Stress researchers have emphasized the relationship between social stress and mental health. However, research investigating police brutality as a stressor is scarce. The authors conceptualize police brutality as a stressor, examining racial variation in its effects on mental health. Data came from the Survey of the Health of Urban Residents in the United States (n = 4,389). Negative encounters with the police were found to be associated with depressed mood and anxiety. The relationship between encounters with the police and depressed mood was stronger among Black respondents and Latinxs compared with Whites. Regardless of personal encounters with the police, the anticipatory stress of police brutality—concern that one might become a victim of police brutality—was associated with depression and anxiety. These findings highlight police brutality as an anticipatory stressor and have implications for whiteness as a resource that protects from the stress of negative police encounters.

Keywords

police brutality, anticipatory stressors, mental health

2 Socius: Sociological Research for a Dynamic World

Alang et al. 3

Over the past several years, there has been increased attention to the impact of negative police encounters on the mental health of communities that are disproportionately policed. These encounters have generally been referred to as police brutality: police action that dehumanizes, with or without conscious intent (Alang et al. 2017; Bandes 1999). Police brutality encompasses physical, sexual, and psychological violence; verbal abuse; and intimidation (Bandes 1999). Police brutality is one of the most enduring forms of structural racism, rooted in the work of organized slave patrols that sought to keep enslaved Africans from fleeing (Alang 2018; Boyd 2018; Cooper 2015). Just like racism, police brutality can be conceptualized as a stressor. Stressors are situations, factors, or conditions that produce stress by impeding an individual’s ability to maintain normal functioning (Aneshensel 2015). We conceptualize police brutality as stressor under the stress process paradigm. The stress process is a prominent sociological framework for understanding variability in risks for negative mental health outcomes. A central premise of the stress process is that differential exposure to stressors is associated with variation in mental health outcomes (Pearlin 1989; Pearlin et al. 1981; Turner and Lloyd 1999). If negative encounters with the police are stressors, then persons with exposure to these encounters will also have worse mental health outcomes than those without negative encounters with the police.

Consistent with the stress process framework, research suggests that greater exposure to negative police actions is associated with a higher prevalence of delusional mood, paranoia, hallucinations, psychological distress, depression, anxiety, and suicidal ideation (Bor et al. 2018; DeVylder, Cogburn et al., 2017; DeVylder, Frey et al., 2017; Geller et al. 2014; McLeod et al. 2020). Geller et al. (2014) were among the first to examine the relationship between police encounters and anxiety. Using a New York City–based sample of young men between the ages of 18 and 26 years, they found that those with more frequent police encounters, especially encounters considered intrusive, were more likely to report symptoms of anxiety than those with fewer encounters. Risks for encounters with the police are higher for

1Lehigh University, Bethlehem, PA, USA

2University of Minnesota Twin Cities, Minneapolis, MN, USA

Corresponding Author:

Sirry Alang, Lehigh University, Department of Sociology and Program in Health, Medicine and Society, 31 Williams Drive, #280, Bethlehem, PA 18015, USA

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and

distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Email: [email protected]

persons with prior criminal involvement (Bowleg et al. 2020; Geller et al. 2014), men (Miller et al. 2017), and young adults (Bui, Coates, and Matthay 2018; Miller et al. 2017). Regardless of personal encounters with the police, simply living in a neighborhood where pedestrians are frequently being frisked increases one’s odds of psychological distress (Sewell, Jefferson, and Lee 2016). Although this body of research generally highlights differences in exposure to police encounters and in mental health outcomes that stem from varied exposure to police encounters, less is known about how variation in mental health outcomes might depend on how people characterize or evaluate their own encounters with the police.

Stress researchers have argued that to fully understand the differential impact of stressors on mental health, attention must also be given to the evaluation or appraisal of the stressor (Louie and Wheaton 2019; McLeod 2012; Thoits 2006). In the case of police encounters, how individuals evaluate their own experiences with the police might matter for mental health beyond solely their exposure to police brutality. For example, Geller et al. (2014) found that when younger men perceived police actions to be fair, ethical, and respectful, they experienced less anxiety. We build on this work, using a larger national sample, to examine how personal evaluations of police actions might be associated with depression and anxiety, and how these associations might vary across racialized groups.

