Mormons and depression podcast

All right, readers, now you get to be listeners, too. The voice of fta is now on the web. Head over to eight hour lunch to hear me podcast with Doug and Heidi.

We talk about, what else, depression and Mormonism. Specifically, we touch on the "Utah has the highest rate of antidepressant use" meme and empirical studies done among Mormons and depression, as well as suicide.

I haven't listened to it yet. I really don't like hearing my own voice recorded. And I don't have headphones at work, so I'll have to wait until I'm home tonight.


From eight hour lunch:

Inside the LDS Church and out, people seem to generally accept that Mormons have had more than their fair share of depression. And who can blame them? Utah women lead the nation in antidepressant use, and our young men are more likely to commit suicide than just about anywhere in the country.

But can Mormonism really make you depressed? For all of the studies and reports out there, the results seem, well—inconclusive. To find out more, Heidi and I spoke with the author of the blog Emerging From the Ashes. She’s taken an in-depth look at the studies that have been done, so you’d better have a listen (you uninformed piece of shit).

a hypothesis

Mormonism highly values intrinsic religiosity (belief in teachings and certain truth claims), but implicitly and explicitly demands that it be displayed extrinsically (near perfect attendance, service in volunteer positions, public, physical and vocal displays of belief and conformity). In part due to these pressures, an unknown percent of members regularly attend services, despite their non-belief, for extrinsic reasons, such as social conformity and family relations. These “faithful non-believers” are most often “in the closet” about their true feelings and beliefs, and this may cause stress, cognitive dissonance, and may result in negative mental health outcomes, particularly with regard to depression.

Simply looking at attendance would not be enough to tease out possible risk factors for mental health outcomes. For example, some people attend because they agree with the teachings and it brings them happiness. Others, however, attend for mostly extrinsic reasons, such as social support and friendship. Yet others attend only to avoid ostracism, or even divorce.

I would hypothesis that that Mormons who attend church, but do not believe the teachings and truth claims, have worse mental health outcomes than those who attend as believers. In other words, those who demonstrate extrinsic religiosity while masking their lack of intrinsic religiosity, have worse outcomes than those who attend for both extrinsic and intrinsic reasons.

Just a thought.

podcast & book

Last night, I recorded a podcast (my first!) with Doug and Heidi over at eight hour lunch. We talked about depression and Mormonism, since I've lately been obsessed with the topic (could you tell?). I'm not sure when they will be able to post the podcast, but I'll watch the site and let you know as soon as I know.

It was unexpectedly exhilarating to talk to them about this topic, and I'm kind of pleased that my voice is now out there, even if not my name.

...


Also, the book Parenting Beyond Belief: On Raising Caring, Ethical Kids Without Religion is now available. It is a collection of essays from a diverse set of humanists and nontheists, including our fellow former Mormon, Agnostic Mom. I've ordered my copy. Check it out and consider buying it if you are interested; I, for one, feel it important to support this kind of effort. We atheists are out there, we are good parents, and we have a voice. Let it be heard.

Finally, one of my posts from Main Street Plaza (a post republished and reworked from here) was linked at Daylight Atheism's The Humanist Symposium. There is an impressive collection of blog entries on positive atheism and humanist values. Personally, I've been wanting to explore this kind of thing more in depth. (Summer project, fta, now get back to work.)

more on depression

These past few weeks I've been perusing the academic literature on Mormonism, as you will have noticed if you're a regular reader. I'm eventually hoping to find the time to turn this into a paper, but for now, I'll share some basic results and take-home messages from three of the studies.

Spendlove, Risk Factors and the Prevalence of Depression in Mormon Women, 1984

This study telephone-interviewed 143 Mormon women and 36 non-Mormon women in the Salt Lake area. They found that 23.8% of the Mormon women were depressed (based on a screening done during the interview), and 22.2% of the non-Mormon women were. So there was no difference in prevalence of depression. They also compared highly-religious Mormon women to not-so-religious Mormon women, and found that there were differences in depression, the "inactives" having more depression. However, when they took into account income, education, caring from spouse, and health status, they found that those differences explained the difference in depression--not activity levels. (I wrote more about this study here.)

