c_s welcome

Maintaining health and functioning is a shared goal of individuals and society. We have a great deal of information about continued problems with funding health care despite limited treatment access anddisparity of treatment access for a great many disorders, among them the psychiatric diagnoses of depression and alcohol dependence or abuse. The scope of mental health needs, the human and economic costs associated with failure to address mental health issues, and goals to increase the provision of appropriate treatment documented in "Healthy People 2010" (USDHHS, 2000) support the importance of additional understanding of mental health and illness, substance abuse, and rural service availability.

Recognition of coping strengths in persons dealing with adversity could potentially provide insight into care and treatment. It is possible that coping strengths increase the likelihood of surviving hardships. It is also possible that coping strengths may be increased by survival of rigorous life experiences. In this study we examined coping strengths present in individuals who reported symptoms of depression or alcohol disorders in response to a state-wide survey. The content of participants’ responses was analyzed to identify the origins of self perceived and reported strengths that contributed to their ability to cope and survive challenges faced in life. In addition, analysis of information shared by residents of this Midwest state provides an opportunity to consider the view often held of rural residents as independent and able to manage hardships, perhaps providing clues to adaptive qualities important to cultivate in times of diminishing health care resources.

Background
The importance of rural residence may reflect environmental influences on adaptation. For instance, Wright (1978) described an interaction of land and people, with the physical characteristics of the environment shaping the development of the inhabitants. Although focused on the experience of plains settlers, this statement is consistent with the themes identified as key to rural adaptation to wide ranging environmental conditions; adaptation often managed with fewer resources and hard work, but with a feeling of satisfaction and unity with the environment (Running, 1998). Sparsity of population likely leads to development of the characteristics believed to be present in rural people: independence and innovativeness. Researchers continue to examine the influence of the place of residence, as is evidenced in Snyder’s (1981) report of families’ compensation for long distances to formal health care. Weinert and Long (1987) and Scharff (1998) lend additional support to the documentation of the strong characteristics of independence and self-reliance, ability to manage on their own or by turning to family and friends rather than to formal agencies. Gessaman (1981) argued that examination of day to day life supported a modified view of the image of a rugged individualist, and described examples of a variety of supportive relationships from other people. This perspective was supported by Dick (1963) who reflected on the necessity of reliance on hospitality and neighborliness in order to survive—perhaps more so in the past even, than now. Other characteristics attributed to rural people include a high value placed on achievement, hard work and determination; more traditional moral values than their urban counterparts; greater hardiness and likelihood of accepting the challenges of life; and strong faith in God (Bigbee, 1991; Bushy, 1991; Henson, Sadler, & Walton, 1998; Lee, 1991; Lee, Hollis & McClain, 1998; Sorgaard, Sorensen, Sandager, Ingebrigstsen, Dalgaard, 1996). In sum, social, economic and geographic differences continue to distinguish the rural-urban experience. An intriguing, historical account of an experience illustrative of these rural qualities is Wilder’s account of a failure to save the oat crop from foraging blackbirds. The negative was turned around by having blackbird pie for dinner and illustrates the strength of redefining circumstances and overcoming obstacles. Ma reportedly said "‘there’s no great loss without some small gain’" (as cited in Miller, 1989, p. 31).

Methodology
Approximately 7000 individuals were first contacted and completed a telephone survey on help-seeking for depressive and/or alcohol disorders following approval from the University Institutional Review Board. Disproportionate sampling ratios were used for frontier (40%), urban (40%) and metropolitan counties (20%). Not all respondents were asked to complete the full interview, including the Diagnostic Interview Schedule (DIS) which provided the basis for the DSM-IV diagnostic variables (see Table 1). Those asked to complete part 2 of the interview were primarily those who passed the screening questions for problems with depression or alcohol use.

Through use of a qualitative interviewing approach, participants were asked to share accounts of life experiences; of helping themselves; and/or seeking help from friends, family, professionals; or use of other resources. Although the specific questions asked varied, depending on the stories shared by the participants, most were asked to identify the source of their coping strengths. Interviews were tape recorded, and the content of the transcribed responses analyzed in order to identify the individual’s own descriptions of the origins of strengths contributing to ability to cope with challenges faced in life. Of the 163 cases, 142 (87%) included content relevant to coping strengths. Content analysis was used to analyze, classify into categories and identify themes occurring in the stories of these research participants.

Sample
In order to be selected for the personal (face-to-face) interview the respondent had to complete the full telephone interview, be diagnosed (using the DIS diagnostic criteria) with either a major depressive episode or alcohol abuse. Qualifying respondents were grouped by sex, diagnosis, urban/rural residence and help-seeking behavior (sought help or did not seek help) in order to select equal numbers of respondents in each dimension. Within these groupings, respondents were randomly selected. Respondents who did not participate were replaced with randomly selected respondents within the same group.