Exposure to stress is rooted in social status and circumstances (Turner, Wheaton, and Lloyd 1995). People with the most marginalized statuses are disproportionately exposed to stressors, and stressors that are strongly associated to less privileged statuses are more likely to endure over the life course (Pearlin, Aneshensel, and LeBlanc 1997; Pearlin et al. 2005). Exposure to stressors such as everyday experiences of racism, poverty, a history of incarceration, and involvement with the criminal justice system even prior to police stops are associated with a range of mental health outcomes (Bowleg et al. 2020; Fedina et al. 2018; Kwate and Goodman 2015; Williams et al. 1997). Racism disproportionately exposes people who are Black and other people of color to police brutality (Alang 2018; Boyd 2018). For example, they are more likely than Whites to be stopped; arrested; injured; psychologically, sexually, and emotionally assaulted; and killed by the police (Barber et al. 2016; Bui et al. 2018; Fedina et al. 2018; Feldman et al. 2016; Miller et al. 2017; Nix et al. 2017; Ross 2015). Therefore, as a stressor, police brutality does not affect every racial group equally. We expect, therefore, that people who are Black and other people of color are more likely than people who are White to anticipate negative police encounters.

We argue that police brutality is an anticipatory stressor. Anticipatory stressors are significant concerns about future harmful experiences, conditions, or events that may or may not ever occur (Pearlin and Bierman 2013). These kinds of stressors create vigilance: behaviors that indicate attempts to avoid or navigate predicted stress and are associated with chronic health conditions among Black adults (Lee and Hicken 2016). Goal-striving stress—an anticipatory stressor grounded in the probability of failed aspirations—is associated with high blood pressure among Black but not among White people (DeAngelis 2020). Grace (2020) examined the association between three kinds of anticipatory stressors— economic insecurity, exposure to traumatic events, and experiences of discrimination—and depressive symptoms among college seniors. The anticipation of traumatic events such as the potential death of a family member, being the victim of sexual assault, and being the victim of a violent crime was associated with depressive symptoms, and these associations varied by race (Grace 2020).

Similarly, the anticipation of police brutality might be associated with poor mental health. We already know that exposure to police brutality affects mental health. We also know that when unarmed Black Americans are killed by the police, the number of mental health days and prevalence of psychological distress increase significantly among Black people but not among Whites (Bor et al. 2018). Taken together, the effects of exposure to and anticipation of police brutality on mental health might vary across racial groups. We explore these relationships here.

Our first objective is to determine whether individual exposure to and evaluations of encounters with the police are associated with depression and anxiety. If negative encounters with the police are stressors following the stress process framework, then evaluations of personal encounters with the police should be given analytical significance when assessing the impact of negative police encounters on mental health. The second objective is to explore the associations between the anticipation of police brutality and depression and anxiety. Regardless of personal experiences of police brutality, the stressful anticipation that one might be a victim of police brutality also matters for mental health. We hypothesize that evaluations of encounters with the police and the anticipatory stress of police brutality both matter for mental health beyond personal exposure to police brutality. Finally, we examine whether the relationship between evaluations of personal encounters with the police and mental health outcomes vary by race and whether the relationship between the anticipation of police brutality and mental health outcomes vary by race.

Methods

Data

Data were obtained from the Survey of the Health of Urban Residents (SHUR) (n = 4,389). SHUR was administered online by Qualtrics to a nonprobability quota sample obtained through leveraging databases of individuals who have opted into participating in surveys. Qualtrics panels are frequently used in social science and epidemiological research (Beymer, Holloway, and Grov 2018; DeVylder, Frey et al. 2017; Grace 2020). The SHUR consists of adults ages 18 and older living in urban areas across the contiguous United States. Black/ African American and Latinx populations were oversampled, as well as persons whose usual source of care was not a doctor’s office (Alang et al. forthcoming). Qualtrics implemented demographic screening questions and recruitment quotas to ensure that specific demographic characteristics were met.

Measures

Two main outcome variables are depressed mood and generalized anxiety, measured using the two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) instrument, respectively. The PHQ-2 and GAD-2 are both initial screening instruments used to assess depression and anxiety in primary care settings. The PHQ-2 asks respondents how often in the past two weeks they have been bothered by (1) little interest or pleasure in doing things and (2) feeling down, depressed, or hopeless. The GAD-2 asks respondents how often they have been bothered by (1) feeling nervous, anxious, or on edge and (2) not being able to stop or control worrying over the past two weeks. Responses for both the PHQ-2 and the GAD-2 include not at all (0), several days (1), more than half the time (2), and nearly every day (3). Scores for each measure range from 0 to 6. Scoring 3 or more on the PHQ-2 indicates likely major depressive disorder or depressed mood with sensitivity of 82.9 percent and specificity of 90.0 percent (Kroenke, Spitzer, and Williams 2003). Similarly, a cutoff score of 3 on the GAD-2 indicates likely generalized anxiety disorder at 86 percent sensitivity and 83 percent specificity (Kroenke et al. 2007). In our analyses, we use a binary measure for depressed mood: 0 if total score on the PHQ-2 is less than 3 (no depression) and 1 if equal to or greater than 3 (likely depressed mood). Generalized anxiety is also measured as 0 (no anxiety) or 1 (likely generalized anxiety).

