A recent news article cites a study that portrays Utah as the most depressed state in the U.S. The article suggests Mormon culture is at least partly to blame for Utahns’ depression, and features photos of a pill bottle and a depressed-looking woman superimposed over the Salt Lake temple.
A post by Kaimi Wenger at T&S touched off a flurry of debate and speculation about whether Utahns are, in fact, more depressed than their fellow Americans and, if so, whether Mormon culture is at least partly to blame. The most common theories and conclusions were:
Conclusion #1: Utahns are not significantly more depressed than anyone else. The main theories advanced to support this conclusion are:
a. Utahns are simply more honest in reporting their depression.
b. Utahns report more depression than non-Utahns because they are not self-medicating with alcohol to mask their depression from themselves.
c. The high amount of anti-depressant prescriptions in Utah exists, not because Utahns are more depressed than anyone else, but because Utah has an excellent mental health care system that provides treatment to those who need it.
Conclusion #2: Utahns are significantly more depressed than others, but Mormon culture has nothing to do with it. The main theories advanced to support this opinion are:
a. Lower education levels correlate with higher depression levels, and Utahns have comparatively lower education levels.
b. Utahns have less available mental health care facilities and professionals.
c. Utahns cannot afford to use the mental health care that is available to them, perhaps because of a lack of health insurance coverage.
d. Utah has a smaller gene pool than other states, which can result in higher depression rates.
Conclusion #3: Utah is significantly more depressed than other states, and Mormon culture is at least partly to blame. The overall theory behind this conclusion is that Mormons, who comprise 70% of Utah’s population, have a Church culture that is demanding, emphasizes perfection, obedience and conformity, and creates an undercurrent of competition that leads to feelings of inadequacy, depression, and suicide.
Over the past week or so, I’ve been able to digest the study and its underlying data, and to compare it against the theories outlined above. I was quite surprised by what I learned, and thought you might be interested to hear about it. But first, I should make an important disclaimer: I have absolutely no formal training whatsoever in psychology, statistics, or any other discipline that would qualify me to write this post. However, to be fair to myself, I should mention that I am a Doctor of Metaphysics, as well as a Certified Jedi Knight, so that ought to more than make up for it.
The Key Findings
The key findings reported by the Mental Health America study are as follows:
- Utah has the highest percentage of adults reporting a major depressive episode from 2004-05. (10.14%)
- Utah has the 3rd-highest percentage of adults reporting serious psychological distress from 2004-05 (14.58%)
- Utah has the 4th-highest percentage of adolescents reporting a major depressive episode from 2004-05. (10.14%)
- Utah has the 7th-highest suicide rate in the nation.
When these factors are combined and compared to others states, Utah comes out as the most depressed state in the U.S. 
Some Interesting Correlations on a National Level
The study states that depression and suicide rates are generally influenced by three factors: biology, environment, and access to mental health care. When it comes to access to mental health care, some interesting correlations on a national level were noted:
- On average, the higher the number of psychologists, psychiatrists, and social workers per capita in a state, the lower the state’s suicide rate.
- The lower the percentage of a state’s population reporting they could not obtain mental health care because of cost, the lower the depression and suicide rates.
- The lower the percentage of a state’s population reporting unmet mental health care needs, the lower the depression rates.
- The higher the number of anti-depressant prescriptions per capita in a state, the lower the suicide rate.
- The higher the percentage of population covered by health insurance, the lower the suicide rate.
- The more educated a state’s population is, the lower the depression and suicide rates.
Utah: A Peculiar State
Based on the documented correlations listed above, one would expect Utah’s high depression and suicide rates to be easily explained by low numbers of mental health care professionals, low anti-depressant prescriptions, low education levels, low health insurance coverage levels, and high numbers of people reporting unmet health care needs and an inability to obtain mental health care due to cost. But Utah is not the worst when it comes to any of those factors.
Here is how Utah ranks in comparison to other states when it comes to the availability of mental health care (including the District of Columbia, so all the ranks below are out of 51):
- State mental health authority expenditures per capita: 26th
- No. of specialty mental health organizations providing 24 hr. treatment: 38th
- No. of specialty mental health organizations providing less than 24 hr. treatment: 45th
- No. psychiatrists per 100,000 population: 44th
- No. psychologists per 100,000 population: 24th
- No. socialworkers per 100,000 population: 23rd
As you can see, Utah has mid-to-low rankings when it comes to the availability of mental health care, but it is by no means the worst. As an example, Texas ranks even lower than Utah in all but one of the categories above, and yet still manages to be in the top 10 least-depressed states. So the availability of mental health care doesn’t seem to be what’s driving Utah’s depression numbers.
When it comes to the affordability of mental health care, Utah ranks mid-to-low again:
- Percent of population reporting could not get health care because of cost: 23rd
- Percent of population with health insurance: 35th
But Utah is by no means the worst in these categories either. Again, by way of comparison, Texas ranks even lower than Utah on both these factors, but still falls within the top 10 least-depressed states.
And despite any shortcomings in the availability and affordability of mental health care in Utah, Utah has the 4th highest percentage of population receiving mental health care treatment (17.4%). And Utah ranks above-average (18th) in anti-depressants prescribed per-capita, which one would expect to correlate with lower suicide rates in Utah, but for some reason does not.
What is more perplexing is that even though Utah ranks 4th-highest in percentage of population receiving mental health care treatment, somehow Utah also has the highest percentage of population reporting unmet needs for mental health care treatment in the past year (8.2%). One would expect a state with high percentage of population receiving treatment (like Utah) to have a correspondingly low amount of unmet treatment needs. But not in Utah. This gives you an idea of how great the demand is for mental health care treatment in Utah.
Why would Utah’s demand for mental health care treatment be so high? It is unclear. But we can also probably rule out economic and educational factors, because Utah has the 8th-highest median household income in the nation, and 24th-highest percentage of population with a college degree.
So What Is Behind Utah’s Depression?
The data above suggest there is something strange going on in Utah. When it comes to depression and suicide, Utah just doesn’t “act like” other states. It defies most of the correlations that exist on a national level. Which leads to the obvious question: if Utah’s depression numbers don’t seem to be driven by the “normal” factors, what is behind Utah’s depression and suicide numbers? What makes Utah so peculiar?
In my next post, I will address two peculiar theories about Utah’s depression and suicide numbers: the “Shrunken Gene Pool” theory, the “Lack of Alcoholic Self-Medication” theory, as well as the 2,000 pound elephant in the room: Mormon culture.
(P.S. For any readers who actually are qualified to analyze these matters, please feel free to completely rip my amateur analysis to shreds.)
Glad to see genetics will play a role in the answer you try to propose.
Also, perhaps it is worth considering whether people in Utah are more likely to trust/visit a counselor/therapist and therefore come away with meds than other states. If so, that is hardly a condemnation of Mormonism, even if it could somehow be proven that the people at issue are actually Mormons, which will be another problem of any answer that blames Mormon culture.
The answer I propose is overly simplistic, but it is this: Utah is the most depressed state because it has the most GUILT, and there is nothing more depressing than mis-managed guilt.
Religious persons are more apt to feel guilt than the general population because they’ve been programmed with a higher standard. Utah, as a state, is unique in its “religious concentration”, and this programming shows up in spades.
