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“Well-Being and Mental Health Towards
an Integrated Policy Approach”
OECD Online Conference
Mental Health and
Political Representation
Dr Luca Bernardi
Department of Politics
Luca.Bernardi@liverpool.ac.uk
9 December 2021
Key Questions We Have Been Exploring
(Mental) Health and Political Behaviour Subfield
• Behavioural questions:
• Do people with mental health problems engage and participate
less in politics? If so, why?

• Attitudinal questions:
• How differently do people with mental health problems perceive
and evaluate politics? How do they make their political
decisions? What are their political orientations and
predispositions?

Mental health —> Political behaviour / attitudes
2
Depression and Political Participation
3
Landwehr, C., & Ojeda, C. (2021). Democracy and depression: a cross-national study of depressive symptoms and
nonparticipation. American Political Science Review, 115(1), 323-330. (Depression: CESD-8).
Mental Health and Political Participation: A Review
• Canada: self-rated mental health (Couture and Breux 2017); self-
reported stress (Couture and Breux 2021)

• European Social Survey: self-reported depression symptoms
(Landwehr and Ojeda 2020)

• Finland: reimbursement for depression drugs (Sund et al. 2017)

• Germany: outpatients with chronic mental illness (Bullenkamp and
Voges 2004); self-reported depression symptoms (Landwehr and
Ojeda 2020)

• United Kingdom: self-reported depression symptoms (Ojeda and
Pacheco 2019; Landwehr and Ojeda 2020)