The primary independent variables are negative encounters with the police and stressful anticipation of police brutality. Respondents were asked if they have ever had any personal negative encounters with the police. Negative encounters included police cursing at the respondent; hitting, kicking, or shoving the respondent; using an electroshock weapon such as a stun gun; or pointing a gun at them. Respondents who reported at least one negative encounter with the police were asked, “Thinking of your most recent experience(s) with the police, would you say the action of the officer was necessary?” The variable negative experiences with the police was then created with three mutually exclusive categories: no negative encounter, necessary negative encounter, and unnecessary negative encounter. We relied on self-reports of whether encounters were (un)necessary to highlight the importance of individuals’ own evaluations of their experiences with the police, an approach consistent with others that investigate the impact of police actions on health (Cooper et al. 2004; English et al. 2017), and with the subjective nature of stressors (Wheaton 1994). Stressful anticipation of police brutality was measured by the frequency of respondents’ worries about police brutality. Respondents were specifically asked how often they worry that they would be a victim of police maltreatment or brutality. Response categories were “never,” “sometimes,” and “always.”

We used self-reported race and ethnicity (Hispanic/Latinx or not) to create a combined race/ethnicity variable with ethnicity assigned first. Categories include non-Hispanic White, non-Hispanic Black/African American, Hispanic/Latinx, Native American, Asian, and other/multiple race. We included control variables in the data that are known to be associated with depression, anxiety, and police brutality. These covariates include age (18–24, 25–34, 35–44, 45–54, 55–64, and 65 years and older) (Bui et al. 2018; Miller et al. 2017) gender (male, female, and gender fluid) (Kahn et al. 2016; Mallory, Hasenbush, and Sears 2015; Nix et al. 2017), level of education (no high school; high school or GED; some college, associate degree, or vocational school; and bachelor’s degree or higher) (Bor et al. 2018; Bowleg et al. 2020; Fedina et al. 2018), work status (not in the labor force, unemployed or looking for work, employed part-time, and employed full-time) (Alang, McAlpine, and Hardeman 2020; Bowleg et al. 2020), as well as activity limitations (yes or no) and self-rated general health (excellent, very good, or good vs. fair or poor), both indicators of health status that are associated with exposure to police brutality and with mental health (Alang et al. forthcoming; McCauley 2017; Turner, Lloyd, and Taylor 2016).

Analyses

We performed a series of logistic models in which depressed mood and generalized anxiety were regressed on personal encounters with the police, controlling for sociodemographic characteristics and health status indicators. We also regressed our outcome variables on the frequency of worrying about police brutality: anticipation of police brutality, controlling for all covariates. We included interactions between police encounters and race/ethnicity and between anticipation of police brutality and race/ethnicity to assess whether race/ethnicity moderated the relationships between police encounters, anticipation of police brutality, and depression and anxiety. We computed predicted probabilities of depressed mood and generalized anxiety to further interpret associations with significant interactions effects.

Results

Characteristics of the sample are presented in Table 1. As shown, more than half of the respondents reported personally

Table 1. Descriptive Statistics by Exposure to Police Brutality.

No Negative Negative Encounter Negative Encounter

Encounter Necessary Not Necessary Total

(n = 1,892 [43.14%]) (n = 1,348 [30.73%]) (n = 1,146 [26.13%]) (n = 4,386)

