Trump's 2016 victory linked to poorer mental health among Clinton voters

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There were 54.6m more days of poor mental health among adults in states that voted for Hillary Clinton in December 2016, compared to October 2016, according to a study. No such increase in poor mental health following the 2016 US election was observed in states that voted for Donald Trump. The increase in average number of poor mental health days per person in Clinton-voting states largely persisted in the six months after the election.

Comparing states in which Trump had received the most votes with states in which Clinton had received the most votes, a team of researchers from the University of California-San Francisco, and Duke University found that in Clinton-voting states, the average number of days on which adults reported experiencing poor mental health in the last 30 days increased by 0.50 days, from 3.35 days in October to 3.85 days in December 2016.

Brandon Yan, the corresponding author said: "The additional half a day per adult translated into 54.6m more days of poor mental health in December 2016 alone for the 109.2m adults living in Clinton-voting states."

The rise in poor mental health days in Clinton-voting states in December 2016 was primarily observed in adults aged 65 and older, women, and white individuals. No changes in poor mental health days were statistically detected among younger age groups, men, or racial and ethnic minority groups in December 2016 in either Clinton – or Trump-voting states.

In states that voted for Clinton, the authors also observed a 2 percentage point increase in the number of people who reported at least 14 days of poor mental health in the last 30 days in December 2016, compared to October 2016, while no such rise was observed in Trump-voting states.

Yan said: "It is notable that following the election the proportion of those with 14 or more days of poor mental health also increased, which may suggest that some individuals may newly meet diagnostic criteria for major depressive disorder."

The authors analysed data on 499,201 adults collected in 2016 and 2017 as part of the Behavioural Risk Factor Surveillance System, a joint state and federal annual household survey. By comparing each monthly cohort of survey respondents, they studied changes in three mental health indicators – total days of poor mental health in the last 30 days, 14 days or more of poor mental health in the last 30 days and being diagnosed with a depressive disorder – in Clinton – and Trump-voting states in the six months following the November 2016 election, compared to the six months before the election.

The authors also found that a 10-percentage point higher margin of victory for Trump in the state was associated with 0.41 fewer days of poor mental health in Trump-voting states. The inverse is also statistically true. In Clinton-states, a 10-percentage point higher margin of victory for Clinton in the state predicted 0.41 more days of poor mental health.

Overall, the findings suggest that the outcome of the 2016 election had a negative impact on mental health for voters of the candidate that lost the election.

Yan said: "Depression rates – which were assessed by asking people if they had ever been diagnosed with a depressive disorder – also started rising in January 2017 in Clinton-voting states and in February 2017 in Trump-voting states. These increases in depression rates continued into the second quarter of 2017." The authors suggest that the rise in depression rates in Trump states suggests that there were likely other coinciding factors contributing to depression, such as rising opioid deaths which especially affected many states that voted for Trump.

The authors caution that the cross-sectional observational nature of the study does not allow for conclusions about cause and effect. Because the respondents' candidate preference and party affiliation were unknown, the authors relied on the candidate's margin of victory or loss in a state to assess which candidate's voters experienced changes in mental health.

Yan said: "Given our findings for 2016, primary care providers, mental health professionals, and the public should not overlook the potential effects from the 2020 election. Health care providers could play a proactive role in monitoring for clinically relevant signs of mental health deterioration and offering appropriate support and intervention following the 2020 election."

Abstract
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.

Authors
Brandon W Yan, Renee Y Hsia, Victoria Yeung, Frank A Sloan

 

Springer material

 

Journal of General Internal Medicine abstract

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