• United States: self-reported depression symptoms (Ojeda 2015;
Ojeda and Slaughter 2019; Landwehr and Ojeda 2020)
4
For a review see:
Bernardi, L. (2021). Mental Health and Political Representation:A Roadmap. Frontiers in Political Science,
2(January), 1–13. https://doi.org/10.3389/fpos.2020.587588
Depression and Political Interest
5
Ojeda, C., Bernardi, L., & Landwehr, C. (N.d.). Depressive Symptoms and the Gender Gap in Political Interest.
APSA 2019. (Depression: CESD-8).
Predicted Probability of Political Interest across
Depressive Symptoms (GESIS).
Predicted Probability of Political Interest across
Depressive Symptoms (ESS).
Depression and Political Efficacy
6
Bernardi, L., Mattila, M., Papageorgiou,A., & Rapeli, L. (N.d.). Down But NotYet Out: Depression,
Political Efficacy, andVoting. Forthcoming in Political Psychology.
Effects of depression and lagged
efficacy on current levels of efficacy
with 95% confidence intervals
(UKHLS).
Coefficient estimates of self-reported
depression (CESD-8) on internal and
external political efficacy (ESS7).
Coefficients on the change in self-
reported depression scores on
political efficacy with 95%
confidence intervals (UKHLS).
Depression, Political Efficacy, and Voting
7
Bernardi, L., Mattila, M., Papageorgiou,A., & Rapeli, L. (N.d.). Down But NotYet Out: Depression,
Political Efficacy, andVoting. Forthcoming in Political Psychology.
Mediation percentages of depression through efficacy for voting in
previous parliamentary elections (ESS) and voting intention (UKHLS).
* p<0.05 , ** p<0.01
ESS
UKHLS
(depression concurrent)
UKHLS
(depression lagged)
Clinical
depression
Self-reported
depression
Clinical
depression
Self-reported
depression
Internal efficacy 11%** 0% 7% 4% 8%
External efficacy 10%** 23%** 38%** 31%* 26%**
Dissatisfaction, Depression and Pre-Referendum Support for Leave
8
Bernardi, L., & Johns, R. (2021). Depression and attitudes to change in referendums:The case of
Brexit. European Journal of Political Research, 60(2), 339-358.
Source: own analyses of UKHLS 2016 wave data.
0%
10%
20%
30%
40%
50%
60%
70%
No Yes No Yes
Dissatisfied Depression
Probability
of
supporting
Leave
Depression and a Post-Referendum Swing to Leave
9
Bernardi, L., & Johns, R. (2021). Depression and attitudes to change in referendums:The case of
Brexit. European Journal of Political Research, 60(2), 339-358.
Source: own analyses of UKHLS 2016 wave data.
0%
10%
20%
30%
40%
50%
60%
70%
No depression Depression No depression Depression
Pre-referendum Post-referendum
Probability
of
supporting
Leave
Depression and Political Orientations in Western Europe
10
Bernardi, L. (2021). Depression and Political Predispositions:Almost Blue? Party Politics, 27(6) 1132-1143.
(Depression: CESD-8)
Depression and left-right orientation (ESS-7)
Depression and party identification (ESS-7)
3.5
4
4.5
5
5.5
6
Predicted
Values
on
Left−Right
Orientation
0 1 2 3 4 5 6 7 8 9 10
Self−rated Depression
Depressive Symptoms and Left−Right
0
.1
.2
.3
.4
.5
.6
.7
Pr(No
Party
ID)
0 5 10 15 20 25
Self−rated Depression
No Party ID (A)
0
.1
.2
.3
.4
.5
.6
.7
Pr(Largest
Right
Party
ID)
0 5 10 15 20 25
Self−rated Depression
Mainstream Right (B)
0
.1
.2
.3
.4
.5
.6
.7
Pr(Largest
Left
Party
ID)
0 5 10 15 20 25
Self−rated Depression
Mainstream Left (C)
Depression and Negativity Bias in Political Evaluations
11
Bernardi, L., & Johns, R. (N.d.). Depression and Negativity Bias in Political Evaluations.
ISPP & EPSA 2019.
Scottish Election Study 2019
0	
0,1	
0,2	
0,3	
0,4	
No	 Self-reported	 Diagnosed	 No	 Self-reported	 Diagnosed	
Sco:sh	government	 UK	government	
Absolute	value	of	beta	coefficient	
Effect	on	evalua3ons	of	perceived	performance	of...	
PosiAve	evaluaAons	
NegaAve	evaluaAons	
ESS-7 (CESD-8), Satisfaction:
- Democracy
- Economy
- Government
- Education system
- Health services
Coefficients on the change in frequency of self-
reported depression mood on satisfaction with
democracy with 95% confidence intervals
(Swiss Household Panel).
Depression and DK Answers in Socio-Political Attitude Items
12
Bernardi, L., & Johns, R. (N.d.). Depression, Item Non-Response, and Political Representation. APSA 2021.
N ESS-7 items = 74 (country Ns > 1,500) ; N SES items = 60 (sample N > 3,000).
0	
0,5	
1	
1,5	
2	
2,5	
3	
3,5	
4	
4,5	
(symptoms)	 (medicated)	 (diagnosed)	
Effect	of	depression	on	DK	count	
Bivariate	
With	controls	
With	mediators
COVID-19 Stressors, Mental Distress, and Political Support
13
Bernardi, L., & Gotlib, I. (N.d.). COVID-19 Stressors, Mental Distress, and Political Support. APSA 2021.
H1
External
Efficacy
Trust in
Government
Government
Satisfaction
COVID-19
Worry
-.11** n.s. -.11**
COVID-19
Stress
n.s. -.11** -.07*
YouGov online survey, March 2021, GB adults, N~1700.Variables range from 0 to 1. * p<0.05 , ** p<0.01
H3
External
Efficacy
Trust in
Government
Government
Satisfaction
CESD-9 -.12** -.19** -.14**
STAI-6 -.11** -.22** -.17*
PSS-4 -.11** -.18** -.18**
H2 CESD-9 STAI-6 PSS-4
COVID-19
Worry
.39** .18** .33**
COVID-19
Stress
.39** .22** .24**
Towards a Theory of Depression and Political Attitudes
14
Bernardi, L., & Gotlib, I. (N.d.).A Cognitive Theory of Depression and Political Attitudes.
MPSA 2021.
Online survey
representative sample of
GB adults (N~1700)
March 2021
CESD-9:
- External efficacy
- Gov’t satisfaction
- Trust in gov’t
Brooding
rumination:
- Internal efficacy
Negativity biases in
news selection:
- Political attention
- External efficacy
- Gov’t satisfaction
- Trust in gov’t
Conclusion
• What policy interventions to improve political trust,
perceptions of government responsiveness, and political
self-efficacy?

• What policy interventions to improve political participation
and engagement?

• Do our findings generalise to other mental health
problems?