Unfortunately, Mormons also seem to be programmed a little heavily on the perfect performance side of things, and it DEPRESSES ME that so many of us are still unable to effectively set aside our guilt as a part of regular participation in gospel covenants. Just as we may be unique in the programming that leads to increased guilt when we try to act like the rest of the world, we ought to also be unique in accessing the balm that lies in Gilead.
I don’t mean to categorize major, real depression in terms as simple as this. But I also believe that major, real depression is a lot more rare than the number of prescriptions suggest. Most people who end up medicating for this are just sad because their life isn’t what they want it to be. And the pharmaceutical answer doesn’t appear to be working. Most (and especially the most recent) studies show that the drugs are actually less effective than a placebo for all cases other than major depression. (the real drugs would be as good as the placebo if only they didn’t screw your brain up while you were getting the placebo effect)
Which brings me back to my main point. The reason that placebos have any effect at all is that they offer HOPE for relief. Gosh, when I was on my mission, I thought that’s what I was doing - spreading a message of HOPE. Hope for relief of all kinds of things. If Utah (and come on, when we say Utah, we’re talking Mormons) is the least hopeful state, we must not be getting that message.
As a trainee in non-clinical psychology (I can’t legally call myself a psychologist–I don’t have my PhD completed, and even when I do finish, it won’t be clinical psych, and I won’t be getting state licensure to practice as a clinical psychologist, and therefore many places will bar me from calling myself a Psychologist, the jerks), I do have some problems with the concept of Utah being the most depressed state, as well as the study in general.
First off, any time you start taking and playing around with statistics, there are arguments to be made about why you made particular statistical decisions and why other possible decisions were ignored. I can, without looking at the data, already think of several potential questions about the study. I won’t list them, but let’s just say that there are plenty of problems. I’m not going into that because I really want to get to the final bit of this: what it all means if you accept that Utah is the most depressed state.
If Utah turns out to be the most depressed state, and it can be ’shown’ to be linked to linked to ‘Mormon Culture’ how do you do that? Actually, you can’t. Let’s break this down. Let’s say you start a survey that asks people all sorts of invasive medical questions and then asks about their religion, thinking you will get a good look at it that way. There are a lot of potential confounds, and you get some seriously messy data. But you can clean it up, no problem. However as you do that, other statisticians start to question your methods, and soon it starts to look fishy. So you decide that the way to do this is part of a nationwide survey–after all if its a Mormon culture thing it should show up in other Mormons outside Utah, right? Except you aren’t thinking clearly, as all Mormons know, becuase Utah Mormons are DIFFERENT. So it doesn’t show up there. Weird.
Actually maybe it does–but only if you think to look at just Mormons in Utah and Idaho. That’s funny? What’s so special about that? But even if it does turn up that Utahn & Idahoan Mormons are seriously depressed for some reason, what is going on? I am uncertain, but considering some of the folks I’ve known from out that way that fit the model of depressed Utahns, I think its probably a bit of perfectionism combined with an unwillingness to really understand the gospel. Think about this for a moment. I know a good Mormon housewife who falls into this category but is one of the ones that probably drives this statistic. She is constantly trying to figure out some sort of alternative medicine or what have you, but she’s a bit kooky. She’s just a bit off. A really nice person, and my wife and I like her and her husband well enough, but she’s got some issues. Like not going to the doctor when she should, and eating garlic as a cure for colds.
I see things like this as an issue in Mormon culture. This is an extreme example, perhaps, but I’ve got a lot of cousins in Utah that are similar in their own way–they just have their quirks that keep this statistic high. Why? Because they are so focused on the drama of their own lives being out of sync with what they perceive to be the right way that they can’t just get on with it. Instead of focusing on learning the gospel and helping their neighbors and maybe even setting a good example, they focus on being nervous about not being good enough. That’s enough to make anyone a wreck. When your whole culture is one of becoming perfect, soon everyone forgets that the purpose isn’t to focus on your own needs but to focus on what you can do for others.
Drama leads to depression, and that’s the issue at hand.
At least, that’s how I read it. Of course I’m not in Utah, thank goodness for that blessing.
Benjamin O may not be interested in picking nits with the statistical decisions made in the cited study, by I am.
First, the suicide rate is meaningless. What might be useful is the attempted suicide rate. The following link provides evidence that Utah’s attempted suicide rate is relatively low (see Table 2):
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1446422&blobtype=pdf
(The above article also has Utah’s completed suicide rate as being around the average, which is at variance with the study cited in the original post.) The discrepancy arises because Utah has a relatively high suicide success rate, which in turn, is probably a function of access to firearms. Suicide attempts with firearms are much more likely to be successful than those by other methods.
The measure used to label Utah as the “most depressed state” is a composite of four separate measures from two different sources. Three of those measures are cited in the original post (the non-suicide ones under Key Findings above) and all come from the same source. The fourth measure, “Poor Mental Health Days,” comes from a different source and shows Utah better than average. Why does it get only 25% weight in the composite measure? Why does the original post ignore it? (Incidentally, if all four measures are fundamentally accurate, the implication is that a higher percentage of Utahns experience depression but that the episodes are either shorter or less severe than elsewhere.)
Finally, most previous attempts to label Utah the “most depressed state” have relied on measures of antidepressant use. By those measures, it wasn’t even close–Utah was in a league of its own. This study does not use antidepressant use in its composite measure, but found a strong correlation between the composite measure of depressedness and antidepressant prescriptions. The interesting thing, however, is that according to this study’s data, Utah ranked 19th in antidepressant prescriptions per capita.
My conclusion? The more of this stuff I see, the more convinced I am that the label as applied to Utah is simply bogus. It is based on cherry-picked data, and one could construct a plausible measure showing Utah in the middle of the pack with little difficulty.
Two factors come to my mind, first all your rates are based on reporting. Could it be we are more open about reporting when we are depressed? I know those with a beef with the church will only justify it by stating their belief that this just means the problem is even bigger. I don’t really know the answer, but I do know that little is to be gained by taking a group to task for reporting depression. For this reason, I just cannot get excited over Utah depression statistics. Because of the stigma depression carries in our society, this the inevitable result of publicizing is to drive the problem underground. Even if guilt is the problem, attacking someone’s religion will only exacerbate the problem. So as I have remarked before, If you really want to help with the problem take a good look in the mirror.
Second is the mountain valleys. Circadian rhythms and lack of exposure to sunlight play clear roles in conditions like seasonal affective disorder. The Scandinavian countries in the winter have the highest suicide rates in the world. Your overall daylight exposure is reduces living in the shadow of mountains. Perhaps you should consider this.
In the end, I don’t think it matters who is more depressed than who, only that they get help. I happen to care quite a bit about this issued as I have wrestled with it myself, belonging to a high risk group, physicians. How’s that for irony. If you would like you can read my take on it here . My personal experience is up at the same sight as well in 4 parts, and of course, the rant I linked to in the first paragraph especially for people like jjackson.
“a Church culture that is demanding, emphasizes perfection, obedience and conformity, and creates an undercurrent of competition that leads to feelings of inadequacy, depression, and suicide.”
