There has been a global, 30-year increase in surface mining (1), which is now the dominant driver of land-use change in the central Appalachian ecoregion of the United States (2). One major form of such mining, mountaintop mining with valley fills (MTM/VF) (3), is widespread throughout eastern Kentucky, West Virginia (WV), and southwestern Virginia. Upper elevation forests are cleared and stripped of topsoil, and explosives are used to break up rocks to access buried coal (fig. S1). Excess rock (mine “spoil”) is pushed into adjacent valleys, where it buries existing streams.

Investigators have suggested that alexithymia is a multidimensional construct and that it is responsive to situational stressors. We tested these hypotheses in a sample of 110 freshman medical students. We conducted factor analyses on the Toronto Alexithymia Scale (TAS), the Beck Depression Inventory (BDI), and the state portion of the State-Trait Anxiety inventory (STAI) and then used LISREL to examine the relationships among the various factors. The results indicated that the TAS consists of several independent dimensions and that the dimensions associated with difficulties identifying and communicating feelings are positively related to depression and anxiety. Thus, the evidence now affirms that alexithymia (as measured by the TAS) is multidimensional and that certain dimensions are state dependent.