Carroll County schools will make campuses tobacco-free in 2015, even including outdoor sporting events

The schools in Carroll County, once one of Kentucky's tobacco strongholds, have begun preparing students, parents, teachers and football fans for smoke-free school campuses starting July 1, 2015.

"This ban will apply on district property at all times, in all places and to all people, including at sporting events and inside vehicles," schools spokesman Carl Roberts writes for The News-Democrat in Carrollton. "The ban also will apply to electronic cigarettes. . . . The district is making every effort to inform students, staff and community members of the transition."

That includes signs, social media, print publications, district memos, and announcements at sporting events, Roberts writes. "At sporting events throughout this school year, cards will be distributed to spectators that provide information about the tobacco-free policy. The cards also will include information on smoking/tobacco cessation classes."

Only 35 of the state's 173 school districts are tobacco-free, but some others are planning to impose bans next year, and more may after this year's school-board elections are out of the way.

Carrollton, which once had several tobacco warehouses, was visited in 1998 by then-President Bill Clinton to explain what his administration wanted to about smoking and help tobacco farmers.

Barren River Health Dept. accredited; joins 5 others in Ky. (Franklin, Fayette, Madison, Northern Ky. and Three Rivers)

The Barren River District Health Department has joined five others in Kentucky with national accreditation.

The Public Health Accreditation Board announced Sept. 18 that the Bowling Green-based agency and nine other health departments had been accredited, bringing the total number to 54.

Kentucky health departments previously accredited are Franklin County, Lexington-Fayette County, Madison County, Northern Kentucky and Three Rivers (Carroll, Gallatin and Owen counties). The Barren River department serves Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Simpson and Warren counties.

"Public health departments play a critical role in protecting and improving the health of people and communities," the board said in a news release. "Health departments provide a range of services aimed at promoting healthy behaviors; preventing diseases and injuries; ensuring access to safe food, water, clean air, and life-saving immunizations; and preparing for and responding to public health emergencies. To receive accreditation, a health department must undergo a rigorous, multi-faceted, peer-reviewed assessment process to ensure it meets or exceeds a specific set of standards and measures. The peer-review process provides valuable feedback to inform health departments of their strengths and areas for improvement so that they can better protect and promote the health of the people in the communities they serve."

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

Doctors and parents of children with cancer seek funding

Doctors and parents of young cancer patients made an emotional plea to state legislators Sept. 17 "to make funding for pediatric cancer a priority," Jacqueline Pitts reports for cn|2's "Pure Politics."

Lobbyist Jamie Bloyd told the Interim Joint Committee on Health and Welfare about her son, Paxton Bloyd, who was diagnosed with stage 4 Burkitt’s Lymphoma in March, and quoted Sen. Chris McDaniel, R-Taylor Mill, as telling the Bloyd family in the hospital “that $10 million of our budget goes to dental care for inmates. But zero dollars go to pediatric cancer research in Kentucky and I just think that is sickening, I think our kids deserve better than our inmates do.”

Max Wise of Campbellsville, who defeated Sen. Sara Beth Gregory of Monticello in the Republican primary, "attended the meeting with his son who is a pediatric cancer survivor," Pitts reports. "In an interview with Pure Politics after the meeting, Wise also noted some of the efforts discussed by Lucas as well as the St. Baldrick’s Foundation and said that there are encouraging signs that there are people looking to help find solutions."

“Government isn’t always the solution,” Wise said. “Maybe it is other organizations that chip in, if it is charities, if it's corporations,” Wise said. “It's little things along the way that everyone can chip in on this and it should not be ‘Let’s just look to government to solve this;’ there’s other sources out there which can play a big part.”

The meeting was held at the offices of the Foundation for a Healthy Kentucky in suburban Louisville.

Public hearing to be held in Bowling Green Sept .19 to discuss fiscal health of Kentucky's rural hospitals

On Sept. 19 in Bowling Green, state Auditor of Public Accounts Adam Edelen will hold the last of 11 public hearings, which have been held across Kentucky this summer, to talk about the financial health of rural hospitals.

