Abstract Political scientists have long known that political involvement exacts costs but they have typically defined these costs in relatively narrow, largely economic terms. Though anecdotal evidence suggests that the costs of politics may in fact extend beyond economics to frayed personal relationships, compromised emotional stability, and even physical problems, no systematic evidence on these broader costs exists. We construct and validate batteries of survey items that delineate the physical, social, and emotional costs of political engagement and administer these items to a demographically representative sample of U.S. adults. The results suggest that a large number of Americans believe their physical health has been harmed by their exposure to politics and even more report that politics has resulted in emotional costs and lost friendships.

Citation: Smith KB, Hibbing MV, Hibbing JR (2019) Friends, relatives, sanity, and health: The costs of politics. PLoS ONE 14(9): e0221870. https://doi.org/10.1371/journal.pone.0221870 Editor: Gregg R. Murray, Augusta University, UNITED STATES Received: January 2, 2019; Accepted: August 16, 2019; Published: September 25, 2019 Copyright: © 2019 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All files are available from the Harvard Dataverse database (https://doi.org/10.7910/DVN/WCPGAU). Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.

Introduction Like all choices, the decision of whether or not to get involved in politics can be viewed in cost-benefit terms. Downs’ [1] classic formulation of political participation began with a somewhat narrow conceptualization. Costs were taken to be the time, effort, and money required to become informed and then to participate in politics, perhaps by traveling to the polls, making a campaign contribution, or communicating with a public official; benefits were the favorable policies enacted as a result of a preferred candidate assuming office. In order to explain a variety of political phenomena, the benefits of politics were quickly expanded to include social and psychological as well as policy benefits. These additional benefits included feelings of fulfillment derived from performing a civic duty [2–3], expressive or solidary benefits produced by joining with like-minded people to support a candidate, party, or cause [4–5], and the entertainment rewards derived from being a “hobbyist” [6]. In addition, research has provided evidence that political participation can positively affect social capital, a collective benefit that not only promotes social cohesion but may even have public health benefits (e.g. [7–8]). Though the benefits of political engagement have broadened and expanded, the costs continue to be viewed in narrow, functional, tangible, and often economic terms. This is unfortunate because, particularly in light of the emotionally-wrenching, increasingly polarized climate of the last few decades, it has become clear that the costs of politics entail more than carving out time to acquire political information or paying a babysitter on Election Day. People often pay social, psychological, emotional, and even physical costs as a result of political engagement, but the extent of these costs and their specific nature and implications have, to the best of our knowledge, never been systematically measured or investigated in large part because suitable instruments have never been developed. That such costs exist is not in question. Damaged friendships, ruined family reunions, and disrupted workplaces, not to mention feelings of guilt, regret, frustration, anguish, and remorse, have all been attributed to political differences. These sorts of psychological stressors are suspected to underlie a range of health problems believed to accompany divisive electoral campaigns, especially when vulnerable populations perceive themselves as targeted [9–10]. There is little doubt that politics is a prominent cause of stress for modern American adults. A recent survey by the American Psychological Association [11] found that 57 percent of Americans identified politics as a very or somewhat significant source of stress, and other polls report that the most commonly expressed fears of Americans center on government and politics [12–13]. The few clinical studies on the health impacts of politics that do exist suggest such effects may be all too real. The polarizing presidential election of 2016 appears to have triggered clinical levels of distress in at least one college population [14], and may even be linked to death rate fluctuations in some geographic areas [15]. More anecdotally, in the wake of the 2016 election, clinical psychologists reported a jump in mental health pathologies directly attributed to politics—what the media have termed “election stress disorder” [16]. In short, there is clearly an empirical basis for the hypothesis that politics, especially the divisive sort of politics characterizing the contemporary civic sphere in the United States, negatively affects social, psychological, and even physical health. Yet there is remarkably little systematic data on the existence and extent of these costs. How widespread are they? Are the costs primarily social and emotional? Do they extend to the physical realm? What kind of person is most likely to believe they suffer as a result of their political involvement? Despite indications that such costs may be real and broadly felt, there is no systematic empirical basis for answering any of these questions. Our specific purpose in this paper is to begin addressing these questions by 1.) constructing and validating survey instruments suitable for assessing the specific costs of politics, thereby eventually making it possible to measure variations over time and across political cultures, 2.) providing the first systematic assessment of the impact of political involvement on social, psychological and physical health at the time our survey was administered, and 3.) identifying the type of person most likely to suffer psychological, emotional, social, and physical costs as a result of politics, again at one point in time.

