Boulder County & Mental Health
May is Mental Health Awareness Month. What impacts mental health in Boulder County and how does it compare to other geographies?
Mental health. I’m sure you know someone, if not many people, that struggle with it and you may even experience mental health struggles yourself. Between diagnoses of depression, anxiety, bipolar disorder, eating disorders, PTSD and more, mental health issues seem to be on the rise (or at least recognition of them is). In fact, the World Health Organization reports that “Around 20% of the world’s children and adolescents have a mental health condition, with suicide the second leading cause of death among 15–29-year-olds”. If you’ve spent much time on Instagram this week you might have seen an infographic highlighting this statistic, or any variety of other story posts related to mental health. After all, May is Mental Health Awareness Month, and what better platform than the one strongly linked with increases in anxiety and depression for spreading this important awareness?
While the infographics are a great place to start, to really understand what is going on with mental health we need to dig into the data. A previous op-ed I published looked into the structural and lifestyle factors linked with poor mental health across the U.S.’s nearly 3200 counties. I used data 2021 county-level data from the University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps program and my data analysis revealed some pretty interesting stuff. For an initial overview of the data check out the correlation matrix between indicators of poor mental health and a slew of other variables.
First, rather surprisingly, the data called into question the impact that mental health care providers have on mental health outcomes: the Pearson correlation coefficients between the number of mental health providers and poor mental health days, frequent mental distress, and suicides were -0.063, -0.128, and 0.0085, respectively, indicating almost no correlation in either direction. I address some reasons why this could be the case outside of mental health professionals being ineffective, but what is really interesting is the contrast between these insignificant correlations and the very strong correlations my data revealed between poor mental health outcomes and structural and behavioral factors. The structural factors of food insecurity, children in poverty, unemployment, air pollution, and disconnected youth had positive correlations with poor mental health days and frequent mental distress, ranging from 0.39 to 0.77. I explain “it’s highly logical that not having access to necessities like food, clean air, and social networks would negatively impact mental health, but no one can prescribe fixing these things as a mental health treatment.” Despite these correlations revealing a lot about why underserved communities suffer mentally, the insights are not as actionable as those revealed by the behavioral factors. I found that the behavioral indicators of insufficient sleep, adult smoking, physical inactivity, driving alone to work, and excessive drinking all had moderate to strong correlations with poor mental health outcomes (as represented by poor mental health days and frequent mental distress). Each behavioral variable was plotted against poor mental health days to demonstrate those correlations.
The conclusion of my initial op-ed was that although we can’t necessarily draw causal relationships between any of these variables and poor mental health, the data reveals more research should be focused on alternative behavioral treatments, as well as continued investigation of the structural factors that lead communities to have poor mental health.
As Mental Health Awareness Month kicks off, I wanted to extend my previous research by zooming in on my own community of Boulder County to see what mental health looks like here, whether the factors revealed to be impactful in the nationwide data remain correlated, and check out some additional variables as well. One thing that makes Colorado unique compared to many other states is our cannabis law. Since research has revealed various links between cannabis use and either improved or worsened mental health, I was curious whether we can see a trend in the mental health data of Colorado counties correlated with their cannabis purchases. Additionally I wanted to compare Colorado mental health to states where cannabis remains illegal. Furthermore, Boulder County is unique within Colorado for its very high college-aged population, and since mental health is such a prevalent issue for young people especially, I wanted to see whether communities with major universities stand out as having worse mental health. Finally, I wanted to see what impact the COVID-19 pandemic had on mental health in Colorado. The National Institutes of Health reports that anxiety and depression were heightened during the pandemic, so I wanted to see if this was the case in Colorado specifically.
I first decided to highlight Boulder’s mental health vs insufficient sleep data in comparison to Colorado and the nation’s. The graph below indicates that overall, Colorado counties and Boulder County have overall lower rates of insufficient sleep and lower rates of poor mental health compared to counties nationwide. The red line shows the overall trend between the two variables for the nationwide data.
Interestingly, Boulder County appears to be somewhat of an outlier compared to the country and the state: it has worse mental health than we would expect based on its low level of insufficient sleep. I thought the poor mental health may be a function of Boulder being a relatively young county, with 15–24-year-olds making up nearly 18% of its total population, in 2021 (the national proportion is about 11%). However, by graphing the rest of the nation’s counties with greater than 15% of their populations aged 15–24, I found that they pretty much followed the national trend. So, a young population alone doesn’t seem to be linked to poor mental health and the behaviors that may strongly influence it, there might be something else going on in Boulder causing it to stray a bit from the trend. Repeating this analysis with the other behavioral factors to see where Boulder falls I found that it falls in line with the national trend for adult smoking and poor mental health (more strongly correlated nationally than in young counties). For excessive drinking Boulder County falls well below the national, Colorado, and young county trend lines, showing that we drink excessively and have even better mental health than could be expected based on the bizarre negative correlation between these two variables. Finally for physical inactivity, Boulder has much lower physical activity than most counties, but it aligns with the national trend line which correlates low physical activity with poor mental health.
Overall these various comparisons tell a mixed story: Boulder has a higher than average rate of some behaviors linked with poor mental health, and lower than average for other factors. Overall though, Boulder seems to be doing relatively well with a poor mental health days raw value of 3.63 compared to the national average of 4.66. This can almost certainly be attributed to the fact that Boulder is a very affluent community and outperforms the majority of counties on the structural indicators linked to poor mental health that I covered in my previous op-ed.
Shifting gears to discussion of Marijuana and the pandemic, I found it’s difficult to conclude much about Marijuana’s effects on mental health just by looking at county-level data. I charted Boulder’s mental health as indicated by poor mental health days from 2010 to 2023, as well as Colorado’s Marijuana sales since its legalization in 2014.
Both are on an overall upward trend, and both had a significant spike during the early pandemic, but I hesitate to draw any causal relationship here. Marijuana has a variety of mental health effects, and its effects vary for every individual, so on a population level, it would be a reach to claim that either worsening mental health or increasing Marijuana sales caused one another. To expand the analysis a bit further though I took a look at various counties across the country that in one way or another bear resemblance to Boulder. I selected 4 counties: 3 which legalized Marijuana at various points during the past decade and one where Marijuana remains illegal and charted their mental health outcomes over time.
The time series below shows that while mental health seems to be worsening all across the country, there aren’t clear enough spikes or dips after a state legalizes weed to claim it as the cause of this change. We do see significant spikes in each county at the beginning of the pandemic however, suggesting that factors like human connection, physical health, and not being in a months-long national emergency are much more important for maintaining mental health than consuming, or not consuming weed.
To conclude, the national increase in poor mental health seems to be a much more concerning trend than any combination of factors unique to Boulder. As a county, Boulder has the privilege of not suffering from many structural issues that result in community-wide mental health struggles. Further research on how marijuana impacts the mental health of individuals should certainly be prioritized, but the increase in marijuana usage is no longer unique to Boulder or Colorado. Ultimately I believe that Boulder’s role in the mental health conversation should be using its status as the site of a huge research university to further studies on these issues not just within our own county, but across many geographic regions and demographic groups that are much more diverse than Boulder’s population. This Mental Health Awareness Month, go ahead and post your infographics, but also consider reaching out personally to friends and family that may struggle with mental health, read about the work being done to push mental health initiatives, and hey, if it helps your personal mental health (and if you’re over 21) feel free to contribute to next year’s Marijuana sales figures.