Not saying I disagree with where you’re headed with this report, Andrew, but is this church culture unique? Isn’t the business world, and most of society, inherently competitive, leading to feelings of
inadequacy, depression, and suicide? What I’m suggesting is that although there are definitely demanding structures in place in Mormon culture and religious practice, there are also demanding social cultural structures that exist outside of the Mormon context. Like Darwin observed, the world is naturally competitive, and the strong survive while the weak are consumed. In ages past, people with physical, emotional, mental problems didn’t have access to programs, pharmaceuticals, and other societal and familial support systems. But now they do, and the law of natural selection is being purposefully
diverted, allowing weaker traits and genetic illnesses to perpetuate in the population where they might not have otherwise. Despite civilization’s advances, competition, cruelty, stuggle, etc. are still
major operative forces in life, and human efforts to thwart natural selection by improving each others lives have helped people become *less* adapted to survival than ever before. (Note: I’m not suggesting some Hitlerian program to eliminate undesirables from the populace here. On the contrary, I believe God has directed men and women in their search to improve their lives through scientific research, technological innovation, and equitable government that provides protection of basic human rights. I’m simply stating that these efforts have worked against a natural order that favors diversity and entropy, not equality and order.)
What is unique about the LDS perspective on life is that our thoughts and actions play heavily into our future destiny in God’s eternal kingdom, and thus every aspect of our lives get put under the microscope, if you will, of both private and (unfortunately) public scrutiny. And in areas with populations that share the same eternal values and reward system, opportunity for depression is going to rise. Because the simple truth of the matter is that some people are better and worse equipped to deal with the stress, disappointment, and discouragement that follow when both the world and your own imperfect self let you down, and you don’t feel like you have the skills to improve your situation.
If the Church is guilty of anything, it may be that it doesn’t effectively accommodate real-world “survival” skills in its doctrines and corresponding practices. “Gentleness and meekness, …love unfeigned, kindness, …without hypocrisy, and without guile” (D&C 121:41-42) are traits embodied by Christ and set as supreme models for behavior, and promise peace and happiness to those who practice them. But these traits work contrary to the natural order of the world, in which aggression, self-interest, and guile (i.e. not revealing true intentions at all times to all people) are favored. These latter traits don’t promise lasting happiness, but they do have a good track record of providing
short-term safety and security to their practitioners. Perhaps some of the problems contributing to LDS depression are: first, the result of an acknowledgment that Christ’s way can lead to happiness; second, a realization that following Christ’s way in a world that naturally opposes it will be difficult; third, actual attempts to follow Christ’s way result in other people failing one’s expectations (being cheating, being lied to, having violence inflicted towards you, etc.), and in an awareness of one’s owns failings and imperfections; fourth, realizing that following Christ’s example isn’t really about happiness after all (John 16:20-22), but that the happiness is only a promised future blessing; fifth, realizing that adapting for survival in a predominately-LDS culture means putting on the appearance that “all is well” and that one is following Christ’s way, when by so doing one is actually practicing deception, pride, etc., or in other words, doing the very things that will forfeit the future happiness promised by following Christ’s way; sixth, the realization that one is thus a hypocrite leads to anxiety, depression, suspicion of other’s (true) attempts at selfless service towards others, etc.; and seventh, the realization that one must continue to put on appearances indefinitely, thus catching one into a vicious downward spiral.
In short, the natural world preys upon the meek and the lowly, and those who are taught to avoid natural survival reactive behavior get put in the difficult position of finding themselves guilty of imperfection, buffeted by the world around them, with few sanctioned coping skills to extract oneself from their unhappy state. This leads to chronic anxiety and depression.
I have to say that the only true answer I see is, in fact, to follow Christ’s example even more, and let the consequence follow. In that I agree with Benjamin O’s remark that there seems to be an unwillingness on the part of many LDS to really understand (and live) the gospel (love one another [unconditionally]; can’t serve god and mammon; bless them that curse you, etc.). Pretensions and selfishness are some of the biggest impediments to tackling issues of depression and anxiety in Utah LDS culture more effectively than medicating the populace.
I have commented elsewhere extensively about how people are interpreting this study. The summary version: It’s crap.
I am wearied of this, so here’s the bullet point summary:
Mormons, in general, don’t self-medicate nearly as much as others; Mormons, therefore, go to their doctor to treat depression much more frequently than others; Mormons, therefore, get prescribed medication for depression more often than others; Mormons, therefore, show up in these studies and get labeled “more depressed” than others. It’s garbage - pure and simple - for one reason.
**What’s wrong with getting medication from a doctor for something that MANY people use alcohol or illegal drugs to treat?**
**What’s wrong with getting help with a real disability - which depression often is?**
I HATE the stigma that is attached to depression, especially when **post-partum depression** has to be a big part of this. Mormon women have more kids, and they have them closer together; hence, more depression related to childbirth. This depression, as mentioned above, tends to last a shorter time but can re-occur; hence, more anti-depressant use during those episodes.
End of rant. Interesting study; ridiculous conclusions.
I agree with Ray. Many people self-medicate with alcohol, so they don’t show up in the study.
Also, it does seem the Utah medical community seems to like to prescribe drugs. For example, (slightly off-topic) use of Pitocin in Utah to induce labor is way higher than the national average. There is data to suggest this increases cesearean sections, and child-birth complications. On the other hand, being able to schedule a birth is seen as a plus.
In short, I think Utah doctors over-prescribe all types of medications, from anti-depressants to antibiotics.
Maybe a different question could be “Why are Utahns so Utarded?
#1 John F. I think your theory that Utahns are more likely to seek treatment is supported by the data that shows Utah being the 4th-highest in percentage of population receiving treatment. As a side note, this shows not all the data in this study is bad for Utah.
#2 JJackson. I agree with the idea that we need to more effectively convey the message of hope. However, when you propose that guilt is what’s behind all the depression numbers, I’m not so sure.
Ben (#3), Lemming (#4) and Ray (#6). Thanks for you critiquing of the study. As far as biases go, the main bias I saw in this study was not an anti-Utah bias, but a bias to demonstrate a causal link between the unavailability/unaffordability of mental health care treatment, and depression and suicide. Bear in mind this organization is somewhat of a lobbying tool designed to help influence public policy and funding for mental health care. Thus, even though the study recognized three main factors leading to depression: biology, environment, and access to treatment, the study evaluated only the latter factor.
But oddly, that seems to actually be an argument in favor of the study when it comes to Utah, because the researchers were essentially going out of their way to demonstrate that depression and suicide were largely the result of poor access to treatment (and not environmental factors such as Mormon culture). They definitely had an agenda. But that agenda was to blame depression and suicide on poor access to treatment. The odd thing here is that Utah doesn’t seem to fit the mold they were attempting to create, i.e., its depression and suicide don’t seem to be susceptible to explaining away because of access to treatment, even though that correlation is successfully demonstrated for many other states.
#5 Steve. Please note that I was summarizing other peoples’ conclusions and theories; I was not giving my own. And please reserve judgment about “where I am heading with this report.” Stay tuned.
#7 Heretic. Stay tuned for part 2 where I will be addressing the self-medication theory. There’s some interesting stuff there.
Ray,
Are you sure you are criticizing the same study Andrew linked to in the original post? It does not rely on antidepressant use as its measure of depressedness.
I thought the percentage of Mormons in Utah is currently 60%, not 70%, like it used to be.
cadams (#11), I relied on the 70% figure quoted in the news article, which was probably too naive and trusting on my part.
Ray and Mormon Heretic: I think this whole self-medication with alcohol and illegal drugs argument has problems: are there studies that show that these substances effectively treat depression? The euphoric effects of drugs and alcohol wear off rather quickly, and would require constant use to maintain an effect. The problem with “self-medication” using alcohol or illegal drugs is 1) huge risk of addiction, and 2) mental and physical impairment while under the influence, which prevents the user from living and working in society effectively. No one “treats” their depression with alcohol and calls it good; alcohol merely displaces the confrontation of one’s depression to a time in the near future after the effects of the alcohol have worn off.