• Does lower perceived sense of representation reflect into
lower actual (substantive and descriptive) representation?
15
“Well-Being and Mental Health Towards
an Integrated Policy Approach”
OECD Online Conference
Mental Health and
Political Representation
Dr Luca Bernardi
Department of Politics
Luca.Bernardi@liverpool.ac.uk
9 December 2021

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OECD Well-being and Mental Health Conference, Luca Bernardi, Lecturer, University of Liverpool

  • 1. “Well-Being and Mental Health Towards an Integrated Policy Approach” OECD Online Conference Mental Health and Political Representation Dr Luca Bernardi Department of Politics Luca.Bernardi@liverpool.ac.uk 9 December 2021
  • 2. Key Questions We Have Been Exploring (Mental) Health and Political Behaviour Subfield • Behavioural questions: • Do people with mental health problems engage and participate less in politics? If so, why? • Attitudinal questions: • How differently do people with mental health problems perceive and evaluate politics? How do they make their political decisions? What are their political orientations and predispositions? Mental health —> Political behaviour / attitudes 2
  • 3. Depression and Political Participation 3 Landwehr, C., & Ojeda, C. (2021). Democracy and depression: a cross-national study of depressive symptoms and nonparticipation. American Political Science Review, 115(1), 323-330. (Depression: CESD-8).
  • 4. Mental Health and Political Participation: A Review • Canada: self-rated mental health (Couture and Breux 2017); self- reported stress (Couture and Breux 2021) • European Social Survey: self-reported depression symptoms (Landwehr and Ojeda 2020) • Finland: reimbursement for depression drugs (Sund et al. 2017) • Germany: outpatients with chronic mental illness (Bullenkamp and Voges 2004); self-reported depression symptoms (Landwehr and Ojeda 2020) • United Kingdom: self-reported depression symptoms (Ojeda and Pacheco 2019; Landwehr and Ojeda 2020) • United States: self-reported depression symptoms (Ojeda 2015; Ojeda and Slaughter 2019; Landwehr and Ojeda 2020) 4 For a review see: Bernardi, L. (2021). Mental Health and Political Representation:A Roadmap. Frontiers in Political Science, 2(January), 1–13. https://doi.org/10.3389/fpos.2020.587588
  • 5. Depression and Political Interest 5 Ojeda, C., Bernardi, L., & Landwehr, C. (N.d.). Depressive Symptoms and the Gender Gap in Political Interest. APSA 2019. (Depression: CESD-8). Predicted Probability of Political Interest across Depressive Symptoms (GESIS). Predicted Probability of Political Interest across Depressive Symptoms (ESS).
  • 6. Depression and Political Efficacy 6 Bernardi, L., Mattila, M., Papageorgiou,A., & Rapeli, L. (N.d.). Down But NotYet Out: Depression, Political Efficacy, andVoting. Forthcoming in Political Psychology. Effects of depression and lagged efficacy on current levels of efficacy with 95% confidence intervals (UKHLS). Coefficient estimates of self-reported depression (CESD-8) on internal and external political efficacy (ESS7). Coefficients on the change in self- reported depression scores on political efficacy with 95% confidence intervals (UKHLS).
  • 7. Depression, Political Efficacy, and Voting 7 Bernardi, L., Mattila, M., Papageorgiou,A., & Rapeli, L. (N.d.). Down But NotYet Out: Depression, Political Efficacy, andVoting. Forthcoming in Political Psychology. Mediation percentages of depression through efficacy for voting in previous parliamentary elections (ESS) and voting intention (UKHLS). * p<0.05 , ** p<0.01 ESS UKHLS (depression concurrent) UKHLS (depression lagged) Clinical depression Self-reported depression Clinical depression Self-reported depression Internal efficacy 11%** 0% 7% 4% 8% External efficacy 10%** 23%** 38%** 31%* 26%**
  • 8. Dissatisfaction, Depression and Pre-Referendum Support for Leave 8 Bernardi, L., & Johns, R. (2021). Depression and attitudes to change in referendums:The case of Brexit. European Journal of Political Research, 60(2), 339-358. Source: own analyses of UKHLS 2016 wave data. 0% 10% 20% 30% 40% 50% 60% 70% No Yes No Yes Dissatisfied Depression Probability of supporting Leave