What's interesting here is that the depression rates for both groups were quite elevated. The depression rate among US women is more like 3%. Part of this difference is due to measurement--the depression rates in the Spendlove study were found through a screening by phone. The 3% rate is probably something like diagnosed-by-clinicians rate, which is certainly lower than the actual rate. Most depression is undiagnosed (get an online screening!). Still, the gap is too wide to be explained away by measurement error.

There was no difference between prevalence rates for these two groups, leading the authors to conclude that Mormon women do not have higher rates of depression that non-Mormons. However, one must also consider that both groups have elevated rates. Why? I could speculate that Mormons have elevated rates for certain reasons pertaining to being Mormon, while the non-Mormons have other reasons for being depressed, such as social pressures of being the religious minority. Hmm. Further studies are needed...Some have been done looking at Mormons outside of Utah. I'll get to those another day.

Fellingham, 2000, Statistics on Suicide and LDS Church Involvement in Males Age 15-34

Okay, this one is not depression specifically, it's suicide, but a lot of suicide results from depression. This Utah-based study looked at death records of boys and men, and checked church records for which office of the priesthood they had attained (Aaronic or Melchizedek). They decided that if a 15-19 year old had the Aaronic priesthood, or a 20-34 year old had the Melchizedek priesthood, he was active. Otherwise they were classified as "inactive" or "non-member." Not a perfect measure, but it was probably the best they could do in the circumstances. The results were rather disturbing: active Mormons had the lowest suicide rates. The general US male population in the age group were 2.5 times as likely to commit suicide as "active" Mormons. "Inactive" Mormons were 4 times as likely to commit suicide, and non-Mormons living in Utah were 6 times as likely to commit suicide. Yikes.

Perhaps the scariest part of this study is that some Mormons would think (read: this is what I would have thought when I was a believer) that this is just proof that being an active Mormon is better. And that the solution is just to re-activate all those "inactives." Simple, right?

There are a couple things I see that are wrong with that logic. First, this study in no way establishes causality. A reader cannot conclude that because they happened to be inactive when they committed suicide, it was the inactivity that caused the suicide. It could have been that mental illness (supposing it was mental illness that led to the suicide) caused the inactivity. Or there could have been an issue (say, he told the bishop he was gay) that caused the bishop to deny advancement in the priesthood, even though the young man was a faithful believer, and perhaps even led to the suicide. There are a lot of scenarios I could come up with; we just don't know.

Second, perhaps it's not something wrong with the "inactive" and non-Mormon boys and men, but with the system in which they live. Maybe it's not the "inactive" ones that are doing something wrong, but it's the church that's wrong for them. Obviously, many Mormons live happy lives. I was happy as a Mormon. But there are some for whom it simply doesn't work; for some, it hurts. These people are the ones more likely to become "inactive." A problem is, though, that there is little room in the church--and especially in Utah--to recognize that it could be something wrong with the church, and not a personal failure or sin of the person for whom it doesn't work. Instead of trying to re-activate the "inactives," it would probably be more appropriate to target those at risk and find out what they need--counseling, therapy, anti-depressants, social networks outside the church, maybe even social networks inside the church. Of course, there is a huge range of reasons why they stop going to church, why they develop mental health problems, and why they commit suicide, and my late-night musings can hardly do any of that justice. So I'll move on.

Norton, Gender Differences in the Association Between Religious Involvement and Depression: The Cache County (Utah) Study, 2006

This study involved interviews with 4468 elderly people (65-100) in Cache County, Utah. More than 90% of them were Mormon. They found that people who attended church more frequently had lower rates of depression (remember, this is not causality, but rather correlation). They also found that the Mormons had twice as much depression that non-Mormons, even after considering other risk factors. This was the most interesting finding to me, but the authors gloss it over in one sentence in the discussion section. That's it.* What the authors considered most interesting was that there was a difference by gender. Women had less risk of depression if they attended frequently, but it was the opposite for men. The ones attended more frequently were more likely to be depressed.

This isn't the first study to find different effects by gender. Many studies show that attending women are benefited more by religiosity than attending men (and that women attend more than men). The authors speculate that the reason men in this group had higher depression was because of loss of social role. That is, it's the younger (middle age) men who hold the important leadership positions, such as bishop, stake president, high council. By the time they are 65+, men generally don't hold these positions (unless they are in the general leadership, which is very small percentage of men). They authors also speculate that for men, church is more business-like, and for women, it's more social/emotional. Thus, older women would benefit from the social contacts at church, while men would more likely feel the loss of being in charge.