Ray: I agree that there’s not really anything wrong with treating real depression medically. That’s not the question the study raises. Really, it is whether clinically-diagnosed depression’s onset can be linked to physical, social, societal, and other environmental parameters. If so, which of these parameters is causing such high rates of reported depression among people in Utah? If not, then what are the true causes of depression?
“alcohol merely displaces the confrontation of one’s depression to a time in the near future after the effects of the alcohol have worn off”
I think much of the chemical treatment of depression by the medical community does exactly what the above quote asserts. My experience is also that most anti-depressant medication is prescribed by a generalist family doctor who has very little expertise beyond what the pharm companies provide in pamphlet form.
A large number of our people are bailing out of things they could learn by dealing with their lives instead of medicating, by whatever means. Instead of growing and feeling, they opt to become a little more zombie-like, a little less passionate. They trade the regular highs and lows of life for a nice, tame baseline. I think it’s a tiny little surrender to the “other plan”…
Again, I realize that my comments cannot possibly apply to everyone - I do recognize that this is a real thing for many people. But depression and ADHD are having a brawl to see which can be the most over-diagnosed. One is overdiagnosed because people can’t deal with their kids - the other because they can’t deal with themselves.
Perhaps the exact figures, percentages and ranks are skewed by different factors and variables… but surely despite all these details, this study shows that depression is at least a major problem in Utah. Even if the state doesn’t rank number 1, these results make me think that we should do more to combat the causes of depression, and foster self-esteem. I have family members who are members of the Church who have struggled with depression, and even if I can’t lay my finger on any individual cause, my impression is that there is more that we could do as a Church to help them recover, and avoid the condition in the first place.
I believe that the Gospel inherently fosters well-being… are we just presenting it in the wrong way? I think this question applies to the worldwide Church, not only Utah culture.
Andy, I agree that regardless of the causes, we need to recognize the problem first. We can nitpick about the study’s use of suicide rates rather than attempted suicide rates, but that does not change the fact that Utah has the highest percentage of population that is SELF-REPORTING a major depressive episode in the previous year.
We cannot have a knee-jerk defensive reaction on this one and dismiss it as yet another Gentile conspiracy to besmirch the good name of Utah. The New Testament and Book of Mormon teach us that whenever we learn of a problem, it’s best to ask “Lord, is it I?” rather than crying that “all is well in Zion.”
Andrew,
As a Utah resident, this study never rang true with me and mine. I was more depressed when I lived in Seattle
Moving to Utah added three months of happy sun and Vitamin D to my life.
John N., sounds like you are one of the lucky 85-90% of Utahns who reported neither a major depressive episode nor serious psychological distress in the prior year.
That helps put things in a bit of perspective. At most, we’re talking about 10-15% of Utahns who report a major depressive episode or serious psychological distress, respectively.
By the way, guess which state has the lowest percentage of adults reporting a major depressive episode or serious psychological distress: you guessed it, it’s Hawaii, at 6.74% and 9.81% respectively. That alone ought to tell you that environment has a lot to do with depression. It also should give you an idea of how much worse the “worst” state is compared to the “best” state. Utah has 3.4% more of its population reporting a major depressive episode than Hawaii, and 4.77% more reporting serious psychological distress than Hawaii.
This study defines a a “major” depressive disorder as “a period of at least two weeks of depressed mood or loss of interest or pleasure in daily activities, and that included symptoms meeting the criteria for major depressive disorder as described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders…”
Does anyone know what the “included symptoms meeting the criteria for a major depressive disorder” are? Would knowing that definition affect how we view the study results?
Stephen, great observation. I think knowing the symptoms would certainly affect how “serious” a problem we see this as being.
On the other hand, it would not answer the question of why, regardless of how you define a “major depressive episode,” adults in Utah report having one more than anyone else.
Wow!! What a great topic and one that has really been on my mind alot recently. The brunt of this discussion has been about statistics and what can be determined by those stats. What I’ll add is a bit of gut-level perspective based on recent examples in my own family having to do directly with this area.
Some facts: I don’t live in Utah.
I live with 3 women (1 wife and 2 teen daughters)
I live with one person who has been diagnosed with “clinical depression” (daughter)
This one person is currently on Zoloft and seeing a therapist.
I think that the other 2 women will be on something fairly soon.
So…. My perspective is a VERY small sample size, but I’ll give you what I know.
I have a 16 yearold daughter who is a very emotional/nurturing/loving sort of a kid. She went through her past year with a series of several events that had left her in a constant feeling of low self-worth. In meeting with her doctor, a psychologist, and a psychiatrist they diag’d her and put her on the meds. In meeting with her therapist on a weekly basis, which I attend as well, it became very apparent that “church” was a major contributor to her feelings of depression.
When we delved a bit deeper, it wasn’t for things like major sins that our LDS leaders would typically attribute to feeling guilty, but for things like: missing mutual, not bringing scriptures, not meeting every single quality for “perfection” that she hears from her Sunday School and YW leaders. We came up with a number of 80% of the number of issues she was facing that came from church when there was no reason to feel bad.
We decided to take her out of the church environment for a time. We took her to Sacrament meeting but that was all. We gave very specific instructions to her Laurel advisor and other church leaders that if they ever talked to my daughter, it was just to be a “Hi” Nothing else. Not a “We miss you”, no “Hope you are feeling better”, nothing.
She still gets some church involvement through Seminary, but even that is fairly controlled as I’m the teacher.
What we have found is that this one thing alone has made a major difference in my daughters ability to heal. She is much better now. We have put more a Christ centered teaching mode that focuses on the primary message of the Savior, and NOT the supplemental message of the church which is “come to mutual, do this, don’t do this, be perfect, you are never good enough, keep this commandment, don’t break that rule, follow this policy, ect….”
So… in my mind. Yes, the church (as opposed to the gospel of Christ) is a major contributor to feelings of depression and anxiety about how a person feels and increases the odds the person will require anti-depressants.
Just a sample size of 1, but my mind is 100% convinced.
the symptoms are daily or near daily
Depressed mood
suicidal thoughts or preoccupation with death
excessive guilt or worthlessness-
(note it is a symptom, not necessarily a cause)
insomnia or excesssive sleepiness
lack of appetite or excessive eating
lack of pleasure any activities, even favorites
difficulty concentrating
fatigue and decreased energy
moving and thinking slowly as apparent to others, not just self, or
excessive agitation.
You have to have at least 5 of these 9.
Andrew,
I have to ask, why is the question of why so critical in your eyes? I have generally found online discussing this is wielded as a club against cultural or religious practices that one does not like. It is much more difficult to look at depression constructively, particularly with the stigma and misunderstanding that surround it. I think the much, much more important question is, “so what do we do to fix it.” I trust that the answer is much easier individually than for an entire state or country.
BTW,
Studies clearly show that depressed people drink more, and that depression is linked with alcoholism. Conventional wisdom in medicine, which holds in my experience is that depression is a cause of their drinking, thus self medicating. Is this the most effective treatment? NO. But hey you can hide your problem in a closet that way. Someone drinking their depression away is highly unlikely to report themselves depressed, don’t you think?
Doc, I am interested in discovering the “why” because the first step to solving a problem is to discover “why” it exists in the first place.