  • 9. Depression and a Post-Referendum Swing to Leave 9 Bernardi, L., & Johns, R. (2021). Depression and attitudes to change in referendums:The case of Brexit. European Journal of Political Research, 60(2), 339-358. Source: own analyses of UKHLS 2016 wave data. 0% 10% 20% 30% 40% 50% 60% 70% No depression Depression No depression Depression Pre-referendum Post-referendum Probability of supporting Leave
  • 10. Depression and Political Orientations in Western Europe 10 Bernardi, L. (2021). Depression and Political Predispositions:Almost Blue? Party Politics, 27(6) 1132-1143. (Depression: CESD-8) Depression and left-right orientation (ESS-7) Depression and party identification (ESS-7) 3.5 4 4.5 5 5.5 6 Predicted Values on Left−Right Orientation 0 1 2 3 4 5 6 7 8 9 10 Self−rated Depression Depressive Symptoms and Left−Right 0 .1 .2 .3 .4 .5 .6 .7 Pr(No Party ID) 0 5 10 15 20 25 Self−rated Depression No Party ID (A) 0 .1 .2 .3 .4 .5 .6 .7 Pr(Largest Right Party ID) 0 5 10 15 20 25 Self−rated Depression Mainstream Right (B) 0 .1 .2 .3 .4 .5 .6 .7 Pr(Largest Left Party ID) 0 5 10 15 20 25 Self−rated Depression Mainstream Left (C)
  • 11. Depression and Negativity Bias in Political Evaluations 11 Bernardi, L., & Johns, R. (N.d.). Depression and Negativity Bias in Political Evaluations. ISPP & EPSA 2019. Scottish Election Study 2019 0 0,1 0,2 0,3 0,4 No Self-reported Diagnosed No Self-reported Diagnosed Sco:sh government UK government Absolute value of beta coefficient Effect on evalua3ons of perceived performance of... PosiAve evaluaAons NegaAve evaluaAons ESS-7 (CESD-8), Satisfaction: - Democracy - Economy - Government - Education system - Health services Coefficients on the change in frequency of self- reported depression mood on satisfaction with democracy with 95% confidence intervals (Swiss Household Panel).
  • 12. Depression and DK Answers in Socio-Political Attitude Items 12 Bernardi, L., & Johns, R. (N.d.). Depression, Item Non-Response, and Political Representation. APSA 2021. N ESS-7 items = 74 (country Ns > 1,500) ; N SES items = 60 (sample N > 3,000). 0 0,5 1 1,5 2 2,5 3 3,5 4 4,5 (symptoms) (medicated) (diagnosed) Effect of depression on DK count Bivariate With controls With mediators
  • 13. COVID-19 Stressors, Mental Distress, and Political Support 13 Bernardi, L., & Gotlib, I. (N.d.). COVID-19 Stressors, Mental Distress, and Political Support. APSA 2021. H1 External Efficacy Trust in Government Government Satisfaction COVID-19 Worry -.11** n.s. -.11** COVID-19 Stress n.s. -.11** -.07* YouGov online survey, March 2021, GB adults, N~1700.Variables range from 0 to 1. * p<0.05 , ** p<0.01 H3 External Efficacy Trust in Government Government Satisfaction CESD-9 -.12** -.19** -.14** STAI-6 -.11** -.22** -.17* PSS-4 -.11** -.18** -.18** H2 CESD-9 STAI-6 PSS-4 COVID-19 Worry .39** .18** .33** COVID-19 Stress .39** .22** .24**
  • 14. Towards a Theory of Depression and Political Attitudes 14 Bernardi, L., & Gotlib, I. (N.d.).A Cognitive Theory of Depression and Political Attitudes. MPSA 2021. Online survey representative sample of GB adults (N~1700) March 2021 CESD-9: - External efficacy - Gov’t satisfaction - Trust in gov’t Brooding rumination: - Internal efficacy Negativity biases in news selection: - Political attention - External efficacy - Gov’t satisfaction - Trust in gov’t
  • 15. Conclusion • What policy interventions to improve political trust, perceptions of government responsiveness, and political self-efficacy? • What policy interventions to improve political participation and engagement? • Do our findings generalise to other mental health problems? • Does lower perceived sense of representation reflect into lower actual (substantive and descriptive) representation? 15
  • 16. “Well-Being and Mental Health Towards an Integrated Policy Approach” OECD Online Conference Mental Health and Political Representation Dr Luca Bernardi Department of Politics Luca.Bernardi@liverpool.ac.uk 9 December 2021