* I owe this insight to my husband.

Mormonism and depression: literature

This is kind of a cop-out post because I don't have time to write much lately, but maybe this will help some people. What follows is a short-list of what resources I have pulled together on Mormonism and depression. Doubtless, there is more out there, and I have concentrated more on scholarly, peer-reviewed literature. If you have anything to add to the bibliography, please let me know. Also, if you would like a copy of anything, let me know at fromtheashesblog@gmail.com. For the items that are available online, I have provided links. (A hearty thanks to those of you who helped me find some of these in the first place.)

I will thoroughly read each of these and write some notes on them when I have more time.

Gray literature (not peer-reviewed)

Ponder, Kent. Mormon Women, Prozac, and Therapy

LDS Use of Antidepressants. entry on FAIR's Wiki.

Express Scripts Prescription Drug Atlas. Executive Summary. (This report is, as far as I can tell, The Source for the idea that Utah has the highest anti-depressant rate. I'll write a post about it.)

Media reports

Julie Cart, "Study Finds Utah Leads Nation in Antidepressant Use," Los Angeles Times, 20 February 2002, A6. (I can't access a copy of this online without paying, but I have the abstract.)

Utah leads the nation in antidepressants and analgesics, study concludes. The Associated Press State & Local Wire. June 21, 2001.

Carey Hamilton. The Salt Lake Tribune. Critics question use of antidepressants; Health: Some call the medications dangerous; Utah, meanwhile, leads the nation in their consumption; Medication criticized by coalition. September 5, 2003.

"Expert: Mormon women less depressed," USA Today, 2 April 2004 (Associated Press article).

Degn, L. Yeates, E. Greenwell, B. Fiddler, L. 1985. Mormon women and depression [transcript of the KSL documentary of the same name]. Sunstone. 49: 19-27.

Peer-reviewed literature

Bauer, Leslie E. 1992. Depression and repression among Mormon women. Dissertation. California State University, Fresno.

Hilton, Sterling C, et al. 2002. Suicide Rates and Religious Commitment in Young Adult Males in Utah. American Journal of Epidemiology. Vol. 155, No. 5: 413-19.

Maxwell, Jeanmarie. 1992. Mormon women and depression. Thesis. University of Nevada, Las Vegas.

Norton, Maria C, et al. 2006. Gender Difference in the Association Between Religion Involvement and Depression: The Cache County (Utah) Study. Journal of Gerontology: Psychological Sciences. Vol 61B, No 3: 129-136.

Overton, Jared L. Latter-day Saints and Mental Health: A Review of the Literature, 1995-2005. Dissertation. Azusa Pacific University.

Spendlove, David C. 1982. Depression in Mormon Women. Dissertation. University of Utah.

Spendlove, David C., et al. 1984. Risk Factors and the Prevalence of Depression in Mormon Women. Social Science and Medicine. Vol 18, No 6: 491-495.

Williams, Marleen. 1993. Correlates of Beck Depression Inventory Scores in Mormon and Protestant women: Religious orientation, traditional family attitudes and perfectionism. Dissertation. Brigham Young University.

instrinsic/extrinsic religious motivation

The depression and Mormon women study I mentioned previously used a specific scale, a set of questions, each of which is scored, then added up to reach a final number indicating strength of intrinsic versus extrinsic religiosity. This is the Intrinsic Religious Motivation scale, based on an earlier study.*

Intrinsic religiosity refers to internal motivation for being religious, such as belief in God, inner peace and happiness, connection with the divine, etc.

Extrinsic religiosity refers to external motivation for being religious, such as meeting people, community conformity, family pressure, heritage, etc.

A person can, of course, be religious both intrinsically and extrinsically. Hence the scale, which allows someone to fall anywhere on a range.