You’re right that some people use these discussions as an opportunity to grind axes they’ve been grinding a long time. However, I don’t think that opportunism should prevent those of us who want to have an honest discussion about something we sincerely want to resolve.
As for the “so what do we do to fix it,” I think understanding “why” more adults report a major depressive episode in Utah than any other state will tell us “what we need to do to fix it.”
As an active, calling-magnifying, temple-attending, full-tithe-paying Mormon who served an honorable full-time mission, was married in the temple, and absolutely loves the Church and what it brings to my life, I can assure you I don’t harbor some hidden motive of bringing down Mormonism.
My favorite alternate theory explaining this high rate of depression in Utah is that most of those who are unhappy are not Mormons, but the non-Mormons who are made absolutely miserable by the fact that they have to live among the Mormons.
Andrew,
But do you like Utah, or are you one of those who dislikes the culture, which after all is different than the church. I am sorry if I came across as casting aspersions but many, many members, myself included at points in my life, like to rail on Utahns. Again, what if why they report being depressed more often is simply a matter of being more open about feelings on questionaires. I think you really have to understand what major depression is before you can even begin to tackle the why. Therefore, I encourage understanding the problem before worsening stigma, which IMHO, is a huge part of the problem. You will make depression worse by problematizing it and making people feel they should not ask for help.
This has probably already been said, but:
The real reason is lack of self-medication. Mormons don’t drink, generally, and are therefore denied the most commonly used anti-depressant, alcohol. Case solved. It is cultural (and I do think Mormonism runs people in the ground, but no more than life does in general), but only because of the abstention to alcohol by a significantly large portion of the state’s population. This would also tie into the lower attempted suicide rate. Alcohol makes for more and poorer suicide attempts.
Ray #7: Ethanol consumption nationwide is down over 15% from what it was in the 70s and 80s. Furthermore, the only noteworthy ethanol figure of which Utah is more uniquely low is beer consumption–which is particularly noneffective in drowning one’s depression compared to wine or spirits. And in those latter beverage categories Utah shares a low point in the nation together with several other states. I’d be interested in seeing that metric graphed against the depression measurements to see if this “self-medication” theory really holds out. I’d be surprised if it does, at least as the most likely scenario. But without taking any thunder away from Andrew’s upcoming sequel, I will wait with interest…
Nevertheless I will grant that healthy skepticism is in order, and appreciate Andrew in #19 stating the figures of what “best” means and “worst” means.
GeorgeGT: My anecdotal experience holds out similar to yours. Since we left Mormonism I have been amazed at how many Mormon acquaintances and former ward members have been curious to hear about our church experience. They always swoon when we talk about the more liberalized atmosphere (on ticky-tacky things like dress codes, etc.), energized worship services, and Christ- and Bible-centered preaching. If my experience is any predictor there are a significant chunk of our former ward who are dissatisfied or less-than-fulfilled with Mormon practice. Nevertheless, I’d categorize most of them as still willing to be Mormon–it’s not like they’re asking us to proselytize them or anything– and still appear to believe the foundational faith claims. So at a minimum, if the pleasant swoons we hear are any indication, I think if local Mormon wards could implement a culture change that could reach some of the same goals as you’ve tried for your daughter that we’d see more satisfied Mormons. But certainly our experience isn’t any more useful for predicting causal links that Mormonism may or may not have with Utah depression than other persons’ anecdotal experiences that may shine more favorably toward LDS member satisfaction with religious cultural practice.
Doc (#27), all I can say is please stay tuned for my next post on this topic and reserve judgment about my intentions until then. Thanks!
I remember telling my bishop once that I had been depressed lately. Nothing against him, he is a wonderful man and I know his calling was inspired, but his answer (not that I needed one), was way off the mark. He said that lots of people get depressed by the press to be perfect and that I needed to not compare to other people and to better understand the Atonement. Both of these suggestions are great, but I don’t feel like they have anything to do with depression. I was not depressed because of any comparisons or pressure to be perfect. That absolutely had no part of my life at the time. What it was, I can’t say, maybe the fact that I wasn’t sure what the next step to take in my life was, who knows, all I can say is that it wasn’t what people like to call perfection pressure.
Michelle (#31):
Excellent point. It seems to reiterate some of Doc’s (#23) fair skepticism. “Perfection pressure” may cause issues, but it may not be linked at all to serious depression, the kind that seems to be what is being discussed.
In my major bout with depression, for which I needed to get counseling, and coping-guidance, my unhappiness with LDS faith and culture was only tangentally linked. The major cause was a crisis with my marriage. Also, my Bishop’s advice was pretty off the mark, cookie-cutter, and pat as well. But I see that more as a reflection that he’s not a trained minister, scriptorian nor counselor. But he’s still a well-intentioned guy. He wasn’t completely wrong; I did need the hope of Jesus in my life. (I just wasn’t gonna find Him in pat advice.) But I also needed to do serious personal effort, some of it together with my wife, to heal our marriage, and cope with depression.
Just for quix
Can I get ahold of you for an email exchange? scoutlaw1@hotmail.com
This, too, is purely anecdotal so take my input for what it’s worth.
My mom suffers from major depressive episodes and lives in Utah.
I think part of the reason does come from alcohol or other activites where one can sort of “blow off steam” or “let your hair down.” While I don’t mean self-medicating specifically, many non Mormons or non practicing Mormons might go out for a night of drinking with friends. We practicing Mormons don’t. I’m not intimating that we should (personally, I find that the pros of drinking are far outweighed by the cons).
Add to that that many women in Utah are home with many children. Not all women are cut out for being SAHMs, including my mom. Her depressive episodes declined dramatically when she went to work outside of the home.
Add to that to the list of “stuff” we practicing Mormons have on our list: church attendance, daily scripture study, HT/VT, callings, temple attendance, genealogy, etc. and the list can become overwhelming. And when one cannot do everything on the list, many will break under the strain.
And then there are financial worries. Paying 10% of ones income can become a financial strain. We can argue the blessings all day long but Utah also has one of the highest bankruptcy rates in the country (maybe the highest?).
And then our culture often equates happiness with living up to church expectations so failure to be happy can often turn into “what am I doing wrong, I must be evil?” thoughts, which can become depressing.
And then the ideal of conformity and obedience (wholeheartedly agree) regardless if one really “feels” that way.
It’s a heavy burden and I do think that church and church culture have to have a heavy baring on the depression statistics.
Purely enecdotal, I know, but I just can’t imagine that the two are not intertwined.
Total speculation, but I wonder how much not having trained clergy plays into this? The LDS church likes to brag about how ‘all’ of thier church leadership is volunteer, but along with paid clergy you get important information about how to deal with emotional issues, and at what point they need to be referred to someone even more professional, and what to look out for in your flock.
And FYI, I was a convert, and didn’t drink before I joined the church, and rarely drink now. And I have never been drunk. And I know lots and lots of non members just like me. And maybe I’m taking things personally where none was intended, but the drinking excuse seems a little trite to me. There are lots of ways to blow off steam, go run a mile, or see a movie, or eat a huge bowl of ice cream, or lock yourself in a room for a good cry or scream…
Just for the record: I have said elsewhere that we need to look closely at things in the Church that contribute to unnecessary stress and depression. I believe that strongly. I also believe we walk a fine line between striving for perfection **as it is meant in the scriptures** (complete, finished, fully developed) and trying to be perfect **as it is defined in our modern culture** (never making a mistake, like the Law of Moses nonsense). If we could fix that basic mis-perception, much of the “guilt-stress” with which too many members struggle would disappear.
