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Did The Election Stress Americans Out? If It Did, We Didn’t See Our Doctors About It

Politics is stressing Americans out — or so we hear.

The 2016 election was contentious, exacerbated by an increasingly polarized electorate and the inescapable 24-hour news cycle. For many Americans who didn’t support Donald Trump, the days after the election were marked by disbelief, anger and sadness. For many who did, the days following Nov. 8 were a time of joy and celebration.

A wealth of anecdotes, and some research, supports the idea that the turbulence and hostility of the current political environment, along with many Americans’ fear that they will be adversely affected by changes in policy, could be bad for our mental health. After the election, for example, the National Suicide Prevention Lifeline reported a surge in calls for help. Recent research has also found that Google searches for “presidential election” are associated with searches for anxiety and depression. And a new report from the American Psychological Association found that 57 percent of Americans say the current political climate is a “very” or “somewhat” significant source of stress and that 59 percent of Republicans and 76 percent of Democrats are stressed about the future of the country. Reports of anxiety related to the political environment are so prevalent that some have started calling the phenomenonPost-Election Stress Disorder.”

But are Americans actually seeking more mental health care?

Our research, based on office visits of 15.9 million Americans in the 10 weeks before versus the 10 weeks after after the Nov. 8 election, suggests that any stress resulting from the recent election hasn’t made Americans — regardless of their politics — more likely to go to their primary care doctors for mental-health-related issues.

We analyzed visits to nearly 13,000 primary care providers in the athenahealth network, a collection of physician practices across the United States that use a common electronic health platform.1 (More mental health care is provided in primary care physicians’ offices than in any other setting in the U.S.) We looked at the months before and after the election and calculated the share of all primary care visits by people who were diagnosed with anxiety, depression or insomnia.2

To assess whether people sought mental health care at disproportionately higher rates in areas that voted heavily for Hillary Clinton, we created two groups of U.S. counties: those in which 70 percent or more of the votes went to Trump (i.e., heavily red counties) versus those in which 30 percent or less went to Trump (i.e., heavily blue counties).

In blue counties — such as Philadelphia County, Pennsylvania; Los Angeles County, California; and Cook County, Illinois — primary care visits for depression accounted for 1.4 percent of all office visits in the 10 weeks before the Nov. 8 election and 1.3 percent in the 10 weeks after. In red counties, which were generally smaller — such as Montgomery County, Texas; St. Tammany Parish, Louisiana; and Cherokee County, Georgia — primary care visits for depression were more common overall (about 2 percent of all visits) but did not significantly change after Nov. 8. No real before-and-after change occurred for anxiety or insomnia diagnoses either.

It’s important to note that our findings reflect changes in mental health diagnoses during the 10 weeks before and after the election — which does not include the weeks after Trump’s inauguration or before the presidential campaigns began. Trends might be different now that Trump has taken office, and the pre-election period may have come with stressors of its own. We also could not analyze changes for sub-populations in whom stress levels might have risen more as a result of the election, e.g., those concerned about losing insurance or potential changes to immigration policies. Also, the network on which our analysis was based, while geographically diverse, was not nationally representative — some areas were overrepresented while others were underrepresented.3

Most importantly, our findings also don’t discount the fact that many Americans may be feeling real anxiety about the political climate and their personal futures, even if they did not seem to visit their doctor about these feelings at different rates before and after the election. And it’s possible that many of those most affected may not have the time or ability to see a doctor as a result of insurance, employment or geographic constraints, or people may simply not bring these issues up with a doctor.

Jon Stewart, the former host of “The Daily Show,recently quipped that “the presidency is supposed to age the president, not the public.” And while he may well be right to imply that Americans are stressed, people just don’t seem to be seeking medical attention for the problem — yet.

Footnotes

  1. This analysis was done using proprietary data from athenahealth, which provides a cloud-based electronic health record, along with billing and care-coordination services, to medical practices and health systems in all 50 states. Data from the network has been used to perform real-time influenza surveillance.

  2. The analysis included both first-time diagnoses and patients with an existing diagnosis who visited the doctor in the periods we analyzed.

  3. Regionally, athenahealth is slightly underrepresented in the West and overrepresented in the Northeast, Midwest and South. Massachusetts, Virginia and Ohio have a particularly high density of athenahealth clients; California, Minnesota, Wisconsin and Idaho have fewer.

Anupam B. Jena, M.D., Ph.D., is an economist, a physician and the Ruth L. Newhouse associate professor of health care policy and medicine at Harvard Medical School.

Josh Gray is vice president of research at athenahealth.

Stewart Richardson is a research associate at athenahealth.

Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School.

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