Major political events such Trump's election and inauguration as president caused massive mood drop among young doctors
Women experienced more than twice the mood decline as men following both 2016 US election and 2017 presidential inauguration, suggesting that the political discourse surrounding issues of gender and sexism throughout the presidential campaign may have disproportionately affected women.
Major American political events, such as the 2016 presidential election and Trump's presidential inauguration, were followed by massive declines in mood among first-year doctors in the US.
The drop in mood immediately after the election was four times greater than any other day the researchers had tracked. It was also greater than the decline seen with the start of internship -- a transition associated with a considerable increase in stress and a five-fold increase in depression, says the research team from the University of Michigan.
This, say researchers, suggests even with the high demands and time constraints of internship, young US physicians were engaged with broader socio-political events. Women were particularly affected by the election results. They experienced mood declines that were more than double of that experienced by their male counterparts following both events, suggesting that the political discourse surrounding issues of gender and sexism throughout the presidential campaign may have disproportionately affected women.
"This suggests to us that interns were deeply engaged with and affected by the election, even while facing the incredible demands of their intern year. It also suggests that the 2016 election was experienced as deeply personal and distressing for many young women in medicine," says Dr. Elena Frank, director of the Intern Health Study.
According to the researchers, analysis shows events with outcomes in line with conservative political ideologies were associated with a mood decrease, while those with outcomes in line with liberal political ideologies were followed by a mood increase. This, says the team, supports evidence that young physicians may increasingly identify as liberal, particularly around factors such as gender, ethnicity, and nationality.
"Political events may be affecting people's moods in ways they didn't before, and we hope our research, in general, can help illuminate the ways that stress and external events affect mental health," says Dr. Srijan Sen, principal investigator of the Intern Health Study and a professor of psychiatry at the University of Michigan.
The first-year doctors or interns work in 80-hour work-weeks, and 24-hour shifts and they are still learning the ropes of the medical profession. The constant stress wears on their mental health, say experts.
But this study, published in The BMJ, shows that for first-year doctors who started their careers in the past few years, certain political events pierced that bubble of intense training. Some political events affected their mood just as much as the intense first weeks of their training had.
"There has always been a vigorous debate in medicine on whether physicians should engage in politics and to what extent. These data suggest deep engagement is happening in young doctors during even their most intense clinical workload," says Dr. Brahmajee Nallamothu, co-author of the study and professor of internal medicine at the University of Michigan.
According to Dr. Sen, given the intensity of the intern year's demands, he was surprised that any external event managed to affect the moods of interns as much as the study shows.He recalls that Hurricane Katrina decimated New Orleans and neighboring areas of the Gulf Coast during his own intern year, and he only became aware weeks later.
"The new generation of physicians seems to be more politically engaged than how doctors had traditionally been seen. This suggests that there is a real opportunity for physicians to lend their voice and join the discussion on issues relevant to clinicians and their patients," he says.
Previous studies show that heavy workloads, medical errors, and sleep deprivation are systematic factors that affect the mental health of training physicians, the new analysis shows that major political events of the last three years in the US changed interns' moods.
The study used data from ongoing research -- Intern Health Study -- which is a prospective cohort study assessing stress and depression during the first year of residency training in the US.
The current paper focuses on daily mood ratings from 2,345 interns who were in their first year of training at US hospitals anytime between mid-2016 and late 2018, and how they changed in the immediate aftermath of major national and world events. They provided daily mood data between 2016 and 2018 as part of the Intern Health Study.
The researchers identified nine political events, including the 2016 presidential election and inauguration, the Muslim travel ban, and US-Mexico border wall funding, and eight non-political events, including the Super Bowl, Hurricane Irma, and a mass shooting at a Florida high school.
The average mood was measured the week after each event and compared with the average mood over the preceding four weeks.
Two-thirds of the major political events in the study period prompted significant changes in interns' moods. Three events -- the 2016 US election, the 2017 US presidential inauguration, and the failure of a federal spending bill to fund a Mexican border wall -- were followed by the largest collective changes in mood. The first of these events was associated with a drop in mood larger than the decline that interns experienced in the first weeks of their intense training, and the second led to a sizable mood drop. The third led to a collective mood boost.
"Our findings describe the susceptibility of young US physicians' moods to major political events during arguably one of the hardest periods of their work lives: intern year," says the study.
The ban on travel from Muslim majority countries and confirmation of Brett Kavanaugh to the Supreme Court were also associated with notable drops in mood, shows analysis. The researchers say no difference in mood was seen with the failure to repeal the Affordable Care Act in the US Senate, the deployment of troops to the Mexico border to meet a large migrant caravan or the 2018 midterm elections. The non-political events during the study period - mass shootings, hurricanes, wildfires, a royal wedding, or a solar eclipse - also did not affect interns' moods.
"Events with outcomes in line with liberal political ideologies were followed by a mood increase, including the signing of a US presidential executive order to keep migrant families together at the US-Mexico border and following the Senate's failure to pass funding for a border wall," says the study.
The researchers say the results may not apply to all doctors or other young, politically liberal populations. However, says the team, these findings "signal that politics and medicine may interact in strong ways in the current era of medicine and that we should carefully consider their implications for young physicians and their patients."
In an accompanying feature, Joanne Silberner, features editor at The BMJ, brings together some of US President Donald Trump's tweets and quotes on various health issues. She notes his swing from being an anti-vaxer to promoting vaccination, his "easy fixes" for the notoriously complicated US health system, and his rally cry on curing AIDS and cancer.
According to Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, Trump's advice on health "could place others at risk if they follow it," and his changing views "simply create confusion and can be harmful."
McKee says, "We know that even when correction of a false message comes from the same source, some people will simply believe even more strongly in the incorrect one."