I wrote about that conflict in a number of posts on my own blog, but the latest is here:
thingsofmysoul.blogspot.com/2008/03/revisiting-perfection-and-aionement.html (Yes, the atonement typo [aionement] is correct. I didn’t see it until too late.)
Having said that, those same pressures are abundant throughout nearly all religions and businesses and schools ad infinitum. Citing them as uniquely Mormon doesn’t hold water.
http://thingsofmysoul.blogspot.com/2008/03/revisiting-perfection-and-aionement.html
Sorry, the full link got cut in the last comment.
It got mentioned a lot in the T&S post but not here. The issue of post-pregnancy depression has to be addressed. The issue of light, which a few mentioned, is also significant IMO.
Wow, not my best few minutes. Here is the foundation post about misconceptions of “perfect”:
http://thingsofmysoul.blogspot.com/2007/12/problem-with-popular-perceptions-of.html
I have a family history of depression. An aunt commit suicide in the 60’s, my parents are on anti-depressants, as well as a sister. This same sister had a bout with alcoholism. To her surprise, her therapist indicated that her drinking was “self-medicating”, and her real problem was depression.
She went to a therapist because she got busted by the cops for underage drinking. She did not know she was “depressed.” So, my point is that there are many people who drink in a self-medicating way, but are not diagnosed as depressed. My sister has never been suicidal, but the drinking played an unconscious role in her depression. So Heather, I think this is problem that is very misunderstood by the general population. Not everybody who drinks is depressed, but there are a surprising number of depressed people who drink, but don’t know they’re depressed.
Purely anecdotal, I know, but since everyone is sharing, I thought I’d put my 2 cents in.
#39 Clark, thanks for bringing up post-pregnancy depression. I’ll add that to the list of theories to address in my next post. A friend brought that to my attention in a private email today as well. So thanks for the tip!
This is a great post. Overall, I think you have done a really nice job analyzing and presenting the discussion, Andrew.
I have some experience, being a family practice doctor in the Midwest. It is true that primary care docs treat the vast majority of major depression in this country, largely due to lack of access to mental health care professionals. In my practice in Michigan, I would estimate that 30% or even more of the patients I see daily are dealing with mental health issues (this includes bipolar, anxiety, substance abuse, ADHD, depression, personality disorders). This doesn’t mean 30% of people in my state are mentally ill however, only that people go to their doctors when they don’t feel well. We did receive psychiatric training during medical school and residency, but I would say that considering how much mental health care I provide, it was not adequate. However, I will add my two bits on some of the above discussion, for what it may be worth, not presenting myself as an expert, and admitting in advance that some of this is opinion and anecdotal
1. Pretty much everywhere more women self identify as depressed than men, probably by a margin of 2 to 1 or more - however some recent studies show that men may get depressed as often as women but they are more likely to express that depression in substance abuse, violence and anger, and less likely to seek treatment.
2. Anecdotally - there DOES seem to be a strong correlation with depression and prolonged bouts of nasty weather - however we have it worse here where I live in the winter as far as gray skies go. ( I was born and raised in Utah)
3. Certainly there is a strong genetic component - if this is the case (and assuming this plays a role in the Utah statistics) - what does that say about our Utah pioneer forebears? Are depressed people more likely to embrace a new religion, for example?
4. Most patients seem to respond best to a physician who empathetically listens, and tries to understand where the patient is coming from, what their ideas regarding their symptoms are, their expectations for treatment (which are determined by many factors including cultural, gender, upbringing, disposition, level of information, etc.).
5. In my practice I not only listen to the patient, but administer standardized question forms to sort out who truly meets clinical standards for major depressive disorder, and who might have something else entirely going on. There are many comorbidities.
6. Alcoholism and major depression is a major comorbidity - meaning that patients frequently will display both conditions -alcohol is a DEPRESSANT, not an anti-depressant, and generally makes underlying depression worse - therefore making the patient more complicated to treat. Other comorbidies are ADHD, anxiety, bipolar, and some physical ailments, such as Alzheimer’s, hypothyroidism, heart disease, etc.
7. Whether or not we can agree on what the statistics mean - I think we have to agree they are not published with any anti-Mormon intent in mind - and I think it is fair to say that Mormonism doesn’t seem to have any particularly measurable beneficial effect on rates of depression, based on that study at least. I find this surprising, since the “good news” really should affect us positively, and hopefully give us reason to rejoice - not the opposite.
8. There have been studies before linking Utah to higher rates of depression - some as old as 20 years ago. This leads me to believe there may be a persistent problem with Utah and depression rates.
9. WARNING - anecdotal evidence - OK, so I have a fairly large bunch of Mormons in my practice, because lots of members of my ward and stake as well as most of the missionaries see me. My experience has been that Mormons as a group seem culturally FAR MORE OPPOSED to taking anti-depressant medications than most of my other patients. I have found this interesting. It is almost as though they see depression as a lack of spirituality, or impugning their will power, or “giving up their free agency” as I heard one person express it.
Generally they will take their diabetic meds, but are less likely to want meds to deal with their depression than those not in the church, even when they seem open to the idea that depression can be chemically based. This leads me to wonder if some Mormons in Utah are actually UNDERREPORTING depression, just a thought. I have seen some improvement in people’s attitudes in my area towards depression as an illness, not a moral failing, over the past ten years. But overall the Mormons in my area seem to lag behind others in accepting this explanation.
10. I am aware of the study quoted somewhere above that anti-depressants failed to show much effect - I can only say that anecdotally I don’t find that to be the case, nor do my partners. We actually feel that those studies may have had some flaws in pre-selecting the patients - which is harder than you might think - there is a high rate of spontaneous remission.
11. It is going to be very hard to tease out which cultural factors induce more depression - but my experience has been that when people feel like they have respect and control in their lives, frequently their depression improves - and vice versa - so maybe these are areas we need to focus on in the church.
12. Really though, I don’t think the church is anytime soon going to start doing a lot of studies on this - so unless some outside source wants to take on the project I don’t see any remediation happening in the immediate future.Sorry for the length of this post, but it stirred up lots of thoughts.
Wow, doc! A few paragraphs would’ve helped! (I’m teasing you
)
I’m glad I persisted, because some good insights are posted in there. I have to admit that I was very opposed to taking meds for depression, in which case, my therapist recommended other things. Even though I was a Mormon, mentally on my way out at that time, I’ve found with my wife and other family members who have struggled with clinical depression, post-partum depression or other mental health issues that an anti-meds bias is very strong, and usually comes out of a fear of admitting one is not in control or of losing one’s willpower to potential addiction. So anyway, your experience resonates with me. I’m therfore inclined to be tremendously skeptical of any theory that would suggest Utahans are more prone to seeking care and resultant drug therapy as an explanation for higher depression rates.
This seems to be done to death recently, generally without considering the general intermountain west area or the effect of the economic pool (if more people would just leave Utah and drive up the wages by drying up the labor supply, there would be less economic stress depression).
working mother (#43), thanks for sharing your insights. I too have come across the studies reporting that women are twice as likely to report depression as men, nationwide. So the “depressed Mormon women” idea should probably more accurately be rephrased to “depressed women” period.