These hearings, along with a study by the auditor's office, are meant to help understand the challenges that face small, community hospitals, which provide health care to 45 percent of Kentuckians and are key economic drivers in those communities, an Edelen press release says.

The auditor is looking at some 66 public, non-profit and for-profit hospitals in rural Western and Eastern Kentucky. His office will conduct a survey about the fiscal health of these hospitals and plans to issue a report later this year.

The hearing will be held at the Holiday Inn University Plaza, 1021 Wilkinson Trace, Bowling Green, on Friday, Sept. 19 at 11 a.m. CDT, following the conclusion of the Kentucky Rural Health Hospital Association annual meeting.

State won't estimate cost of greater-than-expected Medicaid expansion for 'a few additional months' – after Nov. election

By Al Cross
Kentucky Health News

The Republican-controlled state Senate's budget committee chair wants to know how much Democratic Gov. Steve Beshear's expansion of the Medicaid program will cost, since enrollment in the federal-state program has exceeded the administration's expectations.

Medicaid Commissioner Lawrence Kissner told Sen. Bob Leeper of Paducah in a letter Sept. 8 that the administration won't be able to update the estimates "until a few additional months have passed and more data [are] collected" and "after the newly insured population has stabilized."

That pushes the date for new estimates past the Nov. 4 election, in which Republicans are making issues of the expansion's cost and the federal health-reform law that allowed it. U.S. Sen. Mitch McConnell has mentioned it in attacking "Obamacare," and Republicans trying to take over the state House have done likewise.

When Beshear announced in May 2013 that he would expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, using entirely federal money for the first three calendar years, he said it would cost the state $30 million in the 2016-17 fiscal year and $70 million in the 2017-18 fiscal year.

Those figures were based on an estimate by the Price Waterhouse Coopers accounting firm that 308,000 Kentuckians would become eligible for Medicaid but only 188,000 would enroll by 2017, based on calculations by the Congressional Budget Office. But so far, about 320,000 people have enrolled, more than double the 148,000 that the firm estimated would sign up by June 30.

At last report, about 521,000 people had obtained coverage through the state's Kynect health-insurance exchange. About 80,000 of them bought private insurance, and 120,000 qualified for what state officials call "old Medicaid" for a variety of reasons: they were children, blind, disabled or had income less than 69 percent of the federal poverty level, the old limit for the program.

The federal government pays about 71 percent of "old Medicaid" costs and, until the end of 2016, 100 percent of the newly eligibles' coverage. In 2017, it will pay 95 percent of the new costs, falling to the reform law's floor of 90 percent in 2020.

Kissner told Leeper that the administration needed more experience with the new enrollees, and better estimates of projected employment in 2017-18, other "key economic indicators" and how many Kentucky households will have incomes above or below 138 percent of the federal poverty level.

Leeper could not be reached for comment. For a copy of Kissner's letter and related materials, click here.

Expert says Ky. is one of 13 states where people in individual insurance market are better off than before reform law

By Molly Burchett and Al Cross
Kentucky Health News

Most of the focus on Obamacare has been on people who are no longer uninsured, or those who had to get new policies, but Kentucky is one of the 13 states in which the Patient Protection and Affordable Care Act helped people in the individual insurance market, according to a study by a fellow of the Brookings Institution.

To make comparisons across states, assessing the health law's impact on coverage, costs and other factors, economics fellow Amanda Kowalski put each state in one of five groups based on how they implemented the law.

Kentucky and seven other states – Colorado, Connecticut, New York, Rhode Island, Vermont and Washington – as well as the District of Columbia, embraced the law completely by setting up their own health-insurance exchanges and expanding the Medicaid program to households with income up to 138 percent of the federal poverty level.

Overall, average premiums grew remarkably in these states, says Kowalski. On average, premiums in Kentucky rose by 16 percent, less than the national average of 24.4 percent, says the report. In the table, states with their own exchanges are represented by blue and states without their own are in red.