The questions asked in the women and depression study were as follows.**

-My faith involves all my life.
strongly agree; agree; disagree; strongly disagree

-One should seek God's guidance when making every important decision.
strongly agree; agree; disagree; strongly disagree

-In my life I experience the presence of the Divine.
strongly agree; agree; disagree; strongly disagree

-My faith sometimes restricts my actions.
strongly agree; agree; disagree; strongly disagree

-Nothing is as important to me as serving God as best I know how.
strongly agree; agree; disagree; strongly disagree

-I try hard to carry my religion over into all my other dealings.
strongly agree; agree; disagree; strongly disagree

-My religious beliefs are what really lie behind my whole approach to life.
strongly agree; agree; disagree; strongly disagree

-It doesn't matter so much what I believe as long as I lead a moral life.
strongly disagree; disagree; agree; strongly agree

-Although I am a religious person, I refuse to let religious considerations influence my everyday affairs.
strongly disagree; disagree; agree; strongly agree

-Although I believe in my religion, I feel there are many more important things in life.
strongly disagree; disagree; agree; strongly agree

Add it up as follows:
For items 1-7: strongly agree (1); agree (2); disagree (3); strongly disagree (4).
For items 8-10, it reverses: strongly disagree (1); disagree (2); agree (3); strongly agree (4).

The higher the score, the higher the extrinsic religiosity. Remember, in the Mormon/depression study, those with higher extrinsic religiosity had slightly more depression.

My question about this is how well this works for Mormons. The types of Mormons I see as having more extrinsic religiosity would be NOMs, liberal Mormons, fringe Mormons, cultural Mormons, social Mormons, etc. Would this scale tease out these types of people from the rest of Mormons? And would it differentiate them from each other? And how particular is it to Mormons?

For example, Mormons do not generally speak in terms of the "the Divine." Questions that use "Heavenly Father" our "the Lord" might be more appropriate. Also, this question, "My faith sometimes restricts my actions" might be misinterpreted by Mormons in the same way that "I can't...I'm Mormon" T-shirts were. That is, some Mormons may let religion restrict their actions, but don't see it as restriction. They might, therefore, misinterpret this question negatively. On the other hand, this question is ambiguous all around. I can see some with intrinsic religiosity saying, "strongly agree," and feel happy about it, but also someone with extrinsic religiosity saying, "strongly agree," but feelings very unhappy about it. For example, a faithful non-believer might want to drink alcohol, but doesn't in order to keep up appearances, and keep the faithful spouse happy.

Before I came across this study, I hashed together some questions of my own, which would attempt to find NOMs (those who attend/practice, usually but not always, for extrinsic reasons, but don't believe, ). The questions are rather crude, but it was interesting to try to figure out how to measure such things in a simple survey.

1. Of the following, which best reflects how often you attend LDS church services, including other church activities (Enrichment, Primary, YW/YM, meetings, etc.)?

1) a few times a year

2) once a month

3) two to three times a month

4) every week, or nearly every week

5) more than once a week

2. Of the following, which best reflects the reason you attend LDS church services?

1) I attend to keep my marriage together.

2) I attend to please my spouse or parents.

3) I attend for social reasons, or because it is community and/or heritage.

4) I attend because I believe it will bring the greatest happiness in this life and the next.

5) I attend because I know it will bring the greatest happiness in this life and the next.

3. Of the following, which best reflects your current testimony of the LDS church and teachings?

1) I believe the church is not true and not led by God.

2) I have serious questions or doubts, but ultimately I believe it’s true and led by God.

3) I believe the church is true and led by God, even though I may have some questions about certain issues.

4) I believe the church is true and led by God.

5) I know the church is true and led by God.

4. Of the following, which best reflects how well you think your beliefs would be approved of by the rest of your ward or the church at large?

1) Not at all. If I expressed my true thoughts about the church during church, most people would disapprove of what I say and I could be disciplined and/or ostracized.

2) Very little. If I expressed my true thoughts about the church during church, most people would disapprove of what I say and counter my statements with mainstream teachings or testimony-bearing.

3) Somewhat. If I expressed my true thoughts about the church during church, some people would verbally approve and some would verbally disapprove of what I say.

4) Quite a lot. If I expressed my true thoughts about the church during church, almost everybody would verbally approve of what I say.

I included the last question to get at people who may be NOM, but are more comfortable in that role, possibly because their ward is more liberal in general anyway. For example, someone who doesn't believe at all could still answer "quite a lot" on the last question.

It would be interesting to do a study on Mormons and depression, really teasing out differences of religiosity that simply asking "What is your religious affiliation?" would not allow.

*Hoge, D. A Validated Intrinsic Religious Motivation Scale. Journal for the Scientific Study of Religion, Vol. 11, No. 4. (Dec., 1972), pp. 369-376.
**As far as I could tell. The Spendlove study simply referenced the Hoge study, but the latter study has 30 questions, and recommends use of 10 of them. It is unclear whether the Mormon/depression study used all 30 or just the 10.

mormon women and depression

I had already written this post, but a couple of posts by a fellow exmo, Within the Bubble, prompted me to post this now (see his story and more general ideas about mental illness among Mormons).