I’ve considered the weather factor as well, and it goes both ways. On the one hand, Hawaii has the least percentage of adults reporting a major depressive episode. But the grayest, cloudiest states, like Washington, are not the most depressed. Nor are the coldest states. In fact, Minnesota, South Dakota, North Dakota, and other northern states are among the top 10 LEAST depressed states. So if weather is involved, I’m not sure it’s gray skies or cold.
Also, the sunniest states, like Florida and California, fall in the middle of the pack for depression numbers. So sun doesn’t necessarily correlate with less-depressed people.
Stephen (#45), I’d love to see the data your views are based upon. How does the fact that Utah has the 8th highest median household income factor into the idea that this is economically driven? If what you’re saying is correct, wouldn’t we expect Utah to be near the bottom on household income? I’m interested in your thoughts on this.
I really don’t have much to say on this subject as the jury is still out for me. There has been considerable debate in the Salt Lake Tribune about why Utah uses so much anti-depressant medication. Like most things, I don’t believe there’s a singular truth that will peg the real cause. The church certainly plays a role simply because of the high percentage of Mormons in the state.
Why is it that in these type settings we like to down-play the number of members of the church in Utah?
“I thought the percentage of Mormons in Utah is currently 60%, not 70%, like it used to be.”
Does that help the cause some how? Are we trying to say that most of the depressed folks are actually non-Mormon? The actual number is 72% last year (http://newsroom.lds.org/ldsnewsroom/eng/news-releases-stories/utah-membership) and is actually much higher in rural Utah as SLC is considerably lower.
Just my very uneducated look at this depressing subject…
“Utah has the 8th highest median household income” …
Hmm. I’m only aware of the income of select professional groups, and the numbers for Utah are very poor compared to the average I’m aware of. I’m curious about Utah residents having a higher average income per household than 41 other states.
Thanks.
Steve,
I checked a few other sources to compare them to the income data in the study.
This one has Utah ranked 9th for median household income in 2005/2006 based on US Census Bureau data.
http://en.wikipedia.org/wiki/Household_income_in_the_United_States
This one has Utah ranked 11th in 2004 again based on US Census Bureau data.
http://www.census.gov/hhes/www/income/income04/statemhi.html
Great post! Can’t wait for the next installment. My gut tells me (no actual qualifications other than being opinionated) that the real factors are:
1) higher self-reporting and awareness (in my limited experience, Mormons are more prone to rely on doctors and to take medicine, and UT docs prescribe a lot of drugs–doesn’t UT have one of the highest gastric bypass rates?)
2) genetics (the few people I have known who suffered from diagnosed depression also had family members with related conditions).
I have a really hard time buying that “perfection pressure” causes depression. I do, however, agree that depression might cause one to feel overwhelmed by a perceived pressure to be perfect (or at least to hide the cracks in the varnish). While there may be correlation, that doesn’t equal causation. This seems like a chicken and egg argument to me.
I think it’s too easy to blame externalities. If we can blame Mormon culture or any other external factor, we get to absolve personal responsibility to understand and fight against depression. It’s more helpful, I think, to examine what internal attitudes lead to depression so we can help ourselves and other people lose those attitudes. I’m interested in everyone’s thoughts on what those might be.
It would be IMPOSSIBLE to have any empirical data on this, but what does this group thing about this question:
What, do you suppose, is the percentage of patients who see their doctor and get a prescription for this, who have actual, real, clinical depression?
One reason I ask: A number of years ago I was having great difficulty sleeping. I was in school and working nights at a grouop home one the weekend. I finally went to discuss the issue with a doctor. He put me through the depression questionairre, which showed me to be very much NOT depressed. He then proceeded to write a presciption for a low-dose SSRI type anti-depressant. Before filling the prescription, I did a little research and decided that for a sleep problem, I wasn’t willing to include myself in the statistics on what these things can do to you.
As to a “high rate of spontaneous remission”…you don’t suppose that the circumstances of life that had someone feeling sad might have changed to cause this “spontaneous remission”?
My general thought is that most of the symptoms that get medicated are psychological in nature and need a psychological solution rather than chemical ones that need a chemical solution. Since there seems to be so much momentum behind this thing now, folks just go get pills because it’s so much easier than seeing someone who’s qualified to help them. I think this actually results from the kind of stigma that has been mentioned here. No one bats an eye if you say you have a doctors appointment. They view you differently if you say you’re going to see your counselor or psychiatrist. I think it is much easier for people to say that the way they feel results from bad genetics or chemistry than to explore the fact that their thought processes, programming and life-coping skills might need some re-tooling.
JJackson,
The evidence is that a combination of both medicine and counseling work better than either alone. You are right, going to a counselor is very stigmatized and I think that is a travesty. I think too many doctors take care of the pill part without ensuring the counselor part gets taken care of as well. It falls “out of our jurisdiction.” Or it is non-medical and therefore not important, and we are all strapped for time anyway and can’t afford to get involved. I think this is an area where our healthcare system really fails us. We can’t put value on psychosocial issues. I think medicalization of depression is a focused effort to move past these road blocks. The problem is, it is only a partial approach and as such doomed to failure, which I am sure the drug companies appreciate, longer term prescriptions and all.
But I also think it is a mistake to discount genetics and chemistry. Sometimes medication is the only way we can turn the volume down on automatic thoughts of worthlessness, self criticism, helplessness to a point where we can begin to “reprogram.”
I would add that for myself, needing medication was a huge defeat. I took way too much pride in my stubborn independence. The stigma can certainly run both ways.
I’m with you Doc- when I went to see a counselor during college I strongly resisted the idea that I might need any kind of medication to treat my depression. Medicating for depression, to me, was essentially an admission that something was fundamentally, genetically wrong with me. By only seeing a counselor for my depression, in addition to feeling like I had more control over my wellness rather than rely on a pill to make me better, I could also tell myself that I had simply fallen into bad thinking and needed to retrain myself- thus I wasn’t fundamentally flawed, only mis-directed, which to me was a big difference.
Also on the table for me at the time, which I think compounded my depression was the unspoken expectation from myself of emotional perfection, accurately described, I feel, by the following from an interesting article:
“There was a time, not too many years ago, says psychotherapist Dr. Jay Steineckert of ldscounseling.com, when bishops had “an unhidden agenda” that said to their flock “if you’re living the gospel you should be happy, and if you’re unhappy you must be doing something wrong.” Such a simplistic view of happiness “couldn’t be farther from the truth,” he says.”
http://www.mentalhealthlibrary.info/abouthtf/foundationinthenews/couchpulpitarticle.htm
In what way, if at all, would this attitude of ‘emotional perfectionism’ be present and peculiar to Mormonism? Would it exacerbate the depression already present in us?
I am an master of statistics student, and we had an interesting discussion today regarding observational studies vs randomized clinical trials. This depression discussion deals with an observational study.
Observational studies are helpful, but we need to be careful about conclusions. Let me quote from the New York Times Magazine, Sept 2007.
The catch with observational studies, no matter how well designed and how many tens of thousands of subjects they might include, is that they have a fundamental limitation - they cannot inherently determine causation. Testing these hypothesis in any definitive way requires a randomized-controlled trial (RCT) - an experiment, not an observational study.
In class, we talked about Hormone Replacement Therapy, and Beta Carotene and Lung Cancer. In the HRT, there were plenty of observational studies which indicated that women who did HRT, we nearly 1/2 as likely to get heart disease and cancer. However, when a randomized clinical trial was done, one study showed no effect, while another study actually showed an increased risk.
