Kentucky is truly a big blue nation.
A survey of more than one million Americans determined that Kentuckians had the highest levels of mental distress in the country.
Kentucky's well-known and generational problems with poverty and poor education are certain to contribute to the sad findings. And the economic crisis isn't likely to make things better.
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"When you start out in poverty and the national economy tanks, you are worse off," DeWall said. "Money doesn't buy happiness, but it can relieve high amounts of stress."
According to the report released last week by the Centers for Disease Control and Prevention, 14.4 percent of adult Kentuckians reported having felt significant stress, depression or emotional problems in the previous month. Hawaiians had the least stress, with 6.6 percent reporting that they had suffered from "frequent mental distress" in the previous month.
"Frequent mental distress" is defined as having 14 or more days in the previous month when stress, depression and emotional problems were a burden.
The study used information gathered from telephone surveys of 1.2 million people during two periods, 1993 to 2001 and 2003 to 2006.
The Appalachian and Mississippi Valley regions had high and increasing frequent mental distress prevalence, and the upper Midwest had low and decreasing frequent mental distress prevalence.
DeWall said Kentucky's consistently bad rankings for health, including a high percentage of diabetes, heart disease and obesity, goes hand-in-glove with a large amount of stress.
About 876,000 Kentuckians, or roughly 23 percent of the population, have a disability, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition.
Being sick causes stress, and stress can make you sick and isolated.
Even as the Internet spreads and text messages fly through the ether, people are increasingly feeling alone.
"Being lonely is as strong a predictor of negative health outcomes as smoking," DeWall said.
Doesn't it make sense that big cities, with their crowded conditions, noise, crime and significant levels of poverty, would be equally effective incubators of poor mental health?
Not necessarily, DeWall said; there might be more people, but there are more opportunities in big cities.
It might be tough to find a job in, say, Chicago if you become unemployed. But there would be some opportunities. If you live in a small town and the main factory closes, you won't be able to find work without moving, another significant stressor.
Cities also have more opportunity to find help, such as 12-step support groups.
Kentuckians also suffer, DeWall said, because the state's economy is in transition. For example, people who have depended on tobacco for their livelihood for generations have to find a different way to support their families.
So, how will finding out just how sad we are help us?
You can't fix a problem until you know it is real, Schuster said.
And, if people recognize the impact that stress is having on their lives and families, they can take some small steps to alleviate it. Avoid smoking and drinking too much alcohol, and try to get some exercise and eat a healthier diet, DeWall said.
Those things can really make a difference, he said. But even though they are simple, they are not easy.
Often, people just ignore symptoms of stress, such as trouble sleeping or weight gain or lack of energy, Schuster said. Too often, she said, people let their mental health suffer to the point of crisis. Then, she said, the only option is hospitalization, which is not only expensive but also is in limited supply.
Kentucky was ahead of the curve in creating a statewide mental health system, the Comprehensive Care centers. But, she said, funding has not kept pace with demand. Those centers, often the only option for the poor or uninsured, have had to eliminate much of their preventive care. "They have become crisis-response systems," she said.
DeWall and Schuster offer the same short-term solution that could have a long-term impact: Find some money in the massive federal stimulus bill to invest in people's health and well-being.
"Instead of focusing on projects that are shovel-ready," Schuster said, "how about focusing on people and making them job ready?"