 37 percent of the South Dakota post offices and 33 percent of the N.D. post offices were owned by a person or a business with an address 10 miles or less from the post office community.
There was some correlation between the rental rate and the distance between the ZIP code of the post office and the ZIP code of the property owner: In general, the properties with rental rates lower than average were more likely to have a local owner.
Community development consultant Timothy Lampkin sees his Delta town of Clarksdale, Mississippi, as a land of opportunity. He plans to use next month’s National Rural Assembly as a chance to let the rest of the nation know it.
Photo by abbyladybugDowntown Clarksdale. The city is the seat of Coahoma County, which lies on the Mississppi River in the northwest part of the state. It has about 17,000 residents, down from a high of about 22,000 in 1970.
EDITOR’S NOTE: Today we’re starting a series of interviews with a few of the people who will attend next month’s National Rural Assembly, September 8-10, in Washington, D.C. The national gathering of rural advocates focuses on rural America's place in federal policy making. The Rural Assembly is managed by the Center for Rural Strategies, which also publishes the Daily Yonder.
In the Mississippi Delta, Timothy Lampkin sees great opportunity where others see big obstacles.
After leaving Clarksdale for a corporate job, he decided that life wasn’t for him. He returned home to become a community development officer for Southern Bancorp, a mission-driven development bank. When the agency focused more on banking services, Lampkin struck out on his own as a community development consultant.
For all the chronic struggles Lampkin sees in the Delta, he also sees ingenuity and innovation. The region could be a model for a new American approach for dealing with poverty, he said.
His neighbors have always been hardworking, determined, and creative, Lampkin said. Now, he says, they are also ready to break with old traditions and try new ideas.
The Daily Yonder asked Lampkin to describe his part of rural America and tell us his hopes for attending the National Rural Assembly.
Photo by LukeThe Delta is famous for tamales, like these from Hicks’ Famous Hot Tamales and More in Clarksdale. Lampkin says cultural diversity and food traditions are part of the region's strengths.
Daily Yonder: What is your part of rural America like? What are the key issues?
I’m from Clarksdale, Mississippi, a very small town in the Mississippi Delta. The population is under 25,000, [the most recent Census estimate is 17,000] and we are in what is considered one of the most impoverished areas in the nation. Looking at some of the issues we face, they would be access to fresh food, access to clean water, and access to quality education from K-12 all the way up to higher education levels. There has been some progress. But there is a long way to go to really get to the place where I feel we need to be. Where we have quality education for all citizens, not just one part of the population, access to fresh food for all citizens, and access to clean water for all citizens.
Country-of-Origin Labeling for meat coming into the United States remains a contentious issue in Congress, with competing proposals in the Senate and a challenge in the World Trade Organization. The law helps meet consumer demand for more information about food origins, but its future is up in the air.
Senators John Roberts (R-Kansas), left to right, John Hoeven (R-North Dakota), Debbie Stabenow (D-Michigan), and Collin Peterson (D-Minnesota) are in the middle of the Senate fight over country of origin labeling.
Efforts to change federal Country of Origin Labeling (COOL) may be stalled, but they aren’t on the back burner.
The U.S. House of Representatives passed legislation earlier this summer to repeal COOL, but the House is now in in recess. In the Senate, a repeal clause is attached to a highway bill but faces unified Democratic opposition and the support of a few Republicans. It looks increasingly unlikely that any COOL legislation will see action before the end of the summer congressional recess.
Country of Origin Labeling requires that certain products, including beef and pork, are tagged with a label that says where the animal that produced the meat was born, raised, and slaughtered.
The pressure for doing something about COOL is the result of a World Trade Organization ruling saying the legislation discriminates against beef and pork coming into the U.S. from Canada and Mexico. U.S. packers claim that it is too difficult and expensive to keep track of animals requiring different labels in their plants.
The House has already passed COOL-repeal legislation by a margin of 300-131 and its adoption by the Senate would move repeal forward. To force the issue in the Senate, Pat Roberts (R-Kansas), a long-time opponent of COOL, added language repealing COOL for beef, pork, and chicken products to a must-pass extension of the highway bill. His amendment does not include provision for a voluntary COOL program. “We can continue to discuss voluntary labeling programs similar to those already in the marketplace once COOL is repealed,” Roberts said.
Debbie Stabenow (D-Michigan) and John Hoeven (R-North Dakota) have introduced a bill in the Senate that would repeal mandatory COOL legislation and replace it with a voluntary COOL program. In support of her legislation Stabenow said, “It would be a sad day, and I believe irresponsible on our part, if we move back to the days prior to COOL where we were labeling meat that was born in a foreign country and spent most of its life in the foreign country but then could somehow come in and be harvested here and be called a product of the United States.”
Stabenow points out that Canada also has a mandatory country-of-origin labelling law for food products. According to the Canadian Food Inspection Agency website, “When a food product is wholly manufactured outside of Canada, the label must show that the product is imported. … In addition, it is mandatory to state the country of origin on some specific imported prepackaged products, such as … meat products. … For example, prepackaged cheese from the United States imported into Canada is required to be labelled ‘Product of United States.’”