Observational studies of Beta Carotene’s ability to prevent lung cancer at first showed a positive effect of reducing lung cancer in smoker. However, when a randomized clinical trial was done, Beta Carotene actually increased the risk of lung cancer.
Why the discrepency? Observational studies do not have the ability to control for age, sex, or other confounders. Now that is not to say that Obs studies are not without merit. They seem to have correctly shown the beneficial effects of penicillin, as well as the harmful effects of smoking.
RCT’s are not perfect either, as they can often suffer from selection bias. One only need look at the drug industry for evidence. Initial trials showed Vioxx, and other pain relievers to be safe, yet when released to the general public, signs of heart problems showed up later.
So what’s the moral of the story? KC’s observational studies are not conclusive, and we are foolish to make conclusions based on them. However, they are a good starting point, and further studies need to be made which can isolate these potential confounders. Perhaps religion is a confounder, perhaps age, perhaps genetics, perhaps alcohol consumption. Frankly these observational studies can’t tell us, but they do help us look at possibilities. RCT’s need to done for stronger conclusions.
My opinion is that basic, garden-variety depression (as opposed to clinical, genetic depression) is rooted in an individual’s inability to meet some standard. As SteveS and others above point out, standards are to be found everywhere: in business, sports, academics, friendship, relationships, etc. Failing to meet personal, family, or societal standards in these areas can certainly lead to feelings of loss, anxiety, and depression. But is the depression one feels for failing to measure up to these standards equal? I don’t think it is.
Religious community standards are different from business, sports, and academic standards in many profound ways. The ties are deeper, and more intrinsic to one’s identity. If I fail at work, school, or in sports, I move on and find another job, class, or team. This isn’t as easy to do with a religious community. Furthermore, failure to meet standards in business, etc. just does not have the same eternal or soul-defining ramifications as religious community standards. If I fail as a lawyer, or at math, or in football, or even with my girlfriend or wife, these failures, while painful, can be written off as a bad match. I’m not good at this, but I’m good at that. How does one do that with God’s laws?
Mormonism is more orthodox, more exacting, more insular, and more all-encompassing (i.e. impacts one’s whole life) than most other mainstream religious faiths. It simply cannot be ruled out (or shrugged off as just another community with standards) as a factor that can contribute to depression. Not that this is a bad thing… just a fundamental result of having high and far-reaching standards.
Doc 55.
I dont’ mean to discout genetics and chemistry, but I haven’t run into a single person on the meds who doesn’t say that this is the problem. Having known many who’ve suffered (and their families/family history) quite intimately, I’d say that I’d readily concede that 3 out of a couple dozen of them might really fit into that category. The rest were clearly situational/psychological, as borne out by subsequent events. One of the biggest problems I’ve seen many have is getting back to normal after what the pills do to them. Possibly because they didn’t need them in the first place, or were inexpertly prescribed for their particular situation.
I’m not saying AT ALL that this isn’t real and that the genetic/chemical component isn’t a very real cause of disease here.
Last studies I saw, by the way, only supported the conclusion that meds+therapy was best in SERIOUS depression, and it was rated very narrowly better than therapy alone. In all other cases, therapy won hands down because it actually equipped patients with coping mechanisms.
58. Matt Thurston - excellent points
Also: Why are people so afraid of their feelings anyway? (I mean for this to actually be off the present topic, it’s only partially related)
Feelings of sadness, anger, frustration, guilt, even depression can be very useful emotions when they are understood clearly and consciously considered. I don’t think you can make fundamental changes in character without facing these and being pushed and pulled by them.
IMO… it is the focus on “working” out your salvation rather than a focus on the saving grace that comes from a relationship with Christ. The church pushes you too be perfect. After all, the atonement of Christ saves only “after all that you can do”. This cannot be done. We will never be perfect and only Christ can save you. Focusing on trying to please God through works will only lead to depression because it cannot be done.
I also think the pressure that comes from having large families… the husband being expected to provide so mom can stay at home… mom staying at home to raise multiple children and bake cookies for the neighbors and smile through it all while wearing high heels and a dress has a lot to do with it too.
Bottom line, focusing on “working” to please God and not relying on the sacrifice of Christ will lead to depression IMO.
AdamS
This is from a study on depression among the Amish people, whose standards are clearly much more stringent than LDS and whose society is much more insular:
“The Old Order Amish . . . practise absolute pacifism and lead a life free of hostility and aggression. Depression, however, is as much as three times more frequent in Amish populations. In order to study the possible relationship between hostility and depression, we investigated 43 Amish people, using the Buss-Durkee Hostility Inventory and the Beck Depression Inventory. As expected, the total hostility score was significantly lower and the depression score significantly higher in comparison to the normal population. The positive correlation between the two scores (0.45; p < or = 0.002) indicates that the hypothesized reciprocal relationship between hostility and depression is unlikely in the Old Order Amish.”
Anyway, this is an interesting comparison point given the argument that depression correlates with the perfectionism in Mormonism. However, one cannot forget genetic factors among the Amish as a likely influence.
A quick note on the genetic factor in suicides among the Old Order Amish:
“There have been more than thirty family studies of suicide. Violent suicide tends to be likely in families with a strong history of suicide. Particularly interesting are the Amish. They call it “the abominable sin” or “that awful deed.” Also, they keep extensive medical records that can go back thirty generations. Three fourths [of suicides] were in just four families. They were clustered in families with mood disorders. Most who did it were married, with children, and in the prime years of life.”
To an extent, the Amish are a good microcosm to compare for some of the theories being bandied about above, but the obvious caution is that the factors we are discussing among Mormons are much more extreme among the Amish: isolation, high standards (combined with punitive shunning), limited gene pool (yet larger than you might imagine) and family history of depression & suicide.
Didn’t read all the comments. Had to stop somewhere around the point someone kvetched about people making blanket statements and drawing conclusions and then went ahead to infer clearly it’s all about post-partum depression. Alrighty then… pot, meet kettle.
As someone who’s dealt with therapists inside and outside of lds family services (out in the “mission field”) I’d be curious to see a breakdown of those percentages for those who got treatment and that broken down further. Is there a difference between lds social services and everyone else when it comes to being medicated? How about suicide rates? Is there a greater percentage in either group who would deem their treatment successful?
Mormons as a whole believe that they are on a scale toward celestial glory. If your kids are not good enough then you aren’t. Let’s give each other a brake. Beyond that there is a hierarchy of celestial bound individuals that one must overcome but can’t if children are not equaling up. We are a people that believe in a science fiction version of theology. I watched 2001 recently after Arthur C. Clark’s death. Joseph having been born in the age of enlightenment and after the American Revolution built a religion based on both the old and new testaments. Amazing, He was truly the great American religious thinker. Mormonism is truly American. White American. We are the product of the suburbs, the ones who were told that medicine would solve all our problems.
I have a firm belief that Utah is more depressed bc of the impossible standards we force on each other in mormon culture. Only the “norm” is good. If you’re not pregnant within one year of marriage… you’re selfish and taking too long to have children. If we don’t bake our own bread we’re bad homemakers. Of our house is not spotless, and our children little angels we’re bad wives and parents. We tend to be judgmental about each other and so hard on each other. This highly comes from the close proximity of our wards.
Another reason why I believe Utah is more depressed is because of the lack of other interests among women besides raising children. The women alienate themselves from the world for 15-25 yrs while raising their 5-8 children that when they love out they’re lost and have no idea what to do with themselves leading to depression. There are too many things in “mormon culture” that I think would help depression increase.