For a while now, I've been interested in this idea thrown around among Mormons that Mormon women or Utah women have a higher rate of anti-depressant use than the rest of the country. It is bandied about by believers to criticize the super-mom syndrome that, they would say, Mormon culture encourages, but that the True Gospel discourages. It is mentioned by non-believers to support how Mormonism messes women up. I've heard this many times, but I have never heard it backed up by references. It seems to have taken on the status of mythology. Does anyone have any references?

I've been wanting to find out more if any actual research has been done on this. So recently, I poked around at some peer-reviewed literature on Mormons. I found one 1984 study* done on Mormon women and depression (not saying there aren't more, but this is the one I found in my non-thorough looking).

In it, 143 Mormon women and 36 non-Mormon women in Salt Lake were interviewed by phone, and were asked about religiosity and depression, along with some demographic questions (income, number and ages of children, etc). To assess depression, the interviewers used the Beck depression inventory, which is still used today and considered accurate. To assess religiosity, interviewers asked about frequency of church attendance, temple attendance, and prayer, and also "religious motivation."

This study found that there was no difference in the percent of each group of women with regards to current depression, as assessed by the Beck inventory, over the phone. Both groups had about 23% depressed women. Among the LDS women, those who were less educated, felt less caring from a spouse, rated their health poor or fair, and had lower incomes were statistically more likely to be depressed. No surprises there. I would think these hold true for any female, American population.

There were also some intriguing differences among LDS women on some other factors, but none of them were statistically significant (that is, the differences might be only random, not real, because of the sample--but they might be worth studying more). For example, among LDS women, these women were more likely to be depressed:

-infrequent church attenders
-frequent temple attenders
-infrequent pray-ers
-those with non-Mormon husbands
-those with extrinsic religious motivation

Now, it would be easy for a believer to look at this and say, "See, we need to go to church and pray more, just like the leaders say!" But I would posit that depression related to infrequent prayer and attendance are not causal, but only correlated. In fact, this study simply cannot tell us which came first--the depression or the infrequent attendance/prayer. It could be that people who are depressed go to church and pray less often because of depression (likely). Or it could be that people who go to church and pray less often get depression because of not praying and going to church (not likely). Most likely of all, there is a very complicated relationship, involving many other factors that aren't taken into account here. For example, a third factor could be causing them both, i.e., religious doubt and disaffection could lead someone to skip church and experience depression.

Intuitively, one would think that frequency of church attendance, temple attendance, and prayer would all go together--but they don't in this study. This anomaly could be due to the methodological inadequacies of this study, though I am tempted to wonder if frequent temple attenders are depressed and desperately seeking some respite through temple visits. It could be the other way around--that temple attendance is causing depression--but, as much as I would like to believe that, I doubt it.

It does make sense that women with non-Mormon husbands would experience a greater degree of stress, and perhaps depression, given the emphasis placed on the importance of temple marriage, etc. (See my previous post about Mormon marriage and divorce.)

But it's the last one, the extrinsic religious motivation, that intrigues me the most. Simply put, those who attend church because of reasons outside themselves--social life, conformity, family pressure, etc.--had more depression (but not significantly so, remember) than those who attended for their own, internal beliefs --faith in God, it brings inner peace, etc. I wonder if "extrinsic religious motivation" parallels some of the Bloggernacle/DAMU terms we use--New Order Mormon, faithful non-believer, liberal Mormon, etc. If so, are NOMs more likely to be depressed? And why? Is it because of the stress and identity issues of being in the non-believer's closet, as they generally are? Is it related to cognitive dissonance? Is it related to spousal troubles, since many NOMs aren't just ex-mos because of a faithful spouse? Or is the faithful who are more depressed, driving themselves batty trying to live the gospel just right?

So I decided to check out the questions used by this study to measure this aspect of religiosity, wondering if the questions get at situations unique to Mormonism. (In another post.)

*Spendlove, et al. Risk Factors and the Prevalence of Depression in Mormon Women. Social Science & Medicine, Vol 18, No 6, pp.491-495, 1984. If you want a pdf, email me at fromtheashesblog@gmail.com