"In Mormon culture females are supposed accept a calling. They are to be constantly smiling over their family of five. They are supposed to take supper across the street to an ill neighbor and then put up with their husband when he comes home from work and smile about it the whole time. There is this sense that Mrs. Jones down street is doing the same thing, and there is this undercurrent of competition. To be a good mother and wife, women have to put on this mask of perfection. They can't show their tears, depression or agony," Canning said.
"Obedience, conformity and maintaining a sense of harmony" are unspoken but widely recognized behaviors, which all contribute to what he calls "the Mother of Zion syndrome."
When Wendy first started seeking professional help and was put on Zoloft 10 years ago, she felt the sting of shame even from her own family members.
"Marriage and family are so important that there was a huge amount of pressure to make things work. I was supposed to try harder, and buck up and that would make me happier and keep my husband from abusing me," she said.
"There are expectations from the community, but mostly from other women," she said. "It doesn't come down from the church necessarily, but it's passed from mother to daughter. My family was reluctant to see me taking the drugs, but since seeing me at my worst, they now encourage me to take my meds."
The Church of Jesus Christ of Latter Days Saints, however, says the high number of prescriptions is a result of people receiving the drugs they need in Utah more than in other places.
"I don't think it's clear that there's a crisis in Utah," said Brent Scharman, a psychologist and the assistant commissioner of LDS Family Services, a church network that provides counseling. "You've got one camp that says there is more depression and another camp that says we just have more consumers."
Scharman said studies on organized religion and depression found that religious people were generally happier than nonreligious people, and that held true for Mormons.
"It always boils down to the issue of what influence the LDS lifestyle has on the depression phenomenon," he said. "Non-LDS and some LDS people say this is a kind of driven lifestyle and that we push too hard and smile too much. But studies show, and those living it out see, that religion is good support. It creates a positive network and helps people get through crises and deal with long-term problems.
"Are there people who feel 'I'm not living up to the LDS ideal,' or 'I'm not living up to my family's expectations'? Absolutely, there is no question. But having done counseling outside the LDS community, I saw people there, too, who were depressed because of perfectionism," he said. "I wouldn't say it is any worse here than in more diverse communities."
The MHA study evaluated information from the Centers for Disease Control and Prevention, each of the 50 states and Washington, D.C., and factored in suicide statistics to determine each state's "depression status."