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Cited by 746Policing Practices and PerceptionsRacial and Ethnic Identity ResearchPosttraumatic Stress Disorder Research

Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study

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Bor, Jacob, Venkataramani, Atheendar S, Williams, David R, Tsai, Alexander C·2018·The Lancet
DOI 10.1016/s0140-6736(18)31130-9PMC PMC6376989
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Abstract

Background Police kill more than 300 black Americans-at least a quarter of them unarmed-each year in the USA. These events might have spillover effects on the mental health of people not directly affected.Methods In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013-15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent's mental health was reported as "not good". We estimated difference-in-differences regression models-adjusting for state-month, month-year, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings.Findings 38 993 (weighted sample share 49%) of 103 710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07-0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1-2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans).Interpretation Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur.Funding Robert Wood Johnson Foundation and National Institutes of Health.

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  • Police killings of African Americans have an adverse effect on Black Americans' mental health.

    “Bor et al. (2018) found that police killings of African Americans have an adverse effect on Black Americans' mental health.”

    From Reporting on Black Lives Matter in 2020: How Digital Black Press Outlets Covered the Racial Uprisings (2025) · cites this paper as Bor et al. (2018)

    The Discussion reports adverse mental-health effects among Black Americans following police killings of unarmed Black Americans. The claim omits “unarmed,” extending the finding to police killings of Black Americans generally; the Abstract’s Findings report no observed mental-health impact from killings of armed Black Americans. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The BLM movement has negatively affected the mental health of people in the Black community because many identify with the victims.

    “The BLM movement has negatively affected the mental health of people in the Black community because many identify with the victims (Bor et al. 2018).”

    From Reporting on Black Lives Matter in 2020: How Digital Black Press Outlets Covered the Racial Uprisings (2025) · cites this paper as Bor et al. 2018

    The Results report worse mental health among Black Americans following police killings of unarmed Black Americans. The Discussion identifies identification with the deceased as a possible pathway, not an established explanation. The paper does not attribute the harm to the BLM movement. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Extensive evidence shows negative mental health effects of race-related stress in POC.

    “Despite extensive evidence showing the negative mental health effects of race-related stress in POC [6-11,14-17] and the promise of mindfulness meditation to help these individuals cope [20-24,26,30-32,79], this evidence-based treatment continues to be understudied among this high-risk population in both traditional [30,35,36] and digital formats [46-48].”

    From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [14]

    The Results report more poor mental health days among Black American respondents following police killings of unarmed Black Americans. The Introduction also describes a large literature linking racism with health outcomes. But this study examines one race-related exposure in Black Americans, not the mental health effects of race-related stress across people of color generally. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • People of color who experience police brutality or witness incidents involving other racial or ethnic minority group members, either personally or vicariously, suffer from a variety of mental health consequences ranging from anger and fear to PTSD.

    “And people of color who experience police brutality or witness incidents involving other racial or ethnic minority group members, either personally or vicariously, suffer from a variety of mental health consequences, ranging from anger and fear to posttraumatic stress disorder (PTSD; Aymer, 2016; Bor et al., 2018; see Bryant-Davis et al., 2017, for a review).”

    From A call to dismantle systemic racism in criminal legal systems. (2022) · cites this paper as Bor et al., 2018

    The Results report increased poor mental health days among Black Americans following police killings of unarmed Black Americans in their state. The Introduction proposes fear and anger as possible responses and cites descriptive studies of PTSD, but this study did not measure those specific outcomes. It also does not establish the claim for people of color generally, for direct experiences of police brutality, or for incidents involving other racial or ethnic minority groups. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Exposure to police killings of unarmed Black people has not been shown to similarly negatively impact the mental health of White people.

    “Notably, exposure to police killings of unarmed Black people has not been shown to similarly negatively impact the mental health of White people (Bor et al., 2018).”

    From A call to dismantle systemic racism in criminal legal systems. (2022) · cites this paper as Bor et al., 2018

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Research works printed but not linked: 2

  1. [20]Alexander M The new Jim Crow. New York, NY: The New Press, 2012.
  2. [29]Angrist JD, Pischke JS. Mostly harmless econometrics. Princeton, NJ: Princeton University Press, 2009.

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Authors
Bor, J., Venkataramani, A. S., Williams, D. R., & Tsai, A. C.
Affiliations
  • Boston University (US)
  • Leonard Davis Institute of Health Economics (US)
  • Harvard University (US)
  • Massachusetts General Hospital (US)
Corresponding author
Venkataramani, Atheendar S
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2018-07
Volume
392
Issue
10144
Pages
302-310
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(18)31130-9
PMC
PMC6376989
OpenAlex
W2809472886
Cited by
746
References
39
Citations by year
2026: 43 · 2025: 74 · 2024: 88 · 2023: 110 · 2022: 131 · 2021: 145 · 2020: 96 · 2019: 46 · 2018: 12
FWCI
324.35
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K01MH105320, K23MH106362)
Topics
  • Social Sciences › Political Science and International Relations › Policing Practices and Perceptions
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
police killings, police brutality, mental health, African Americans, spillover effects, racial disparities, racial bias in policing
MeSH terms
Adolescent, Adult, Aged, Black or African American, Female, Homicide, Humans, Interview, Psychological, Male, Mental Health, Middle Aged, United States, Police, Behavioral Risk Factor Surveillance System, Young Adult, Racism, Non-Randomized Controlled Trials as Topic

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