However, under Obamacare, premiums don't tell the whole story, because people earning up to 400 percent of the poverty level are eligible for tax credits that reduce their monthly premium cost. Kentucky’s average cost decreased 19 percent.

This cost decrease, combined with an increase in coverage, suggests that Kentucky’s individual market had been adversely selected. Adverse selection is the tendency for people to avoid buying insurance until they need it, which often drives up insurance premiums. Individual health-insurance coverage in Kentucky increased by 38 percent, with exchange enrollment representing 43 percent of the increase, Kowalski reports.

Kowalski compared states that allowed or did not allow renewal of non-grandfathered insurance plans, in response to complaints that cancellation of their plans contradicted the promise made by advocates of the law that if people “liked their plan they could keep it.” Kentucky and 26 other states grandfathered such plans, and Kowalski concluded that it cost people in their individual markets $220 a year because the people keeping non-grandfathered plans were healthier.

Kentucky was among 41 states that saw increased health-insurance markups, additional amounts charged by insurers beyond the average cost of paying claims. These increases appear to reflect uncertainty about the insurance market; insurance companies had to set premiums without knowing the health status of enrollees and likely protected themselves with markups.

Kowalski's analysis relies on data from the first half of 2014. "The national experience might evolve over time" and as regulations become more defined within the law itself, the impact of the law will be better understood, she writes.

The study may come as a surprise to critics of the law, who have focused on the many Kentuckians who had to get new health-insurance policies because their old once did not cover the 10 things the law requires.

Some critics continue to say those Kentuckians numbered 280,000, but that number is outdated and incorrect, according to the state Department of Insurance. It's more like 130,000.

"The 280,000 represented the number of people in the individual and small group markets at the time who potentially could have received a letter saying their health insurance policies were being discontinued because benefits were changing," department spokesman Ronda Sloan said in an email.

"Those receiving the letters were told the current plan didn’t meet the requirements of the ACA but were offered a new plan that did," Sloan wrote. "They also were free to shop around either on or off the exchange."

Of the 280,000 who could have been in jeopardy, "48,302 were in grandfathered plans, so they were not affected," Sloan wrote. "Another 63,832 were offered transitional relief (President Obama’s request that companies be given the option to extend policies). Most of the remaining group had an option to take early renewal, which would have continued their pre-ACA policies" through at least Dec. 1 of this year. "So, from our perspective, almost everyone in the original 280,000 group had some option to continue existing coverage – and all of them could have moved to an ACA-compliant plan either on or off the exchange."

Most overweight diabetics don't know how much to exercise for weight loss, and they don't exercise enough

By Melissa Patrick
Kentucky Health News

Many overweight people with diabetes don't exercise enough for weight loss, and they also don't have a clear understanding of the recommended amount of exercise, according to a study reported by the Health Behavior News Service, part of the Center for Advancing Health.

The study, which looked at the exercise habits in people with diabetes, found that men with diabetes exercise more than women with diabetes, and, not surprisingly, that diabetic women who are trying to lose weight exercise more than those who aren't. But no one in the study was exercising the recommended amount for weight loss, according to the study report, published in American Journal of Health Promotion.

“We were not surprised that, overall, people with diabetes trying to lose weight were not engaging in enough physical activity,” study co-author Gina Pariser, associate professor at Bellarmine University in Louisville, said in a press release. "This finding emphasizes the need for health care professionals to provide more detailed and individualized education on exercise.”

Kentucky ranks 17th in diabetes and fifth in obesity, according to the 2014 "The State of Obesity: Better Policies for a Healthier America" report. It also says that more than 80 percent of people with diabetes are overweight or obese.

"Adults who are overweight or obese are at an increased risk for developing diabetes," the release notes. "Regular participation in physical activity may not only help reduce weight, but also help treat diabetes, and may prevent consequences associated with physical inactivity."