A medical relief organization that first served international health-care needs is focusing closer to home on America’s underserved. For some, the free health-care clinic designed to serve thousands of patients in one weekend is a primary source of healthcare.
Photo by Emily GoldsteinPatients seeking free medical care started lining up the day before the clinic opened to ensure they get a spot in the first-come, first-served system.
The Remote Area Medical clinic sets up shop only once a year in Southwest Virginia, but Michele Kokoska is a regular.
“At the moment it is my main source of health care,” said the resident of Coeburn, Virginia.
Veteran patients like Kokoska know to arrive early to be one of about 3,000 patients to receive care. She got the Wise County Fairgrounds in Wise, Virginia, at 7 p.m. on a Thursday to be near the front of the line when volunteers started handing out numbers at 3 the next morning.
Others arrived even earlier.
“Lack of insurance brought me out here today,” said Kokoska.
Although it began as an international relief program, Remote Area Medical (RAM) now also works domestically, traveling across the U.S. to provide comprehensive health care.
For one weekend in July, the Wise County Fairgrounds in Wise, Virginia, are turned into a health-care carnival with participants traveling from all over Virginia, Kentucky, Tennessee, and North Carolina seeking medical care. Although the Affordable Health Care Act has expanded access to medical care for some, gaps persist.
Glenn Burdick, R.N., a healthcare provider from Front Royal, Virginia, has volunteered at RAM for three years and runs a free clinic in Front Royal. He said he’s seen first-hand the pitfalls of the current health-care system.
“It’s a shame we can’t put politics aside and take care of our people,” he said.
Across Illinois, communities are organizing “car gatherings” to pull people into town. The events satisfy Americans' obsession with the automobile and offer hopes of cash-register receipts for local businesses.
Timothy Collins The young owner of a 1913 Ford Model T does some engine work. The car, which he has had since the beginning of the year, was his grandfather’s.
Monmouth, Illinois, has a long Main Street and 9,444 residents, give or take a few.
Once a year, Main Street is closed, turning into an island of maybe 1,500 antique and classic cars and trucks, including scads of hotrods surrounded by shifting sea of 15,000 people, give or take a few thousand.
It's summer, time for the Maple City Machines Cruise Night. The event, which goes back 20 years or so, happened on July 31. The same weekend, there was a car show in nearby LaHarpe, and another, much smaller cruise in on the Courthouse Square in Macomb, both on Saturday.
Car shows, cruise ins, and cruises are different. Car shows offer trophies and prizes. Some may be combined with sales. Cruise ins are park, look, and talk events. Cruises are just that, driving events.
Timothy Collins A 1950 Chevrolet from Iowa has only about 9,000 original miles, according to the sign. Car gatherings are fairly common in small towns around here during the warmer months from May to October. Small or large, these gatherings have character. Sometimes they are fundraisers. Sometimes they are just for fun, a pleasant way to socialize on a warm evening. Events in most rural towns don’t match the scale of Monmouth. Some are held at restaurants or on town squares. They always have some interesting cars and offer the chance to meet—or watch—intriguing people.
Leland Payton is a photographer and writer who runs Lens & Pen Press with his wife Crystal. Their books feature writing and photography primarily about the Midwest and Ozarks, where the couple spends a lot of time exploring small towns. Payton spoke with the Yonder about what makes these areas unique, and why they’re such worthy subjects.
All photos by Leland PaytonAfter being a plaintiff in a lawsuit to stop Truman Dam, I was let go from my job as a photographer with the University of Missouri Extension. To make a living, Crystal and I dealt in pieced quilts, mostly vintage. This is Pearl Thate, a quilt maker who lived in Carrolton.
Daily Yonder: Where did you grow up? Tell us a little bit about your background. Leland Payton: Most of my childhood was spent in Sedalia, Missouri, which is on the border between the tall grass prairie and the hills of the Ozarks. In high school, I played jazz tenor sax, collected arrowheads, and fished the creeks every chance I got.
DY: You now live in Springfield, Missouri. How did you end up there? LP: We settled in Springfield primarily because of the excellent schools. Our older son had four years of Japanese by the time he graduated from high school and is now a Foreign Service Officer with the State Department. Our younger son has a master’s in English and an MBA both from Missouri State University here. He is a successful podcaster and freelance writer.
Because it’s close to Jefferson City, Bonnots Mill at the mouth of the Osage River has avoided the collapse of many Missouri villages.
DY: When did you first start taking pictures? LP: All children draw. I never stopped. I always took a sketchpad when I looked for arrowheads or fished. I gradually started using a camera instead of pens and brushes in my mid twenties. This was a concession to commerciality.
DY: You and your wife, Crystal Payton, established Lens & Pen Press, a publishing company whose mission is to “document, explain and illustrate one of America’s least known but most surprising and distinct geographic and cultural regions.” What do you find most surprising and distinct about the Ozarks and the Midwest? LP: Through much of the American past, regionalism was acknowledged, even celebrated, and there were many representations of regional subjects in books and works of art in the national arts and media. In the last half-century big city, even international, interests have dominated. The things writers and artists found interesting about America’s regions are still present, they’re just not published or publicized on a national level as much as they once were.