Analysis suggests that in states that voted for Hillary Clinton in November 2016, there were a total of 54.6 million more days of poor mental health the following month compared with October 2016.

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Healthcare providers in the United States should be alert to the possibility of deteriorating mental health among some of their patients following the presidential election. This is according to a team of health policy specialists led by researchers from the University of California, San Francisco (UCSF).

In states where Clinton won the majority of votes at the last presidential election in November 2016, the scientists found evidence of worsening mental health the following month.

There was no significant change in states where Donald Trump secured the most votes.

“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,” says first author Brandon Yan, a third-year medical student at UCSF.

Because individuals’ voting choices are confidential, the researchers relied upon which candidate won a particular state as a proxy to assess the possible effects of the national result on its voters’ mental well-being.

They analyzed the responses of 499,201 adults surveyed in the Behavioral Risk Factor Surveillance System between May 2016 and May 2017.

This ongoing survey involves phoning residents by random dialing to ask about their health-related behaviors, chronic health conditions, and use of preventive services.

The scientists looked at responses to questions about how many days respondents experienced stress, depression, and problems with emotions during the past 30 days.

They adjusted for demographic differences between states that might affect mental illness rates, including age, sex, socioeconomic factors, education levels, and health trends in the months leading up to the election.

After these adjustments, they found that in states won by Clinton in 2016, the mean number of days of poor mental health per adult increased significantly, from 3.35 days in October to 3.85 days in December.

The authors say this equates to 54.6 million extra days of poor mental health in December for the 109.2 million adults living in states where Clinton won a majority.

On average, every 10-percentage-point greater margin of victory in Clinton states was associated with 0.41 more days of poor mental health per adult in December compared with October.

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

In states won by Trump, the mean number of days of poor mental health per adult declined from 3.94 days in October 2016 to 3.78 days in December 2016, though this change was not statistically significant.

The study appears in the Journal of General Internal Medicine.

The researchers also looked at how many survey respondents reported experiencing 14 or more days of poor mental health in the previous 30 days. This is one of the criteria recommended in the latest Diagnostic and Statistical Manual of Mental Disorders for diagnosing major depressive disorders.

The proportion of respondents who met this criterion for major depression in Clinton-won states increased by 2% in December 2016 compared with October 2016, and remained steady afterward. There was no such increase in Trump states.

Finally, the researchers tallied answers to whether respondents had ever been diagnosed with a depressive disorder.

According to the survey, the rate of diagnoses in Clinton states began to rise in January 2017, increasing by 2.1% compared with October 2016.

In Trump states, the rate of diagnoses of depression began to increase in February 2017, by 1.8% compared with October 2016.

These increased reports of depression diagnoses continued into the second quarter of 2017 in both Trump and Clinton states.

The scientists believe that other factors probably contributed to the increasing depression rates, particularly among Trump voters. During this period, the U.S. faced a steep increase in opioid-related deaths, with several states that voted Trump hit particularly hard.

In addition, they note that there has been a trend of increasing depression rates nationally in the U.S. across the past decade.

However, those in the U.S. may be at even higher risk for stress and depression when the latest presidential results are finally confirmed.

“The situation is worsened by the pandemic,” says Dr. Hsia.

“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.”

Established mental healthcare and screening routines may fail to reach those patients who are not visiting their primary care providers due to the crisis.

The authors note several important limitations of their study.

Their analysis used data from a monthly national survey rather than following individuals over time, so it could not establish a causal relationship between voting for the losing candidate and poorer mental health.

The reliability of the findings is dependent on how well survey respondents reflect the whole population.

The authors also note that there could be systematic differences in healthcare access between Trump and Clinton states.

In addition, the conclusions are based on respondents’ recollection of diagnoses and how many days of poor mental health they experienced, rather than clinical records.