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Dr. Jack L. Jensen Dr. Cameron R. John Haylee Adamson Utah Valley University Argosy University Utah: The Happiest or Most Depressed State? Slide 2 The Research We will present a few research studies which have piqued our curiosity about happiness and depression in the state of Utah As we present the data we hope that you will critically evaluate the research In addition we hope that you will begin to think about why? Lets begin with Happiness Slide 3 Happiness The 2008 Gallup-Hathaways Well-Being Index A telephone survey: in-depth interview, series of questions focusing on health and well-being Six Domains: Life Evaluation Index Emotional Health Index Physical Health Index Healthy Behavior Index Work Environment Index Basic Access Index Slide 4 Well-Being Rankings Rankings of states show the following: 1. Utah41. Michigan 2. Hawaii42. Tennessee 3. Wyoming43. Oklahoma 4. Colorado44. Missouri 5. Minnesota45. Indiana 6. Maryland46. Arkansas 7. Washington47. Ohio 8. Massachusetts48. Mississippi 9. California49. Kentucky 10. Arizona50. West Virginia Note: Texas = 21 Slide 5 Utah Six Domains:State:District: Life Evaluation Index 2/5082/435 Emotional Health Index10/50122/435 Physical Health Index7/50105/435 Healthy Behavior Index13/50183/435 Work Environment Index1/503/435 Basic Access Index8/50149/435 Slide 6 Utah vs. Texas #1 Six Domains:Utah:Texas: Life Evaluation Index 2/506/50 Emotional Health Index10/5020/50 Physical Health Index7/5017/50 Healthy Behavior Index13/5029/50 Work Environment Index1/5014/50 Basic Access Index8/5045/50 Slide 7 Why? Why is Utah at the top of the well-being ranking? What are the possible contributors? Now lets look at depression. Slide 8 Mental Health America Data Combined databases from: National Household Survey on Drug Use and Health conducted by SAMHSA Behavioral Risk Factor Surveillance System conducted by the CDC Four Measures: Percentage of adult population experiencing major depressive episode in past year Percentage of adolescent population experiencing major depressive episode in past year Percentage of adults experiencing serious psychological distress Average number of days in the last 30 days when mental health was not good Slide 9 Psychological Distress Serious Psychological Distress (SPD) West Virginia had the highest rate of SPD (15.3%) Oklahoma, Utah, and West Virginia were in the top fifth for both age groups 18-25 and 26 or older and among all persons 18 or older Major Depressive Episode (MDE) 2004-2005: 7.7% of all persons age 18 or older experienced MDE in the past year 9.9% among young adults aged 18-25 *source: Mental Health America: www.mentalhealthamerica.net Slide 10 MDE Population 18 or older Utah highest rate (10.1%) Hawaii lowest rate (6.7%) Utah was the only state to rank in the top fifth in all three age groups Slide 11 Depression Ranking by State Utah (1) West Virginia (2) Kentucky (3) Rhode Island (4) Nevada (5) Oklahoma (6) Idaho (7) Missouri (8) Ohio (9) Wyoming (10) Texas (42) North Dakota (43) Illinois (44) Louisiana (45) Minnesota (46) Maryland (47) Iowa (48) New Jersey (49) Hawaii (50) South Dakota (51) Slide 12 Suicide Ranking by State Alaska (1) Nevada (2) New Mexico (3) Montana (4) Wyoming (5) Idaho (6) Utah (7) Colorado (8) Arizona (9) West Virginia (10) Nebraska (42) Hawaii (43) Maryland (44) Connecticut (45) Illinois (46) Rhode Island (47) New Jersey (48) Massachusetts (49) New York (50) District of Columbia (51) Slide 13 Five Factors of Depression (Mental Health America) Mental Health Resources More resources less depression Barriers to Treatment Less barriers less depression Mental Health Treatment Utilization Higher antidepressant use, lower suicide rate Socioeconomic Characteristics More education less depression Mental Health Parity Greater coverage more people getting services Slide 14 Tale of Two States Utah Antidepressant Use.75199 MH Treatment 17.4% Income $53,700 College Degree 27% Insurance 83.6% Psychiatrists 7.3 Psychologists 40.9 Social Workers 166 Expenditures $73.56 Cost Barrier 12.3% Unmet Need 8.2% Equates to highest depression???? Texas Antidepressant Use.49815 MH Treatment 10.7% Income $42,100 College Degree 25.5% Insurance 76.4% Psychiatrists 7.4 Psychologists 28.4 Social Workers 112 Expenditures $36.70 Cost Barrier 18.5% Unmet Need 3.9% Equates to bottom ten in depression???? Slide 15 Alcohol Statistics Mental Health America 50.4% of Americans aged 12 or older reported past month use of alcohol in 2002-2004 Utah County had the lowest rate of any area in the nation (19.8%) District of Columbia had the highest rate (74.7%) Slide 16 Alcohol Use Ranking by State Wisconsin (1) North Dakota (2) Minnesota (3) Iowa (4) Rhode Island (5) Nevada (6) Pennsylvania (7) Nebraska (8) Illinois (9) Delaware (10) Idaho (42) Florida (43) Georgia (45) Arkansas (46) Mississippi (47) West Virginia (48) Kentucky (49) North Carolina (50) Utah (51) Tennessee (52) Slide 17 Correlations Depression and Suicide r (49) =.498; p =.0001** Depression and Alcohol r (49) = -.272; p =.053 Top ten depressed states: r(8) = -.526; p =.118 Alcohol and Suicide r(49) =.249; p =.078 Slide 18 Illicit Drug Use National Survey on Drug Use and Health 2003: 8.2% of the population aged 12 or older used an illicit drug in the past month Utah was lowest with 6.3% Slide 19 Summary Utah continues to see high rates of depression Many possible explanations which need to be explored through research Increase the understanding Slide 20 College Level Data Slide 21 Previous Research Change from 20 years ago from service oriented/vocational counseling to personal problems (Robbins et al.1985) 77% of clients were presenting with two or more concerns (Johnson et al. 1989) Thirteen years of client files also indicating the increase in personal problems being seen in college counseling centers. (Benton et al. 2003) Slide 22 Utah Valley University Student Health Services Survey 13% of students report having skipped a semester or reduced course load due to mental health concern. 20,148 students enrolled for Fall 2004 2,619 students could have benefited from some type of intervention/counseling Slide 23 Current Research Initial study looked at 1998-2004 Utilized categories from Benton Over 1200 files were accessed Verified that students were coming in with more severe problems Follow up study looked at 2005-2007 Utilized current health center intake form Created database based on form(s) Health center changed forms three times during this period Created symptom categories not diagnostic Allows for greater sensitivity to clients and their experience Slide 24 Results N-Size = 330 Gender 56.1% Female 43.9% Male Average number of sessions = 4.61 (SD=4.46) Marital Status 57.6% Single 24.5% Married 7.3% Divorced Slide 25 Sad, Blue, or Depressed (past month) Follow up study = 64.2% Slide 26 Other Symptoms of Depression Loss of Interest in Activities 49.1% Feelings of Worthlessness 47.9% Feelings of Hopelessness 50.9% Excessive Worry 48.5% Problems Getting to Sleep 47.3% Slide 27 For Example Sexual Activity and Marital Status N = 139 58 Single 65 Married 12 Separated 130 are sexually active Single, sexually active = 52 Overall Feelings of Guilt 48.5% 66% of single, sexually active endorse feelings of guilt Slide 28 Summary Continued increase of students seeking help for depression Increase in students seeking assistance with psychological symptoms compared to the past High level of guilt associated in clients seeking services Additional research needed to explore this Slide 29 Possible Explanations Religion A two-edged sword Religiosity a protective factor Individuals struggling with their religious values LDS religion could be perceived as a performance based religion A template for further research Slide 30 Possible Explanations Hypothesis: If you are active and participating in your religion then it is a positive buffer against depression. If you are struggling with your belief system and dont feel a part of your religion, or if you are experiencing intense guilt for perceived violation of personal/religious expectations, it could make a person more vulnerable for depressive episodes Slide 31 Possible Explanations Drug Use Utah has low use of alcohol and illicit drugs Utah has a high rate of legal prescription drug use for depression Hypothesis: Utah citizens do not self-medicate emotional problems to the same degree as citizens in other states resulting in depression being felt more acutely Utah residents are more likely to seek legal drugs for relief Slide 32 Possible Explanations Healthy vs. Toxic Perfectionism Toxic Perfectionism Research has shown toxic perfectionism and stress to be precursors for depression Hypothesis: Utah has a higher than average level of toxic perfectionism leading to higher rates of depression Slide 33 Possible Explanations Relationship issues unique to Utah Pressure to marry young Data on national average age for marriage* Utah oMedian age of men = 23.9 oMedian age if women = 21.9 National Average oMen = 27.1 oWomen = 25.3 Experience of shame, rejection, loneliness for not being married *http://www.sccommunityprofiles.org/census/medage.php Slide 34 Possible Explanations Hypothesis: Because of the unique cultural expectation to marry young, Utah young adults who are not married experience higher levels of shame, rejection and loneliness leading to higher levels of depression Slide 35 Summary So, is Utah the happiest or most depressed state? What are the possible contributors to being the most depressed state? What hypotheses have we left out? Research during the coming academic year with a team of researchers from UVU and Argosy will be pursuing this important question