Police Killings of Unarmed Victims Tied to Poor Mental Health in Blacks

George Citroner

July 17, 2018

Black individuals in the United States are three times more likely than whites to be killed by police, but new research suggests it is the killing of unarmed blacks that adversely affects the mental health of this population.

The study, which used information from the Mapping Police Violence (MPV) database and Centers for Disease Control and Prevention (CDC) survey answers from almost 104,000 adult black respondents, compared the mental health effects on adult blacks in the months leading up to and after a police killing.

"When we sum up to a population level, we find that these killings led to an additional 55 million days of poor mental health each year in the black American adult population," study investigator Atheendar S. Venkataramani, MD, PhD, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, told Medscape Medical News.

"That is almost as large as the yearly burden of poor mental health born by black Americans from diabetes, which is a highly prevalent chronic disease in this population," added Venkataramani.

The findings were published online June 21 in the Lancet.

"Structural Racism"

Venkataramani said that over his career, he has come across a great deal of anecdotal evidence as well as small, local-area studies suggesting that mental health worsens in the black community after police killings of civilians.

"One motivation of the study was to examine this population's mental health burden of these events," he said.

"In addition, many scholars and policy makers have interpreted police killings of unarmed black Americans as a signature manifestation of structural racism. So, another reason to do the study was to try to understand how manifestations of structural racism influence health," he said.

In the "quasiexperimental" study, investigators used information from 103,710 adult black respondents to the Behavioral Risk Factor Surveillance System, an annual national survey conducted by the CDC. They also used data of police shootings from the MPV database.

In the 3 months before the survey, 38,993 of the respondents reported being exposed to news of one or more police killings of an unarmed black American in their state of residence.

On average, exposure to a police killing of an unarmed black person in the 3 months prior to being interviewed led to an increase of 0.14 days of poor mental health per month for 3 months after each killing. 

"While this may seem like a small number, this is an average. It combines effects for individuals across levels of exposure, which we couldn't measure in the data," said Venkataramani.

"So, some people may not have been exposed, others may have been exposed and had smaller effects, while still others were exposed and had much larger effects," he added.

The greatest effect on mental health was observed 1 to 2 months after exposure.

The killing of an unarmed black or white individual did not affect white respondents to the survey.

"We believe the study adds causal, population-level evidence to a growing body of work suggesting that police killings affect mental health among black Americans," Venkataramani said.

"More generally, the literature on racism and health has focused a great deal on the relationship between interpersonal racism and health, and most of the analyses have been unable to establish cause and effect. In this vein, our use of a natural experiment methodology adds causal evidence linking a different domain of racism to health outcomes: structural racism," he noted.

"In addition, the results speak to the importance of vicariously experienced racism as a driver of health," he said.

"Distressing Messages"

Commenting on the findings for Medscape Medical News, Gail Saltz, MD, associate professor of psychiatry at the New York–Presbyterian Hospital Weill Cornell Medicine, New York City, said the study seems to indicate that being black in America "is more randomly dangerous simply because one is black and society is treating you as a less important human life.

"These are distressing messages, to say the least," added Saltz, who was not associated with the research.

Saltz said that whites may not have the same response to unarmed blacks being killed because "it doesn't appear to signify a message of whiteness being perceived as dangerous or white being perceived as 'less than.' This shows that the effect is not merely one of identification with the unarmed person shot and trauma by this identification but rather a sign of structural racism."

She speculated that the black respondents were not adversely affected by news of armed blacks being shot because that type of circumstance "presents police with a potential reason to shoot them because of the gun, rather than their race. Having a gun is perceived as controllable, while race is not."

"Being unarmed and therefore posing no danger but still being shot reinforces the idea that a black person can be killed for being black, which can be terrifying," said Saltz.

She said the main issue is that the black community does not feel they can protect themselves, even by following the rules and by trying to be good citizens. They are still in danger because of their race, a belief reinforced "every time they hear news of another unarmed black killed by police."

Previous research by Venkataramani published in 2015 in Social Science and Medicine suggests that indirect exposure to a violent event, such as the World Trade Center attacks, can create emotional distress among those not directly affected.

Venkataramani said this phenomenon, known as "vicarious trauma," occurs when a person so strongly identifies with a victim of violence that that person experiences genuine emotional repercussions regarding the event.

Help-Seeking Stigmatized

Saltz agreed, noting that "one can still have an acute stress reaction from indirect exposure to violence and trauma, although the less direct, the less likely this is. However, repetition of such indirect trauma will increase the odds."

In addition, "a black person who has experienced structural racism in another way may also feel more traumatized by these shooting events because of their meaning," she said.

Saltz noted that black individuals in the United States can be reticent to seek the help they need and may have an overall tendency to avoid counseling.

"Unfortunately, there remains a great deal of stigma against those seeking mental health services in this community," she said.

Although she is confident there are effective ways to address this issue, more open discussions of how this is an example of structural racism and of ways the community can work together to stop it are needed.

Saltz added that it is critical that this population have improved access to therapy, as well as education about how helpful therapy can be and the "red flags" that indicate it's time to seek treatment.

Venkataramani noted that the study findings "highlight the importance of structural racism in driving health outcomes among black Americans and suggests that the impacts at a population-level are very large."

Future research "should look at the mechanisms underlying the findings, the moderating effects of the type of exposure, and community-level factors and assess impacts on other health outcomes," which his laboratory is currently working on.

"The results suggest the importance of community-level mobilization of mental health resources after traumatic events like police killings and further underscore the importance of reforms to reduce police killings," Venkataramani concluded.

The study was funded by the Robert Wood Johnson Foundation and the National Institutes of Health. Dr Venkataramani and coauthors have disclosed no relevant financial relationships.

Lancet. Published online June 21, 2018. Abstract

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