'Postelection Side Effects' Have Many on Edge

Ricki Lewis, PhD

June 14, 2017

Clinicians should be prepared in specific ways to help patients presenting with anxiety, distress, fear, and physical manifestations that result from reaction to societal events in general, and to the recent US presidential election in particular, according to an article published in the June 8 issue of the New England Journal of Medicine.

David R. Williams, PhD, MPH, and Morgan M. Medlock, MD, MDiv, both from Harvard University in Cambridge, Massachusetts, cite past elections that boosted psychological well-being among groups who mostly voted for the winner, such as the 1994 election of Nelson Mandela in South Africa and the US election 14 years later of Barack Obama.

The flip side is those who suffer anxiety and fear from election outcomes, which may precipitate physical symptoms. "Research suggests that these events can have negative health effects on people who have been direct targets of what they perceive as hostility or discrimination and on individuals and communities who feel vulnerable because they belong to a stigmatized, marginalized, or targeted group," the authors write.

Katherine C. Nordal, PhD, executive director for professional practice at the American Psychological Association (APA), described the health fallout from stress in a news release. "Chronic stress...can make existing health problems worse, and even cause disease, either because of changes in the body or bad habits people develop to cope with stress. Low levels of social support have even been linked to increased risk of death from heart disease, infectious diseases and cancer."

The APA assesses the nation's stress level with an online survey ("Stress in America") every August. When findings from 2016 indicated growing concern about the looming presidential election and its possible outcome, with more than half of Americans reporting significant stress from the election, the APA conducted another survey in January 2017, questioning 1019 adults. That survey found Democrats more likely than Republicans (72% vs 26%) and minorities (69% of blacks, 57% of Asians, 56% of Hispanics) more likely than non-Hispanic whites (42%) to cite the election aftermath as a significant stressor. Two thirds of respondents claimed they were stressed about the future of the nation, indicating an ongoing, if not escalating, problem.

Dr Williams and Dr Medlock offer a guide for healthcare providers to address "postelection side effects" of anxiety stemming from hostility (such as racism and anti-immigrant actions) from the community or the larger world and worries about reductions in health and social services. Their suggestions transcend the provider–patient relationship.

  1. Address emotional distress, such as by providing "safe spaces" where patients can express their concerns to clinicians who initiate discussion of the specific stressors.

  2. Take a public stand against hate crimes, hostility, and use of discriminatory language.

  3. Be aware of issues specific to local patient populations, such as immigrants living in nonsanctuary cities, and connect people with community organizations that can help access health and social services.

  4. Direct patients to resources to quell their fears, such as social groups or spiritual organizations.

  5. Assist the community in promoting tolerance, such as working with K-12 school boards to address discrimination against vulnerable student groups. This suggestion is in response to a survey of 2000 teachers conducted by Maureen Costello for the Southern Poverty Law Center that found many students "emboldened" by recent political rhetoric to bully, harass, and intimidate "students whose races, religions or nationalities have been the verbal targets of candidates on the campaign trail."

Reid Blackwelder, MD, a family physician practicing in Kingsport, Tennessee, and professor and interim chair and vice chair of Medical Student Education at East Tennessee State University, Johnson City, told Medscape Medical News that the first suggestion, addressing emotional distress, is critical. "It is most important to recognize and respond to the emotion of the moment. Many physicians aren't comfortable doing that. I can treat pneumonia, but I can't fix the stress in your life. This is a big part of bedside manner, part of connecting with people. A provider must empathize, normalize concerns, and help people figure out a plan to get through these tough times."

Vaile Wright, PhD, director, Research and Special Projects at the APA, extends the recommendations. "Health care providers may not always think their individual roles are to address social stressors, yet the links between these kinds of stressors and poor health outcomes is becoming more evident. Sometimes addressing these concerns — like reducing barriers to care by providing inclusive services to all individuals — may be as important as helping individuals learn personal strategies for managing stress. While medications may be effective for individuals who are experiencing significant impairment in their daily life, such as missing work or not being able to take care of family members due to unmanaged stress, for most people learning effective coping and problem-solving skills are likely to have a more long-term impact on their ability to manage their stress," she told Medscape Medical News.

Dr Williams reports grants from the National Institutes of Health and the Robert Wood Johnson Foundation and grants and personal fees from the Kellogg Foundation outside the submitted work. Dr Medlock and the commentators have disclosed no relevant financial relationships.

N Engl J Med. 2017;376:2295-2299. Full text

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