	Coping Strength and the Adversity of Depression or Alcohol Use: The Human Spirit or Ruralness? by Betty J. Craft PhD, RN,CS and Sister Carol Grasser, PhD, RN,CS. College of Nursing University of Nebraska Medical Center – Omaha And David Johnson PhD University of Nebraska – Lincoln And Suzanne T. Ortega, PhD University of Missouri – Columbia Maintaining health and functioning is a shared goal of individuals and society. We have a great deal of information about continued problems with funding health care despite limited treatment access anddisparity of treatment access for a great many disorders, among them the psychiatric diagnoses of depression and alcohol dependence or abuse. The scope of mental health needs, the human and economic costs associated with failure to address mental health issues, and goals to increase the provision of appropriate treatment documented in "Healthy People 2010" (USDHHS, 2000) support the importance of additional understanding of mental health and illness, substance abuse, and rural service availability. Recognition of coping strengths in persons dealing with adversity could potentially provide insight into care and treatment. It is possible that coping strengths increase the likelihood of surviving hardships. It is also possible that coping strengths may be increased by survival of rigorous life experiences. In this study we examined coping strengths present in individuals who reported symptoms of depression or alcohol disorders in response to a state-wide survey. The content of participants’ responses was analyzed to identify the origins of self perceived and reported strengths that contributed to their ability to cope and survive challenges faced in life. In addition, analysis of information shared by residents of this Midwest state provides an opportunity to consider the view often held of rural residents as independent and able to manage hardships, perhaps providing clues to adaptive qualities important to cultivate in times of diminishing health care resources. Background The importance of rural residence may reflect environmental influences on adaptation. For instance, Wright (1978) described an interaction of land and people, with the physical characteristics of the environment shaping the development of the inhabitants. Although focused on the experience of plains settlers, this statement is consistent with the themes identified as key to rural adaptation to wide ranging environmental conditions; adaptation often managed with fewer resources and hard work, but with a feeling of satisfaction and unity with the environment (Running, 1998). Sparsity of population likely leads to development of the characteristics believed to be present in rural people: independence and innovativeness. Researchers continue to examine the influence of the place of residence, as is evidenced in Snyder’s (1981) report of families’ compensation for long distances to formal health care. Weinert and Long (1987) and Scharff (1998) lend additional support to the documentation of the strong characteristics of independence and self-reliance, ability to manage on their own or by turning to family and friends rather than to formal agencies. Gessaman (1981) argued that examination of day to day life supported a modified view of the image of a rugged individualist, and described examples of a variety of supportive relationships from other people. This perspective was supported by Dick (1963) who reflected on the necessity of reliance on hospitality and neighborliness in order to survive—perhaps more so in the past even, than now. Other characteristics attributed to rural people include a high value placed on achievement, hard work and determination; more traditional moral values than their urban counterparts; greater hardiness and likelihood of accepting the challenges of life; and strong faith in God (Bigbee, 1991; Bushy, 1991; Henson, Sadler, & Walton, 1998; Lee, 1991; Lee, Hollis & McClain, 1998; Sorgaard, Sorensen, Sandager, Ingebrigstsen, Dalgaard, 1996). In sum, social, economic and geographic differences continue to distinguish the rural-urban experience. An intriguing, historical account of an experience illustrative of these rural qualities is Wilder’s account of a failure to save the oat crop from foraging blackbirds. The negative was turned around by having blackbird pie for dinner and illustrates the strength of redefining circumstances and overcoming obstacles. Ma reportedly said "‘there’s no great loss without some small gain’" (as cited in Miller, 1989, p. 31). Methodology Approximately 7000 individuals were first contacted and completed a telephone survey on help-seeking for depressive and/or alcohol disorders following approval from the University Institutional Review Board. Disproportionate sampling ratios were used for frontier (40%), urban (40%) and metropolitan counties (20%). Not all respondents were asked to complete the full interview, including the Diagnostic Interview Schedule (DIS) which provided the basis for the DSM-IV diagnostic variables (see Table 1). Those asked to complete part 2 of the interview were primarily those who passed the screening questions for problems with depression or alcohol use. Through use of a qualitative interviewing approach, participants were asked to share accounts of life experiences; of helping themselves; and/or seeking help from friends, family, professionals; or use of other resources. Although the specific questions asked varied, depending on the stories shared by the participants, most were asked to identify the source of their coping strengths. Interviews were tape recorded, and the content of the transcribed responses analyzed in order to identify the individual’s own descriptions of the origins of strengths contributing to ability to cope with challenges faced in life. Of the 163 cases, 142 (87%) included content relevant to coping strengths. Content analysis was used to analyze, classify into categories and identify themes occurring in the stories of these research participants. Sample In order to be selected for the personal (face-to-face) interview the respondent had to complete the full telephone interview, be diagnosed (using the DIS diagnostic criteria) with either a major depressive episode or alcohol abuse. Qualifying respondents were grouped by sex, diagnosis, urban/rural residence and help-seeking behavior (sought help or did not seek help) in order to select equal numbers of respondents in each dimension. Within these groupings, respondents were randomly selected. Respondents who did not participate were replaced with randomly selected respondents within the same group.