Utah/Statistical claims/LDS use of antidepressants

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PERSPECTIVES MEDIA QUESTIONS RESOURCES 2014 CONFERENCE

    Is the rate of antidepressant use in Utah much higher among Mormons than the general population?

QUESTIONS


Critics charge that the rate of antidepressant use is much higher among Mormons than the general population. They claim this is evidence that participation in the LDS Church is inordinately stressful due to pressure for Mormons to appear "perfect."


To see citations to the critical sources for these claims, click here

CONCLUSION


While Utah does have the highest rate of antidepressant use in the United States, there is no evidence that this is because of stress from the LDS lifestyle and culture. Credible research has shown that LDS women are actually more likely to identify themselves as "happy" than non-Mormon women. Religion generally (and the LDS religion specifically) has been repeatedly shown to be either beneficial or neutral for mental health and well-being.

Without further research, critics of the Church have no convincing evidence that higher anti-depressant use in Utah is caused by problems or difficulties associated with being a believing, practicing Latter-day Saint.

DETAILED QUESTIONS AND ANSWERS

Background

Prescription drug use by state or region has been difficult to assess. In 2002 Express Scripts, one of the largest mail-order pharmaceutical providers in the United States, released their Prescription Drug Atlas, which shows prescription drug orders from their individual clients by state. A Los Angeles Times article on the study concluded that

[A]ntidepressant drugs are prescribed in Utah more often than in any other state, at a rate nearly twice the national average.... Other states with high antidepressant use were Maine and Oregon. Utah's rate of antidepressant use was twice the rate of California and nearly three times the rates in New York and New Jersey, the study showed.[1]

Are Latter-day Saint women in Utah more depressed?

What the study did not indicate is the reason antidepressant use was higher in Utah than in other states. Critics of the Church were quick to correlate this data with the high rate of LDS Church membership in Utah, thus blaming the Church and Mormon culture for the problem. Kent Ponder Ph.D, a Latter-day Saint, produced an article in which he correlates the use of antidepressants specifically with pressures placed on Mormon women. Ponder concludes:

This problem is clearly, closely and definitely linked to The Church of Jesus Christ of Latter-Day Saints. Approximately 70% of Utahans are Mormons. Jim Jorgenson, director of pharmacy services for the University of Utah, confirmed that Utah has the highest percentage of anti-depressant use, hypothesizing that large families, larger in Utah than in other states, produce greater stress. (Large Utah families are primarily Mormon families).

The same LDS Church that works so well for many works very badly for many others, who become chronically depressed, especially women.[2]

Yet the study released by Express Scripts makes no claims as to why some states use more prescription drugs of one type or another. Far from being "clearly, closely and definitely" the fault of the LDS Church, Ponder has no evidence whatsoever; he is giving his belief and casting it as a proven fact.

The Express Scripts study includes a number of factors that Ponder overlooked in his paper that are helpful in assessing the situation:

  • Utah ranked seventh in total prescriptions overall. This indicates that Utahans are heavier than average users of all prescription medications.
  • Utah also ranked high in use of penicillin, insulin, thyroid hormones, antirheumatics, and anticonvulsants. Is Mormon culture also responsible for higher incidences of infection, diabetes, hypothyroidism, arthritis, and epilepsy?
  • Idaho and Arizona, the two other states in the "Mormon Corridor" with large LDS populations, did not rate high in antidepressant use. If LDS culture is responsible for high levels of stress leading to antidepressant use, why didn't those two states rank closer to Utah?

There are other possible factors outside the scope of the Express Scripts study that may also play a part here:

  • The results could indicate that Utahans are more enlightened about depression and mental illness and therefore don't stigmatize these conditions. In such a social climate more people are willing to seek help and are prescribed drugs.
  • The results could also indicate that Utah employers offer better mental health benefits than employers in other states, making access to mental health services and medications easier.[3]
  • Utah has a low rate of recreational alcohol use, especially among practicing Mormons who completely abstain from alcoholic beverages. Alcohol is commonly used by adults as an aid to stress relief, a "lubricant" for social interactions, and to "treat" (unwittingly or not) symptoms of anxiety, depression, and the like. Since many Mormons will not consider alcohol an "option," they could be more likely to seek help from a professional instead of turning to commercially available mood-altering substances.

Are Mormons more depressed than non-Mormons?

The critics' attitude toward members of the Church is nothing new. The same approach was taken by 19th-century critics:

In 1858 a writer from Harper's Weekly traveled to Utah and made the observation that the Latter-day Saint lifestyle turned LDS women into "haggard, weary, slatternly women, with lackluster eyes and wan, shapeless faces, hanging listlessly over their gates, or sitting idly in the sunlight, perhaps nursing their yelling babies—all such women looking alike depressed, degraded, miserable, hopeless, soulless" (G. L. Bunker and D. Binton, as cited in Judd 1987, p. 150). In 1860, Dr. Robert Bartholomew, the assistant surgeon of the United States Army, visited Utah and described LDS men as having "an expression of compounded sensuality, cunning suspicion, and a smirking self-conceit." While many anecdotal descriptions (such as the ones above), essays (see Burgoyne and Burgoyne 1978), and media specials have discussed the detrimental effects of the LDS lifestyle on mental health (especially that of LDS women), few have any grounding in research evidence. None of the studies included in this analysis that included depression as one of its variables indicated support for an unhealthy relationship between Mormonism and depression.[4]

Shortly after Mr. Ponder released his paper, Brigham Young University sociologist Sherrie Mills Johnson used data from national surveys to show that Mormon women are less likely to be depressed than American women in general. Johnson's conclusions upheld findings of some earlier studies that Mormons have no more depression than the nation's population as a whole.[5]

