• Brandon W Yan, Renee Y Hsia, Victoria Yeung, and Frank A Sloan.
• Philip R. Lee Institute for Health Policy Studies and School of Medicine, University of California, San Francisco, 513 Parnassus Ave, Suite S-245, San Francisco, CA, 94143, United States. Brandon.Yan@ucsf.edu.
• J Gen Intern Med. 2021 Jan 1; 36 (1): 170-177.

BackgroundThe 2016 presidential election and the controversial policy agenda of its victor have raised concerns about how the election may have impacted mental health.ObjectiveAssess 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.DesignPre- versus post-election study using monthly cross-sectional survey data.ParticipantsA total of 499,201 adults surveyed in the Behavioral Risk Factor Surveillance System from May 2016 to May 2017.ExposureResidence in a state that voted for Trump versus state that voted for Clinton and the candidate's margin of victory in the state.Main MeasuresSelf-reported days of poor mental health in the last 30 days and depression rate.Key ResultsCompared 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).ConclusionsIn 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.

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