The weight of office? A scoping review of mental health issues and risk factors in elected politicians across democratic societies

Background: The mental health and capacity to govern of democratically-elected politicians have become burgeoning topics of interest. Notably, in fulfilling demanding and high-stress roles, political officeholders could encounter distinctive risk factors, yet existing research literature about these subpopulations remains underexplored. Aims: This scoping review aimed to systematically examine the breadth of available evidence on mental health issues and risk factors affecting democratically-elected politicians internationally and to identify future research needs. Methods: Using pre-defined eligibility criteria based on JBI guidelines, a systematic keyword search was conducted in May 2024 of MEDLINE, Scopus, and APA PsycNet, supplemented by snowballing techniques. Only those studies reporting primary, empirical evidence on mental ill-health or risk factors with psychological correlates from serving politicians in “Full†or “Flawed†democracies (per Democracy Index) were included from 1999 to 2024. Titles and abstracts were screened and the full-texts of potentially eligible literature were assessed before extraction and synthesis. Results: Eighteen sources met the eligibility criteria, cumulatively encompassing ~3,500 national, state, and municipal politicians across seven democracies (Australia, Canada, the Netherlands, Norway, New Zealand, the United Kingdom, and the United States). Cross-sectional surveys were predominantly utilized, with lesser use of mixed-methods approaches, qualitative interviews, and longitudinal cohorts. Violence emerged as a key concept, with twelve sources (66.7%) underlining its psychological toll and certain data indicating a disproportionate impact on female officeholders. Furthermore, four sources (22.2%) explored general psychopathology trends, revealing varying but sizeable mental ill-health and high-risk alcohol consumption rates, and two studies (11.1%) demonstrated adverse effects from specific occupational conditions. Conclusions: Current literature suggests that democratically-elected politicians can face complex mental health challenges. However, significant research gaps remain, including a paucity of prevalence estimates, longitudinal data, and intervention studies. Equally, the underrepresentation of most democratic countries accentuates the need for a more diverse evidence-base to better support the mental wellbeing of politicians worldwide.