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Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study
Open accessAbstract
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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“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)
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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
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“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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“This is especially alarming considering that 49% of a nationally representative sample of more than 100,000 Black Americans were found to have been exposed to at least one instance in which police had killed an unarmed Black American in their state in the prior 3 months (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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Cites
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Self-citationRacism as a Determinant of Health: A Systematic Review and Meta-Analysis
Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015) · PLOS ONE · doi:10.1371/journal.pone.0138511 · Cited by 2,610
Understanding Everyday Racism: An Interdisciplinary Theory
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Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012
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Racism and health: evidence and needed research
Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040218-043750 · Cited by 2,398
Self-citationWilliams, D. R. (2018) · Journal of Health and Social Behavior · doi:10.1177/0022146518814251 · Cited by 1,014
Self-citationSocial Determinants of Mental Health: Where We Are and Where We Need to Go
Alegria, M. M., NeMoyer, A., Falgas‐Bagué, I., Wang, Y., & Álvarez, K. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0969-9 · Cited by 1,006
Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex
Edwards, F., Lee, H., & Esposito, M. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1821204116 · Cited by 916
Braveman, P. A., Arkin, E., Proctor, D., Kauh, T., & Holm, N. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01394 · Cited by 858
Metadata
- 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
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 392
- Issue
- 10144
- Pages
- 302-310
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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