Over 1 in 3 coal miners (and former coal miners) suffering from black lung disease struggle with depression; one in ten has recently considered suicide, a US study found.

In the US (and in most parts of the world), coal mining is a rapidly declining industry. A century ago, there were 883,000 coal miners in the US, while nowadays, there are just over 50,000. But we should be paying more attention to their health, the authors of a new study urge — especially their mental health.

“Although coal mining is on the decline, the rates of black lung in Southwest Virginia continue to increase. Coal miners in Central Appalachia face disparities in health related to a range of complex social, economic, occupational and behavioral factors,” said researcher Dr. Drew Harris, a pulmonary medicine expert at UVA Health. “This study highlights the unrecognized crisis of mental illness in miners that warrants urgent attention, resources and expanded care.”

The life of a coal miner is anything but easy. From the hours spent underground and the toxic gases they can be subjected to, miners have a lot to deal with. Add the risk of being crushed or injured by collapses or explosions, and it’s not hard to understand how one could end up with dark thoughts.

To top it all off, coal miners are subjected to inhaling coal dust, which over the years, can cause pneumoconiosis or black lung disease. Recent studies showed that about 1 in 6 American miners suffer from industrial bronchitis, a recurring condition manifested through swelling (inflammation) of the airways of the lungs caused by coal dust.

Between 1970–1974, the prevalence of black lung disease among US coal miners who had worked over 25 years was 32%. The rate went down steadily as regulations improved, and the incidence dropped to 9% in 2005–2006. But a 2018 study by the National Institute of Occupational Safety and Health showed a small but concerning resurgence of the illness, with the highest rates recorded in almost 20 years (10%).

Harris, who works at Stone Mountain, the only federally funded black lung clinic in Virginia, found that more than 15% of the 1,400 miners X-rayed in the last year at Stone Mountain had progressive massive fibrosis — the most severe form of black lung.

Harris wanted to gauge their mental health, so he and his colleagues reviewed data acquired at the clinic since 2018, looking for signs of anxiety, depression, and PTSD.

Out of the over 2,800 miners that voluntarily completed the survey (most of which were veteran miners, and all but a handful were white and male), 883 (37.4%) reported symptoms of major depressive disorder. An even larger proportion (38.9%) had clinically significant anxiety, and over 1 in 4 had symptoms of PTSD.

A disturbingly large number of the miners (11.4%) had considered suicide in the past year. The average for Virginia is only 2.9%.

“The rates of mental illness identified in this large population of U.S. coal miners is shocking,” Harris said. “Improved screening and treatment of mental illness in this population is an urgent, unmet need that warrants urgent action.”

“These rates of mental illness far exceeded those documented in coal mining populations internationally,” the researchers write in a new scientific paper outlining their findings. 

The researchers also found that the more severe the black lung disease was, the more the mental health of the patients degraded. Among the patients who required supplemental oxygen to help them breathe, almost half reported depression, and 15.9% had considered suicide.

This is important in more than just one way, as mental health conditions can not only severely degrade one’s quality of life, but it can also reduce the likelihood of sticking to medication that can limit the damage caused by black lung disease.

This is unlikely to be a US-only problem. Studies outside of the United States have also found a high risk of mental illness among coal miners. Turns out, a highly stressful, risky, and disease-inducing environment is likely to lead to mental health issues. This is something worth addressing even as much of the world is looking at phasing out coal and transitioning to more sustainable energy sources — it’s important that the health and mental health of coal miners is not abandoned as an afterthought.

The study was published in JAMA.