Election Angst? In States that Back Losing Nominee, Residents’ Mental Health May Falter

November 2, 2020

Stress, Depression Surged in Clinton Strongholds After 2016 Election, UCSF-Duke Study Shows

By Suzanne Leigh

Black and white photo of one hand giving thumbs up, one hand giving thumbs down

Whether a Trump triumph or a Biden victory, millions of Americans may expect a decline in their mental health if they live in states that favor the losing candidate. And the higher the margin of victory for the losing candidate, the greater the number of days of stress and depression for residents in those states.

In a study led by UC San Francisco and Duke University, researchers combed data from close to 500,000 adults, looking at mental health indicators during the 2016 general election. They found that residents who lived in states with a Hillary Clinton majority experienced on average an additional half-day of poor mental health in the month following election (December) compared with the month before (October).

This translated to 54.6 million more days of stress and depression in December 2016 alone for the 109.2 million adults living in Clinton states, the authors reported in their study, which published in the Journal of General Internal Medicine on Oct. 31, 2020.

“Clinicians should consider that elections could cause at least transitory increases in poor mental health and tailor patient care accordingly,” said author Renee Y. Hsia, MD, of the UCSF Philip R. Lee Institute for Health Policy Studies and the Department of Emergency Medicine.

Hsia pointed to two surveys, taken before and after November 2016, that found approximately 50 percent of Americans reported that the election was a significant source of stress.

The researchers used the Behavioral Risk Factor Surveillance System, a joint state and federal annual household survey of 499,201 adults, to compare the impact of the election. Respondents in the 20 Clinton states said that during the past 30 days, they had experienced “stress, depression and problems with emotion” on average 3.35 days in October 2016 compared with 3.85 days in December 2016.

For voters in the 30 Trump states, poor mental health occurred for an average of 3.94 days and 3.78 days in the month before and the month after the election, a difference that was statistically unchanged, the authors stated. In contrast, researchers noted a 2-percentage point uptick in the number of respondents in Clinton states who reported 14 or more days in one month of poor mental health – a marker for major depressive disorder – during the same period. No such increase was found in Trump states.

‘Unexpected Nature of Loss’ May Have Worsened Mental Health After Clinton Defeat

“It’s possible the mental health worsening in the Clinton states had been exacerbated by the largely unexpected nature of the loss – at least according to pre-election polls,” said first author Brandon Yan, a third-year medical student at UCSF.

The researchers found that Clinton’s margin of victory in each state was predictive of the degree of mental health change from October 2016 to December 2016. A 10-percentage point higher margin predicted 0.41 more days of poor mental health. Conversely, a 10- percentage point higher margin of victory for Trump predicted 0.41 fewer days of poor mental health.

By April 2017, the number of residents of Clinton states who reported that their health care providers said they had depression had risen by 3.2 percentage points since October 2016. However, residents in Trump states were not immune to increased depression. By April 2017, it had inched up by 2.8 percentage points – a jump that may partially reflect the opioid epidemic that claimed more than 47,000 lives that year, many of them in red states, the authors noted.

According to Hsia, Americans may be at even higher risk for stress and depression with the upcoming election. “The situation is worsened by the pandemic; the usual approaches to depression screening and mental health care may fail to reach those patients who are not seeing their primary care providers,” she said. “The pandemic, as well as the economic downturn, are resulting in more isolation and loneliness. Americans are worried about disease spread, and they have heightened fears about job security, keeping a roof over their heads and ensuring their children are keeping up at school.”

Authors: Senior author is Frank A. Sloan, PhD, of Duke University; co-author is Victoria Yeung of UC Berkeley.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.