The prevalence and impact of type 2 diabetes in Appalachia is understudied despite the presence of high-risk socioeconomic conditions (e.g., low levels of education and income). Appalachian counties experience greater burdens of poverty, income inequality, unemployment (1), and diabetes compared with non-Appalachian counties (2–5). Rates of comorbid depression have not been documented in this region. Patients with type 2 diabetes are two times more likely to experience depressive symptoms than their peers without diabetes (6). Depression prevalence in studies using self-report depression inventories was found to be 32.9%, with lower rates (28.5%) observed in studies using diagnostic interview schedules (6,7). Depressive symptoms are associated with worsened blood glucose levels (8), diabetes complications (9), increased functional disability (10), worsened adherence to diabetes regimen (11), higher ambulatory care costs (12), and increased mortality (13). The current study was conducted to identify rates of self-reported depression and to identify the socioeconomic and medical correlates of depression among type 2 diabetic patients attending family medicine and endocrinology appointments from rural Appalachian counties of southeastern Ohio and West Virginia. It was hypothesized that poverty would increase the risk of comorbid depression in this region. Participants, recruited from family medicine and endocrinology practices, were diagnosed with type 2 diabetes for ≥1 year and aged ≥18 …