Is it Time to Recognize Political Anxiety as a Social Determinant of Health?

Abstract

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Introduction

Physicians are on the lookout for social determinants of health, which are those economic, social, and environmental factors that shape a person’s well-being (or lack of it). Physicians often ask patients what their sleep schedule is like or if they have secure access to food and housing, to construct an accurate picture of the patient’s quality of life. Questions that once might have felt invasive (“Does anyone in your household regularly scream at you?”) now feature regularly in clinical encounters. Given the volatile state of US politics, it might not be unreasonable for physicians to try and determine whether and to what extent political rhetoric takes a negative toll on patients’ health. There is potential for the DSM-5 to include political anxiety as a new disorder. Physicians should begin to take political stress seriously as a social determinant of health.

Political Stress and Anxiety

A 2020 article investigated the role that partisan politics plays in health outcomes.^[1] The title blasted the results: “Partisan Politics may be Literally Killing Us.” According to the authors, “mortality rates increase by 0.7% for every 10% of the population that votes for the losing candidate.” This turns out to be a more than 3 percent increase in mortality rates “for extremely partisan counties.” In other words, the study suggests that Party Loss (PL) has deadly consequences. Although questions of cause versus correlation are beyond the scope of the paper, the authors suggest the answer for the uptick in death might have to do with an increase in anxiety and social isolation. Chronic stress kills — and many voters, it seems, are chronically stressed. 

In 2019, a psychiatrist at the University of Michigan gave an interview discussing how to avoid “political fatigue.”^[2] Signs that political discussions are stressing you out might include high blood pressure, weight fluctuation, and sleep struggles. Her first recommendation: be aware of how much time you spend consuming political media. 

Easier said than done. Social and mainstream media are an inescapable feature of life in 2024. The media are paid for by advertisements and during campaign season, these advertisements are often political. So, even though you might be sitting down with your family to watch an anodyne program like Jeopardy, you’ll likely see some sort of “attack ad” — the very name of which tells you that it’s been created to foster hostility. 

It's not only political ads, though. Even mainstream news feels as if it is engineered to elicit the strongest possible response from readers. This has to do with the financial stakes of the news game: with less (or sometimes no) revenue from subscriptions, media are forced to compete for digital audiences. They do so by goading you into clicking on their headlines. The first newsroom I was part of was progressive by most political standards. On one of my first days on the job, I asked a colleague why the televisions in the main office were set to FOX News. “I guess so that when they say something stupid, we can be the first outlet to write an article about it.” I learned that day that this news organization’s mission included not only reporting the news but also making people angry. To some reporters, these were two sides of the same coin.

Even when news is not written to elicit anger, it seems constructed to make readers feel emotionally involved with the story. In the past month alone, there have been countless reported variations on a single theme: “Early polling shows the presidential race to be neck and neck, but here’s an alternative data point that might make you feel very strong.”

A 2023 poll found that 90 percent of Americans always, often, or sometimes feel “angry” when they think about politics, with about the same number reporting they always, often, or sometimes feel “exhausted.”^[3] The same survey asked Americans to sum up their feelings about American politics in a word — four in five respondents used negative words, like “divisive,” “dysfunctional,” and “sad.”

Politics in the Doctor’s Office

The question healthcare providers need to answer is whether this data ought to make its way into exam rooms. For example, if a patient who complains of sleeplessness comes in for an examination the week before an election wearing a t-shirt advertising a political candidate, a physician might find this clinically relevant. Perhaps the physician might consider asking the patient if the upcoming election is affecting their emotional or mental health. Or if in the days following an election, a patient, similarly dressed, presents to the ED complaining of chest pains, the physician might try to determine whether political disappointment — “Party Loss,” as the above-mentioned study calls it — might be contributing to the patient’s increased anxiety levels.

Of course, mentioning politics in clinical settings, especially to patients who seem all too eager to discuss them, carries a certain risk. It is possible that asking about the patient’s level of political involvement might trigger them to launch into a rant, experience a spike in blood pressure, and yell. Or worse, the patient could become hostile towards the provider and ask about the provider’s own political leanings. This, however, need not end in a negative clinical outcome. The physician could calmly explain that she likes to limit discussing politics to certain times and with certain people. By doing this, she is modeling for the patient a different way of engaging politics: with respect, with restraint, and with people of her own choosing (i.e., not strangers on the internet or passing acquaintances).

Recommendations

Physicians are beginning to take the role that social determinants play in the health of their patients seriously. Given the ubiquity of political rhetoric in the US, physicians have good reason to see “political sentiment” as one such determinant of health. Hostile political rhetoric risks tearing apart friends, families, and neighborhoods. As physicians now understand, a person’s health is inextricably tied up with the health of the communities to which she belongs. Social isolation, for instance, is a good predictor of negative health consequences. If a patient reports that she is not visiting her parents for the holidays because of their political differences, a physician could consider including this information in the patient’s clinical chart.

Some might argue that discussing “political anxiety” in healthcare settings is an example of medicalization: political anxiety, they might reason, is a social issue that ought not be brought under the purview of medicine. But social issues have health consequences, both at an individual and population level. While stress might be triggered by, for instance, social phenomena, its physiological effects are profound. It is not always possible to treat the latter without addressing the former. Treatment, however, does not necessarily need to be pharmaceutical: sometimes simply recommending breathing exercises or nature walks might do the trick. In a similar way, physicians discussing political anxiety with their patients will likely not prescribe medications at first. Simply suggesting the patient be mindful about their political content could be a good first step.    

People experience anxiety for a variety of reasons. The DSM-5 includes Illness Anxiety Disorder (IAD). The next version could even include preliminary recommendations for studying “Political Anxiety Disorder” (PAD) or Obsession With Respect to Controlling Political Outcomes. Just as patients who suffer from IAD obsessively check their online portals for the latest lab results, some patients obsessively check political polls. There should be a point where the physician suspects this patient’s behavior is negatively affecting her health. It is conceivable that a physician ought to recommend a patient take a break from cable news. It might be appropriate for medical organizations to release policy statements urging the general public to be on the lookout for signs of political anxiety in themselves and in their families.  While for now other types of anxiety may include political anxiety, noting the importance of politics as a social determinant of health may highlight the need for physicians to develop best practices and recommendations, like limiting political news, taking breaks from social media, and finding common ground with those with opposing views.

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[1] Maas A, Lu L. “Elections have Consequences: Partisan Politics may be Literally Killing Us.” Applied Health Economic Health Policy. Jan 2021: 19(1): 45-56.

[2] Health Lab. “5 ways to manage political induced stress,” Republication November 4, 2024.

[3] Pew Poll Center, September 2023, “Americans’ Dismal Views of the Nation’s Politics”