Mental health during and after protests, riots and revolutions: A systematic review

OBJECTIVES

Protests, riots and revolutions have long been a part of human history and are increasing globally, yet their impact on mental health remains largely unknown. We therefore systematically reviewed studies on collective actions and mental health.

METHOD

We searched PubMed, Web of Science, PsycINFO and CINAHL Plus for published studies from their inception until 1 January 2018. Study quality was rated using the Newcastle-Ottawa Scale.

RESULTS

We identified 52 studies (n = 57,487 participants) from 20 countries/regions. The prevalence of post-traumatic stress disorder ranged from 4% to 41% in riot-affected areas. Following a major protest, the prevalence of probable major depression increased by 7%, regardless of personal involvement in the protests, suggestive of community spillover effects. Risk factors for poorer mental health included female sex, lower socioeconomic status, exposure to violence, interpersonal conflicts, frequent social media use and lower resilience and social support. Nevertheless, two studies suggested that collective actions may reduce depression and suicide, possibly due to a collective cathartic experience and greater social cohesion within subpopulations.

CONCLUSION

We present the first systematic review of collective actions and mental health, showing compelling evidence that protests even when nonviolent can be associated with adverse mental health outcomes. Health care professionals therefore need to be vigilant to the mental and psychological sequelae of protests, riots and revolutions. Further research on this emerging sociopolitical determinant of mental health is warranted.

A Perspective on the Baltimore Freddie Gray Riots: Turning Tragedy Into Civic Engagement and Culture Change in an Academic Department of Medicine

PROBLEM

The Johns Hopkins University School of Medicine Department of Medicine (DOM) sought ways of enhancing community engagement after the death of Freddie Gray and consequent unrest in Baltimore City.

APPROACH

The DOM launched a five-part noon lecture series in May 2015-"Journeys in Medicine"-to facilitate discussion among DOM faculty, staff, trainees, and community residents regarding the city's unrest. This evolved into a department-wide civic engagement initiative in July 2016 to enhance employee and community engagement. The civic engagement committee is composed of two collaborative steering committees: Staff Engagement and Community Engagement.

OUTCOMES

The DOM has sponsored and/or participated in programs to address major concerns raised during the Journeys in Medicine series-improving the strained relationship between police and the community, mentoring young people, involving more DOM employees in community activities, sharing research results with the community, and addressing cultural differences to enhance relationships and communication. To enhance staff engagement, a Nursing Diversity Council, complementing the Faculty Diversity Council, has been established. DOM faculty and staff have participated in and championed several disease-focused physical activity endeavors (e.g., walks) that, collectively, have raised over $40,000. Community service projects include supporting registration and screenings at a local health fair, a professional clothing drive, and DOM Days of Service.

NEXT STEPS

The Johns Hopkins University School of Medicine DOM is developing an administrator leadership program and continuing to participate in meaningful activities, leading to tangible outcomes designed to strengthen connections to the surrounding neighborhood and enhance engagement among all DOM employees.

Sports Fans, Alcohol Use, and Violent Behavior: A Sociological Review

This review makes four contributions to the sociological study of sports fans, alcohol use, and violent behavior. First, this article focuses explicitly on the relationship between alcohol use and violent behavior among sports fans. This is a worldwide social problem, yet it is quite understudied. Second, this article synthesizes the fragmented literature on alcohol use and violent behavior among sports fans. Third, this article identifies four broad sets of risk factors-sociocultural, event/venue, police, and crowd-that appear to be closely related to violent behavior among sports fans. Finally, to help explain the possible correlation between alcohol and violence among sports fans, this article draws upon the key understandings from the literature on alcohol and violence in wider society. The article concludes with suggestions for future research.

Does media coverage influence public attitudes towards welfare recipients? The impact of the 2011 English riots

Following the shooting of Mark Duggan by police on 4 August 2011, there were riots in many large cities in the UK. As the rioting was widely perceived to be perpetrated by the urban poor, links were quickly made with Britain's welfare policies. In this paper, we examine whether the riots, and the subsequent media coverage, influenced attitudes toward welfare recipients. Using the British Social Attitudes survey, we use multivariate difference-in-differences regression models to compare attitudes toward welfare recipients among those interviewed before (pre-intervention: i.e. prior to 6 August) and after (post-intervention: 10 August-10 September) the riots occurred (N = 3,311). We use variation in exposure to the media coverage to test theories of media persuasion in the context of attitudes toward welfare recipients. Before the riots, there were no significant differences between newspaper readers and non-readers in their attitudes towards welfare recipients. However, after the riots, attitudes diverged. Newspaper readers became more likely than non-readers to believe that those on welfare did not really deserve help, that the unemployed could find a job if they wanted to and that those on the dole were being dishonest in claiming benefits. Although the divergence was clearest between right-leaning newspaper and non-newspaper readers, we do not a find statistically significant difference between right- and left-leaning newspapers. These results suggest that media coverage of the riots influenced attitudes towards welfare recipients; specifically, newspaper coverage of the riots increased the likelihood that readers of the print media expressed negative attitudes towards welfare recipients when compared with the rest of the population.

