Changes in Mental Health Following the 2016 Presidential Election
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BACKGROUND: The 2016 presidential election and the controversial policy agenda of its victor have raised concerns about how the election may have impacted mental health. OBJECTIVE: Assess how mental health changed from before to after the November 2016 election and how trends differed in states that voted for Donald Trump versus Hillary Clinton. DESIGN: Pre- versus post-election study using monthly cross-sectional survey data. PARTICIPANTS: A total of 499,201 adults surveyed in the Behavioral Risk Factor Surveillance System from May 2016 to May 2017. EXPOSURE: Residence in a state that voted for Trump versus state that voted for Clinton and the candidate’s margin of victory in the state. MAIN MEASURES: Self-reported days of poor mental health in the last 30 days and depression rate. KEY RESULTS: Compared to October 2016, the mean days of poor mental health in the last 30 days per adult rose from 3.35 to 3.85 in December 2016 in Clinton states (0.50 days difference, p = 0.005) but remained statistically unchanged in Trump states, moving from 3.94 to 3.78 days (− 0.17 difference, p = 0.308). The rises in poor mental health days in Clinton states were driven by older adults, women, and white individuals. The depression rate in Clinton states began rising in January 2017. A 10–percentage point higher margin of victory for Clinton in a state predicted 0.41 more days of poor mental health per adult in December 2016 on average (p = 0.001). CONCLUSIONS: In states that voted for Clinton, there were 54.6 million more days of poor mental health among adults in December 2016, the month following the election, compared to October 2016. Clinicians should consider that elections could cause at least transitory increases in poor mental health and tailor patient care accordingly, especially with the 2020 election upon us. J Gen Intern Med DOI: 10.1007/s11606-020-06328-6 © Society of General Internal Medicine 2020
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11606-020-06328-6. Received July 29, 2020 Accepted October 16, 2020
INTRODUCTION
President Donald Trump’s 2016 election victory and controversial campaign agenda raised concerns about the election’s impact on health.1 A pre-2016 election survey found that 52% of Americans considered the election to be a “significant source of stress,” while 49% reported the election outcome to be a significant source of stress in January 2017.2 The few published studies assessing the impact of the election on mental health used online search data and small surveys and found evidence of increased stress and anxiety following the election.3–5 However, whether this reported stress translates into population-level changes in perceived mental health and diagnosed mental health conditions is largely unknown. With the 2020 election upon us, understanding the last presidential election’s impact on mental health could help health care providers anticipate and better address electionrelated health effects this November and beyond. In
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