Materials and methods To achieve these goals we administered a series of specially drafted survey items to a representative sample of American adults. Data were collected by YouGov from March 15 to March 20, 2017. YouGov uses an online panel of approximately 1.8 million US respondents to create representative samples. Our sample was specifically matched to a 2010 American Community Survey (ACS) sampling frame on gender, age, race, education, party identification and political interest. The total N is 800, large enough to detect effects of r = .10 with 80 percent power (sample size required for r = .10, alpha = .05, and beta = .20, is N = 783). This study was approved by the University of Nebraska-Lincoln Institutional Review Board (Project ID: 52013). Given that no validated batteries of the impact of politics on health exist, our survey instrument had to be created from scratch, and the sample described above is the first to respond to our survey items. Our survey instrument, however, is anchored in pre-existing and widely used diagnostic batteries. Specifically, as a starting point we employed the diagnostic instruments used by Alcoholics Anonymous (AA) and Gamblers Anonymous (GA), and adapted and modified the questions to probe for the impact of politics. For example, a question common to both the AA and GA surveys is, “Does gambling [your drinking] ever cause you to have difficulty sleeping.” In our survey we have a similar item: “I have lost sleep because of politics,” with response categories ranging from “strongly agree” to “strongly disagree.” We drafted 32 such items designed to probe the impact of politics in four broad categories: physical health, emotional health, regretted behavior, and social/lifestyle costs. It is possible people will misattribute the causes of emotional or physical distress, blaming politics for unhappiness that actually stems from a different source. Our goal, however, is not to ascertain the degree to which politics is objectively causing particular problems but rather the degree to which people perceive politics as the source of those problems. This is consistent with longstanding patterns in research on gambling and alcoholism which typically investigate self-report attributions [17] because effective strategies to alleviate a person’s problems are intimately connected to that person’s perceptions of the source of those problems. Our survey also included variables designed to capture a wide range of individual traits and characteristics such as socio-demographics (race, income, age, gender, employment status, and frequency of church attendance), personality (the Ten-Item Big-5 Personality Inventory and an abbreviated version of Altemeyer’s dogmatism battery), political attitudes (partisanship; ideology; disapproval/approval of Donald Trump; preferences on social and economic issues; attitudes toward those who hold opposing political beliefs), political knowledge (score on a five-item test of political knowledge), political interest (a four-point, single item), and political activity (frequency of political discussions, self-reported voting frequency, and five participatory behaviors–attending a political meeting, working in a political campaign, making a campaign contribution, holding any form of public office, and contacting a public official). Table 1 reports measurement, coding information, and descriptive statistics for all variables used in our analysis. PPT PowerPoint slide

PowerPoint slide PNG larger image

larger image TIFF original image Download: Table 1. Variables and measures. https://doi.org/10.1371/journal.pone.0221870.t001

Discussion Political interactions and experiences impact institutions and elites but also ordinary individuals. The costs of exposure to politics extend to social, mental, emotional, and physical health and the results presented here indicate that these costs are fairly widespread. Our sample was designed to be representative of the approximately 248 million adults living in the United States. Important caveats always attend when extrapolating from samples to populations but if our findings are even remotely externally valid then tens of millions of American adults perceive politics as exacting significant social, psychological and even physical health costs. Rough estimates based on Table 2 would be that approximately 94 million people believe they have been stressed by politics, 44 million believe they have lost sleep, 28.5 million that their physical health has been adversely affected, and 11 million that politics led them to consider suicide, though particular caution surrounds behaviors that are less common. For example, the 4.1 percent who report suicidal thoughts as a result of politics are less than 40 respondents in our sample, so even small amounts of sampling error could significantly change proportional estimates. Still, even the most conservative interpretation of these numbers suggests that large numbers of Americans are convinced that politics is exacting significant social, psychological and even physical costs on their well-being. To try and put our results in comparative perspective we used the National Longitudinal Study of Adolescent to Adult Health [23] as a point of comparison. Though administered to young adults rather than a representative sample of all ages, this is a reliable and respected data source that asks a large number of roughly parallel questions on the effects of alcohol consumption. Approximately 11% of the Add Health respondents reported that alcohol use had created problems with family, friends, or people at work, which is slightly less than the numbers for parallel political items (see Table 2). In other areas, 15.4% of the Add Health sample reported that alcohol use interfered with responsibilities at work or school. In our sample, 6% reported losing time from work or school because of politics and 8.5% said politics delayed them from completing an assignment, task, or job. Further, 9.1% of the Add-Health sample reported legal problems because of drinking, presumably mainly as a result of DUIs and similar offenses. In our sample 4.3% said politics had created legal problems for them. Our results also provide insight into the populations most likely to believe politics is adversely affecting them at the time the survey went to the field. They are younger and unemployed; more disagreeable (more critical and quarrelsome), and less emotionally stable (more anxious and easily upset). They tend to be politically liberal, strongly disapprove of President Donald Trump, and have low opinions of their political opposites (they see them as uninformed, closed-minded, and untruthful). They also tend to discuss politics frequently and to be actively involved in a range of political activities. It may be that the costs of politics were unusually acute when this survey was administered, just two months after the inauguration of an extremely polarizing president. The fact that left-leaning people who disapproved of Trump were among the most consistent in reporting negative health costs raises the possibility that our sample is capturing a moment in time when costs for that group were particularly high. On the other hand, the presidencies of George W. Bush and Barack Obama were so deeply divisive [24] that each of the last three presidents was labeled, with empirical support, the most polarizing ever. Our expectation is that, while the ideological leanings of those most adversely affected by politics will change from administration to administration, the tendency of those who are most politically involved and interested to be most adversely affected will persist and this brings us to our final point. Determining the extent to which the costs of politics vary across time and contexts is an important mission—one that we believe will be facilitated by our efforts to construct and validate appropriate survey batteries. We believe the batteries offered here will make it possible to take regular soundings of the perceived costs of politics, thereby building a knowledge base regarding the conditions under which politics is believed to be the most (and least) damaging to personal well-being. The 10-item battery in particular captures a wide range of costs and is concise enough to be included in most survey instruments. Democratic governance brings undeniable benefits to its citizens and in some cases political involvement is undoubtedly beneficial to personal well-being [25]. At the same time, for many people election campaigns and the contentious discussion of issues and candidates that surrounds them bring undeniable costs. Only by identifying, measuring, and analyzing the personal costs of open, democratic politics will it be possible to ameliorate them.