A good review of the literature on religion, mental health, and the Latter-day Saints specifically is now available on-line: Daniel K. Judd, "Religiosity, Mental Health, and the Latter-day Saints: A Preliminary Review of Literature (1923-95)," in Latter-day Saint Social Life: Social Research on the LDS Church of its Members, edited by James T. Duke, (Religious Studies Center, Brigham Young University, 1998) off-site the abstract of which reads:

Analysis of the data indicates that Latter-day Saints who live their lives consistent with their religious beliefs experience greater general well-being and marital and family stability, and less delinquency, depression, anxiety, and substance abuse than those who do not. This review of research also concludes that there is very little support for the assertion made by some that religious belief, practice, or affiliation is antithetical to mental health....[6]

In religious people generally,

  • 59% of studies from 1985–1995 suggest a positive benefit on mental health; another 26% were neutral.[7]
  • "This most recent analysis of data (1985-95) indicates that high scores on measures of religiosity (activity, attitude, affiliation, and belief) are facilitative of marital and family stability, adjustment, and personal well-being. This most recent analysis also indicates that those who score high on measures of religiosity show the highest positive correlation with measures of mental health. Also, those who score higher on scales of "intrinsic" religiosity score better on measures of mental health than those with an "extrinsic" religious orientation. There also appears to be little difference in measures of mental pathology with respect to religious affiliation."[8]

That is, an active inner spiritual life is more protective than merely outward forms of religious observance.

For studies involving members of the Church of Jesus Christ specifically:

  • 70% were positive; 24% had neutral effects on mental health (thus, only 6% showed a negative effect);[9]
  • LDS women were less depressed than other women; LDS men were no different from non-LDS men.[10]

Thus, the available research does not support the contention that religious people have more mental health problems than non-religious people, or that being a Latter-day Saint religious person is mentally unhealthy. If anything, being LDS is protective against mental health difficulties, which is in keeping with the general consensus that religion is psychologically beneficial.

Correlation or causation?

It is easy to find a correlation between two things:

  1. Utah has many Mormons and uses more antidepressants than other states.
  2. Roosters crow when the sun rises.
  3. IV drug abuse has increased as digital computers have become more common.

However, correlations do not necessarily imply causation:

  1. The suggestion that religion in general, or the Church of Jesus Christ in particular, causes depression has been examined and found to be false: in the vast majority of studies, religion either has no effect on mental health, or improves it.
  2. Roosters do not cause the sun to rise; if anything the reverse is true.
  3. IV drug use and the presence of digital computers are not likely related at all--they are two different social phenomena.

Correlations are easy to come by. They may suggest causes for further study, but they mean little by themselves. They prove nothing.

Critics like to point to a correlation between a high LDS population and a high anti-depressant use, and then assume that this is causative. But, they either do not know—or do not want us to know—that the causation which the correlation suggests has been tested, and has not supported the conclusion they wish to draw.

Critics who use this approach are therefore often guilty of at least one logical fallacy:

Other evidence about levels of happiness in Utah

Mitchell L, Frank MR, Harris KD, Dodds PS, et al. (2013) The Geography of Happiness: Connecting Twitter Sentiment and Expression, Demographics, and Objective Characteristics of Place. PLoS ONE 8(5): e64417. doi:10.1371/journal.pone.0064417 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064417

If we are going to use Utah as a surrogate measure for Mormons (something which may not be proper), we should also consider evidence on the other side of the coin.

A 2013 paper found that, based upon Twitter metrics, Utah is in the top five most happy states:

The happiest 5 states, in order, are: Hawaii, Maine, Nevada, Utah and Vermont. The saddest 5 states, in order, are: Louisiana, Mississippi, Maryland, Delaware and Georgia.[11]

If we are to blame the Church for Utah's antidepressant use, then we must also credit the Church for Utah's over-all happiness.

Endnotes

  1. [note] Julie Cart, "Study Finds Utah Leads Nation in Antidepressant Use," Los Angeles Times, 20 February 2002, A6.
  2. [note] Kent Ponder, Ph.D., "Mormon Women, Prozac® and Therapy," unpublished, 2003. Italics in the original; author's capitalization ("Latter-Day") and spelling errors ("Utahns") retained. [It is the FAIR wiki's policy not to link to critical web sites, but Ponder's paper can be easily found with a Google search.]
  3. [note] The Express Scripts study did not include prescriptions ordered through Medicare and Medicaid, so the data include only orders filled through employer-based insurance plans.
  4. [note]  Daniel K. Judd, "Religiosity, Mental Health, and the Latter-day Saints: A Preliminary Review of Literature (1923-95)," in Latter Day Saint Social Life: Social Research on the LDS Church and its Members (Religious Studies Center Specialized Monograph Series, Vol. 12), edited by James T. Duke, (Provo, Utah: Religious Studies Center, Brigham Young University & Salt Lake City, Utah: Bookcraft, 1998), 486–487. ISBN 1570083967. ISBN 978-1570083969. off-site
  5. [note] "Expert: Mormon women less depressed," USA Today, 2 April 2004 (Associated Press article). off-site
  6. [note]  Judd, 473.
  7. [note]  Judd, 477.
  8. [note]  Judd, 477–478.
  9. [note]  Judd, 478.
  10. [note]  Judd, 488.
  11. [note]  Mitchell L, Frank MR, Harris KD, Dodds PS, et al., "The Geography of Happiness: Connecting Twitter Sentiment and Expression, Demographics, and Objective Characteristics of Place," PLoS ONE 8(5) [May 2013]: e64417.


Further reading and additional sources responding to these claims

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