Threat, prejudice and the impact of the riots in England

This paper examines how a major outbreak of rioting in England in 2011 impacted on prejudice toward three minority groups in Britain: Muslims, Black British and East Europeans. We test whether the riots mobilized individuals by increasing feelings of realistic and symbolic threat and ultimately prejudice, or whether the riots galvanized those already concerned about minorities, thus strengthening the relationship between threat and prejudice. We conducted three national surveys - before, after and one year on from the riots - and show that after the riots individuals were more likely to perceive threats to society's security and culture, and by extension express increased prejudice toward Black British and East European minorities. We find little evidence of a galvanizing impact. One year later, threat and prejudice had returned to pre-riots levels; however, results from a survey experiment show that priming memories of the riots can raise levels of prejudice.

The "swinish multitude": controversies over hogs in antebellum New York City

In the first half of the nineteenth century, New Yorkers fought passionately over the presence of hogs on their streets and in their city. New York’s filthy streets had cultivated an informal economy and a fertile environment for roaming creatures. The battles—both physical and legal—reveal a city rife with class tensions. After decades of arguments, riots, and petitions, cholera and the fear of other public health crises ultimately spelled the end for New York’s hogs. New York struggled during this period to improve municipal services while adapting to a changing economy and rapid population growth. The fights between those for and against hogs shaped New York City’s landscape and resulted in new rules for using public space a new place for nature in the city.

"Ready to shoot and do shoot": black working-class self-defense and community politics in Harlem, New York, during the 1920s

Throughout the first three decades of the twentieth century, black people in New York City encountered white violence, especially police brutality in Manhattan. The black community used various strategies to curtail white mob violence and police brutality, one of which was self-defense. This article examines blacks’ response to violence, specifically the debate concerning police brutality and self-defense in Harlem during the 1920s. While historians have examined race riots, blacks’ everyday encounters with police violence in the North have received inadequate treatment. By approaching everyday violence and black responses—self-defense, legal redress, and journalists’ remonstrations—as a process of political development, this article argues that the systematic violence perpetrated by the police both mobilized and politicized blacks individually and collectively to defend their community, but also contributed to a community consciousness that established police brutality as a legitimate issue for black protest.

"But burn - no": the rest of the crowd in three civil disorders in 1960s Chicago

Examining the internal dynamics of three civil disturbances on the West Side of Chicago during the late 1960s, this article describes the presence of numerous people who were not participating in the upheaval. It pays particular attention to “counterrioters,” civilian residents of the neighborhoods and members of local organizations, who tried to persuade those engaging in violence to stop. Local dissent from the tactic of violence suggests that historians should describe these events using the neutral language of social science rather than the politically loaded labels of “riot” or “rebellion.” The article argues that American historians of urban disorders should use the methods of European scholars of the crowd to study the actions of participants in order to ascertain their political content, rather than relying on an examination of their motives.

Validity of the construct of post-traumatic stress disorder in a low-income country: interview study of women in Gujarat, India

The validity of the clinical construct of post-traumatic stress disorder (PTSD) has been questioned in non-Western cultures. This report describes in-depth interviews exploring the experiences of women who were traumatised by the communal riots in Ahmedabad, India, in March 2002. Three specific narratives are presented which describe experiences that closely resemble re-experiencing, avoidance and hyperarousal. Thus, symptoms described as characteristic features of PTSD in biomedical classifications are clearly expressed by the women in our study, and are attributed by them to trauma and grief. We conclude that PTSD may be a relevant clinical construct in the Indian context.

An exploratory comparison of disasters, riots and terrorist acts

One question that emerged following the 11 September attacks was how to categorise and classify the event within existing disaster and conflict-event research frameworks. A decade ago, Quarantelli (1993) compared findings on the similarities and differences between consensus- and conflict-type events by illustrating a conceptual distinction between the two. In this paper, this discussion is expanded to include terrorist attacks by offering comparisons from research findings following 11 September. We provide analyses of individual, organisational, and community-level behaviour in crisis situations and suggest how 11 September is both similar to, and differs from, consensus- and conflict-type events as they were previously considered. Applications for emergency management are also suggested.

Psychological perspective for a theory of behavior during riots

In a riot situation some individuals actively participate in antisocial behavior, but others do not, and still others act to discourage hostile activity. Four concepts from general psychology including (1) insufficiency of internal control or lack of internalized restraints acquired through learning, (2) effects of frustration, (3) emotional excitement, and (4) precipitating incidents (one or more) are proposed as contributors to the behavioral involvement of participants. Some hypotheses and the role of such variables as emotional contagion, imitation, opportunism, and anonymity are discussed.