Health-care professionals need to do more than just encourage their diabetic patients to exercise, the researchers say in the release.

“Education about specific amounts of physical activity is needed to achieve goals such as weight loss and blood sugar control,” Pariser said. “Plus, instruction in the use of tools to objectively measure the amount of physical activity, like pedometers, should be provided.”

This study analyzed the association between exercise and weight control in 733 adults with diabetes and 4,572 without diabetes. Participants used a device to measure their physical activity and were asked if they were trying to lose weight, trying to maintain their weight or neither trying to lose nor maintain weight. For more information about diabetes and exercise, click here.

Respiratory virus that is sweeping Midwest has found its way to Kentucky; frequent handwashing remains best defense

The respiratory virus that has been hospitalizing children in the Midwest has come to Kentucky, reports Chris Kenning of The Courier-Journal: "Kraig Humbaugh, deputy commissioner of the Kentucky Department of Public Health, said the Centers for Disease Control and Prevention recently confirmed that five of 10 cases it tested from Kentucky were enterovirus D68."

Enteroviruses are common and tend to peak at this time of year, and enterovirus D68, a less common strain of this common virus, causes mostly respiratory illness. The CDC says symptoms for enterovirus D68 can range from mild to severe respiratory illness and that mild symptoms look very much like a cold: fever, runny nose, sneezing, cough, and body and muscle aches.

But it is the severe respiratory symptoms that are causing hospitalizations, particularly among children with asthma or underlying medical conditions, Kenning notes.

"In Kentucky, the spike in respiratory illnesses was first noticed in the central part of the state several weeks ago. But it is now being reported elsewhere, including in Louisville, although D68 has not been confirmed in Louisville," he reports. No deaths have been reported in Kentucky or in other states, officials told him.

"Hospitals in Colorado, Missouri and potentially eight other states are admitting hundreds of children for treatment of an uncommon but severe respiratory virus," probably enterovirus D68, The Washington Post reports.

From mid-August to Sept. 12, 97 people in Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri were confirmed to have respiratory illness caused by enterovirus D68, according to the CDC.

The virus is spread when the infected person coughs, sneezes or touches a contaminated surface. There is no treatment or vaccine for the virus.

The best ways to reduce your risk are: frequent hand washing; keeping unwashed hands off of your eyes, nose and mouth; avoiding contact with people who are sick; and disinfecting communal surfaces frequently.

Humbaugh told Kenning that he is encouraging families who have children with cold-like symptoms that cause difficulty breathing to consult with their doctor. If you're sick, he said, stay home.

Ky. newspapers support Beshear's expanded smoking ban for state-government sites, back statewide smoking ban

The Kentucky New Era in Hopkinsville stands firmly in favor of the executive order put in place last week to ban employees and visitors from using all tobacco products in most state government buildings, says a recent editorial, republished by the Georgetown News-Graphic.

The paper also joined in the governor's hope that the General Assembly in 2015 will pass a law barring smoking in workplaces and enclosed public spaces, saying, "It is time for Kentucky lawmakers to adopt a statewide smoking ban."

“When it comes to preventable illnesses and death, nothing in Kentucky is as devastating as smoking and tobacco use,” Beshear said. “Yet Kentuckians continue to use tobacco more than the residents of any other state. And as a result we lead the nation in cancer deaths.”

The New Era reminded its readers that the rights of nonsmokers who are exposed to secondhand smoke are just as important as the rights of the private business owners.  It also added that the complaint that smoking bans hurt businesses, doesn't hold up.

"Kentucky cities that have approved public smoking bans — including Hopkinsville — have proven that restaurants survive just fine without smoking sections," the New Era said. "In fact, many businesses gain customers who previously stayed away because they did not want to breathe secondhand smoke."

The editorial reminds its reader that the governor's executive order is a temporary solution and the real solution is to enact a smoking ban before the governor leaves office in December 2015. ANo smoking-ban bill has ever gotten a vote in either chamber of the legislature.

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.