UC Irvine

Black Americans experience more prevalent—as well as more severe and disabling—chronic depression compared to other races/ethnicities. Suicide rates among Black youth have also increased substantially in the past two decades. Many scholars attribute a portion of race-related differences in health outcomes to structural racism. Structural racism comprises methods of reinforcing inequitable systems that societies use to foster racial discrimination. In the justice system, Black Americans have a higher likelihood of police stops, police killings, and incarceration (vs. whites) after accounting for criminality. Such racially disparate systems may have implications for mental health within the broader Black community through perceived unfair discrimination, hypervigilance, vicarious racism, and disruption of family networks and social capital. In three analytic studies, I test whether increases in (i.) police stops, (ii.) police killings of unarmed Black Americans, and (iii.) incarceration correspond with greater psychiatric help-seeking among Black Americans.

Following the New York City Stop, Question, and Frisk (SQF) policy, police stopped Black Americans at 2.5 times the rate of whites, after controlling for crime and precinct differences. I examined whether police stops following the SQF policy in New York City corresponded with greater psychiatric Emergency Department (ED) visits among Black Americans. Through pathways of perceived unfair discrimination and hypervigilance, police stops may precede greater mental health symptoms within the Black community. Using time-series methodology to control for seasonality and other patterning, I find that police stops correspond with a 0.02 increase in psychiatric ED visits among Black Americans. Stops including frisking coincide with a 0.05 increase in psychiatric ED visits and stops including use of force show a 0.11 increase in psychiatric ED visits among Black Americans. Use of force had the greatest influence as perceived threats of physical violence towards others may incite greater psychiatric symptoms within the community.

Police are almost 3.5 times more likely to kill Black Americans than whites. Additionally, Black Americans have nearly 1.5 times the likelihood of being unarmed when killed compared to whites. I investigated whether and to what extent police killings of unarmed Black Americans precede a severe and acute mental health outcome among Black Americans: depression-related ED visits. Theories on vicarious racism and linked fate posit that individuals indirectly experience racism targeted at other persons of color. I examined the relation across 75 counties from five US states between 2013-2015. Fixed effect linear regression analyses controlled for time-invariant county factors. I also accounted for the number of hospitals and arrests for violent crimes (per 100,000 population). I find that police killings of unarmed Black Americans correspond with an 11% increase in ED visits related to depression (per 100,000 population) among Black Americans in the concurrent month and three months following the exposure. The justice system incarcerates nearly 2.3 million individuals in the US. Black Americans comprise 40% of those incarcerated despite representing less than 15% of the population. Theoretical work postulates that mass incarceration erodes social capital and family networks within Black communities. I examine the relation between incarceration and psychiatric Emergency Department (ED) visits among Black Americans. I also estimate whether the ratio of Black American to white incarceration (an estimate of structural racism in the justice system) corresponds with an increase in psychiatric help-seeking among Black Americans. I find that a one unit increase in incarceration (per 100,000 population) corresponds with a 1.4% increase in psychiatric ED visits (per 100,000 population) among Black Americans. Structural racism in incarceration (i.e., one unit increase in ratio Black and white incarceration) also varies positively, with a 2.2% increase in psychiatric ED visits (per 100,000 population).

Police stops, police killings of unarmed Black Americans, and incarceration have substantial adverse psychiatric implications for Black communities. A reduction in racial disparities through policies enforcing changes in policing behavior and sentencing reforms may modestly reduce adverse mental health among Black Americans. Additionally, this work adds to the emerging theoretical and empirical literature on structural racism and its presence in the justice system. Inequitable social systems may significantly influence mental health among Black Americans.