Seattle ranks as most medicated metro for mental health reasons

Jan. 3—Even in a normal year, a lot of people feel down around this time. The holiday season can be a trigger for anxiety and depression for some. And for those of us who live in the Seattle area, the unrelenting gray skies that are typical don't help matters.

Of course, 2021 hasn't been a normal year. The pandemic is still raging, fueled by the highly contagious omicron variant of the coronavirus.

Whatever the reasons, Seattle ranks as the most medicated major metro area for mental health conditions, according to a new survey from the U.S. Census Bureau. It shows that more than 1 in 5 adults in the Seattle area have taken prescription medication to help with emotions, or with concentration, behavior or mental health, in the past four weeks. The survey was conducted from Dec. 1-13.

The survey includes data for the 15 largest metro areas in the U.S. — Seattle just makes the cut at No. 15. Among these major metros, Seattle had the highest percentage of adults taking medications for their mental health, at 21% (or about 660,000 Seattle-area adults).

At the other end of the spectrum, only about 11% of adults in the Riverside-San Bernardino area in California were taking medications to treat mental health conditions.

This data comes from the Household Pulse Survey, an experimental product of the U.S. Census Bureau. Unlike other census products, which have a long lag time, the Household Pulse Survey provides near real-time data.

These statistics are intended to help inform officials and policymakers about the impacts of the pandemic on communities across the country. Because the pandemic has taken a toll on the mental health of many Americans, the survey includes a number of questions related to the topic.

I've previously reported on this data because Seattle has also ranked No. 1 for the percentage of residents experiencing depression and anxiety.

Even so, I was a little skeptical about the survey results about mental health medications at first. For one thing, as with all survey data, there is a certain amount of error built into it. On top of that, any survey related to people's mental health is bound to have some degree of variance. Many folks tend to go on and off prescription drugs that treat depression, anxiety and other mental health concerns.

Fortunately, the Household Pulse Survey is an ongoing program, so I was able to see if Seattle ranked consistently high for use of these medications over time. I checked each of the most recent surveys from the previous phase of questioning, which began on July 21 and ended on Oct. 11 — there were a total of six surveys in this period.

Interestingly, three metro areas have consistently ranked near the top for the percentage of adults taking prescription medications for mental health conditions: Seattle, Boston and Philadelphia.

Why these three? It may seem like a bit of head-scratcher at first glance, but it's very likely related in part to racial demographics.

The survey data shows white people are significantly more likely to use medications for mental health conditions than any of the other major racial/ethnic groups. Asian people are the least likely to use them. (This is true nationally, and in the Seattle area.)

In most of the major U.S. metros, white people are less than half of the total population. But in Seattle, Boston and Philadelphia, white people make up more than 60% of the total. That is most likely one factor in why these three areas have a higher use of these medications.

Similarly, the metros that are consistently toward the bottom of the pack for the use of these medications have a very high percentage of people of color. In Riverside-San Bernardino, Los Angeles and Miami, people of color make up at least two-thirds of the total metro population.

Research supports what the survey shows: White people are indeed more likely to use antidepressant medications than people of color. The same is true of drugs that treat attention deficit disorder. Part of the reason seems to be that doctors are more likely to diagnose white patients with mental health conditions, and to prescribe them these drugs. There are probably other factors involved, such as differing attitudes about mental health conditions among racial groups.

Similarly, women are more likely than men to take medications for mental health conditions. Part of the reason for this is that women are more likely to seek help from a health care professional for depression.

The Household Pulse survey shows that 29% of women in the Seattle metro take medications for mental health conditions, compared with just 13.5% of men.

The survey cross tabs show some other points of demographic variance in the use of these medications in Seattle. A higher percentage of people who are divorced, separated or widowed use these medications than married people. And people with lower household incomes tend to be more likely to use them than people with higher household incomes. These patterns can be seen nationally, as well.

And although the sample is quite small in Seattle, the data shows that LGBTQ+ people are significantly more likely to use mental health medications than those who do not identify as LGBTQ+. This same pattern is evident nationally.

The survey also asked respondents if they had received counseling or therapy from a mental health professional in the past four weeks. Seattle again ranked No. 1, even slightly higher than New York, where it's often joked that everyone is in therapy. In the Seattle metro, 12% of adults (or about 380,000 people) said they'd received counseling or therapy.

Another 14% of Seattle-area adults (about 430,000 people) said they needed professional counseling but did not get it (for any reason). Again, that was the highest percentage among the 15 major metros.

It would be great if there was pre-pandemic data that we could use to establish a baseline level of use of these medications. But the Census Bureau only began this survey project in response to the pandemic, so we can't know if — or how much — the use of these medications has increased in Seattle.

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