The events surrounding the death of George Floyd in 2020 and the ensuing protests highlighted the deep-rooted problems of police violence and structural racism in our country. Nearly three years later, the headlines continue to detail shocking episodes of police brutality, often directed toward individuals who pose little or no threat. Tyre Nichols in Memphis is one of the more recent casualties. Of course, meaningful change will take time, but it is disheartening to see so little progress.
According to data collected by the non-profit organization, Mapping Police Violence, police killed 1123 people in the United States, and notably people of certain races and ethnicities are disproportionately impacted. Police kill more than 300 Black Americans each year. Black Americans are nearly three times as likely to be killed by police than white Americans, and Black Americans are five times more likely to be unarmed when killed.
In a study published in The Lancet, by a team of researchers led by Alexander Tsai, MD a staff psychiatrist at MGH and Associate Professor of Psychiatry at Harvard Medical School, attempted to quantify the population-level health impacts of police killings in a nationally representative sample of Black Americans.
In this population-based, quasi-experimental study, the researchers combined data on police killings with individual-level data collected from the nationally representative sample of adults in the 2013–15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the impact of police killings of unarmed Black Americans on the self-reported mental health of Black Americans in the general population. Local community was defined as the state in which the respondent was living. They looked specifically at the number of police killings of unarmed Black Americans in the same state during the three months prior to the BRFSS interview.
Mental health was assessed using the following question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” This survey item is widely used to monitor trends in population mental health and has been shown to have a high degree of internal and construct validity.
In this cohort, 38,993 of 103,710 Black American respondents were exposed to one or more police killings of unarmed Black Americans in their state of residence during the 3 months prior to the survey. Black respondents were exposed to an average of one police killing of an unarmed Black American during the 3 months prior to interview (range 0–7), or approximately four killings per year.
Each additional police killing of an unarmed Black American was associated with an additional 0.14 poor mental health days among Black American respondents. The largest effects on mental health were observed in the 1–2 months after exposure. Extending these findings to the population as a whole, the researchers estimated that police killings of unarmed Black Americans could contribute 1.7 additional poor mental health days per person per year, or 55 million excess poor mental health days per year among Black Americans as a whole. These estimates suggest that among Black Americans, the mental health burden stemming from police killings is comparable to the mental health burden associated with diabetes.
The findings were very specific. Police killings of unarmed Blacks did not impact the mental health of while Americans. There was not an increase in poor mental health days among respondents of either race in response to police killings of unarmed white or armed Black Americans. These findings suggest that the meaning ascribed to police killings of unarmed Black Americans most likely mediates the adverse mental health effects of these events on Black Americans. The authors note, “Police killings of unarmed black Americans are perceived by many as manifestations of structural racism and as implicit signals of the lower value placed on Black lives by law enforcement and legal institutions—and by society at large.”
The authors comment that the current study is probably an underestimation of the mental health impact of police killings on Black Americans. Given the recent increase in the media coverage of police killings, the authors strongly suspect that the mental health impacts of police killings are not contained within local communities or the boundaries of a state.
Based on these findings, police killings of unarmed Black Americans represent an important public health issue among Black Americans. Leading medical societies and foundations such as the American Medical Association, the American Public Health Association, and the Robert Wood Johnson Foundation have cited these findings to support their calls to declare racism a public health crisis. As mental health providers, we must support the implementation of interventions to reduce the prevalence of these killings and must work to increase support and access to mental health services for Black Americans affected by these events.
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Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018 Jul 28; 392(10144):302-310.
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