	%	n	%	n	%	n	%	n
Depressed mood	25.2	477	36.3	489	42.7	490	33.2	1,456
Generalized anxiety	25.4	482	37.4	504	42.0	482	33.4	1,468
Anticipation of police brutality Never	78.3	1,414	63.3	852	40.3	462	63.5	2,728
Sometimes	17.1	309	25.9	349	41.7	478	26.4	1,136
Always	4.6	83	10.7	145	18.0	206	10.0	434
Total	100	1,806	100	1,346	100	1,146	100	4,298
Race and ethnicity Non-Hispanic White	65.8	1,244	68.0	916	55.1	631	63.6	2,791
Non-Hispanic Black	13.3	251	11.8	159	18.6	213	14.2	623
Hispanic/Latinx	9.9	188	11.7	158	14.3	164	11.6	510
American Indian/Alaska Native	0.9	17	1.4	19	2.2	25	1.4	61
Asian	5.3	100	2.5	33	3.0	34	3.8	167
Other/multiple	4.9	92	4.7	63	6.9	79	5.3	234
Total	100	1,892	100	1,348	100	1,146	100	4,386
Age category (y) 18–24	19.9	377	16.6	224	21.2	243	19.24	844
25–34	24.3	460	29.8	402	30.45	349	27.61	1,211
35–44	17.9	338	23.7	319	22.77	261	20.93	918
45–54	12.8	243	15.0	202	13.61	156	13.7	601
55–64	11.3	213	9.1	122	8.81	101	9.94	436
≥65	13.8	261	5.9	79	3.14	36	8.57	376
Total	100.0	1,892	100.0	1,348	100	1,146	100	4,386
Gender Male	23.8	450	26.7	360	26.18	300	25.31	1,110
Female	73.7	1,394	70.6	951	69.46	796	71.61	3,141
Fluid	2.5	48	2.7	37	4.36	50	3.08	135
Total	100.0	1,892	100.0	1,348	100	1,146	100	4,386
Level of education No high school	5.9	112	7.0	94	8.73	100	6.98	306
High school or GED	25.1	475	22.1	298	29.23	335	25.26	1,108
Some college associate degree, technical/vocational school	41.1	777	50.4	679	45.03	516	44.96	1,972
Bachelor’s degree or higher	27.9	528	20.6	277	17.02	195	22.8	1,000
Total	100.0	1,892	100.0	1,348	100	1,146	100	4,386
Employment status Not in the labor force	37.6	668	29.0	386	29.44	335	32.69	1,389
Unemployed, looking for work	13.2	234	9.9	132	13.8	157	12.31	523
Working part-time	14.3	254	16.5	220	16.78	191	15.65	665
Working full-time for pay	35.0	623	44.6	594	39.98	455	39.35	1,672
Total	100.0	1,779	100.0	1,332	100	1,138	100	4,249
Activity limitations No	66.8	1,230	49.0	660	53.58	614	57.76	2,504
Yes	33.2	612	51.0	687	46.42	532	42.24	1,831
Total	100.0	1,842	100.0	1,347	100	1,146	100	4,335
Self-reported general health Excellent	15.2	286	15.1	204	11.69	134	14.25	624
Very good	30.0	566	26.7	360	24.35	279	27.52	1,205
Good	33.8	637	33.2	448	35.43	406	34.05	1,491
Fair	16.7	315	19.5	263	22.08	253	18.98	831
Poor	4.3	81	5.4	73	6.46	74	5.21	228
Total	100.0	1,885	100.0	1,348	100	1,146	100	4,379

Table 2. Bivariate Odds of Depressed Mood and Generalized Anxiety by Experiences of Police Brutality.

Depressed Mood

Generalized Anxiety

Personal encounter with police (reference: no negative encounter)

Negative necessary encounter 1.68 *** .13 1.74 ** .13

Negative unnecessary encounter 2.21 *** .17 2.12 *** .16

Frequency of worrying about police brutality (reference: never)

Sometimes 1.64

Always 2.36

Note: OR = odds ratio.

**p ≤ .01. ***p ≤ .001.

having negative encounters with the police, and 1 in 4 felt that negative police actions toward them were unnecessary. Although 10 percent of the sample always worried that they would become victims of police brutality, 6 in 10 never had such worries. Non-Hispanic Whites made up 63.6 percent of the sample, non-Hispanic Black respondents were 14.2 percent, Hispanic/Latinxs made up 11.6 percent, and American Indians and Alaskan Natives were 1.4 percent. Almost 4 percent were Asians, and 5.3 percent reported more than one racial category or another race not listed in the survey. One third of the respondents met the cutoff for depressed mood, and one third also met the cutoff for generalized anxiety. The sample was disproportionately female, and more than half had attended some college or obtained college degrees. About one third of the respondents were not in the labor force, but the majority worked for pay either full-time or part-time. Most of the respondents reported good, very good, or excellent general health, and 4 in 10 were somewhat limited in the kinds of activities they performed because of mental, physical, or emotional problems.

Table 2 shows bivariate (unadjusted) associations between encounters with the police and the mental health outcomes of interest and between anticipation of police brutality and odds of depression and anxiety. Compared with persons with no negative encounters with the police, those who reported negative but necessary encounters with the police had significantly greater odds of meeting criteria for depressed mood (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.45–1.96), and odds of depressed mood were highest among those who reported police encounters that were negative and unnecessary (OR = 2.21, 95% CI = 1.89–2.59). Similarly, unadjusted odds of depressed mood were higher among those who sometimes worry about police brutality (OR = 1.64, 95% CI = 1.42–1.89) compared with their counterparts who never worry about police brutality and highest among respondents who always worry about police brutality (OR = 2.36, 95% CI = 1.97–2.81). We also examined bivariate relationships between police brutality and generalized anxiety. As shown, negative encounters with police, whether perceived as necessary (OR = 1.74, 95% CI = 1.50–2.03) or unnecessary (OR = 2.12, 95% CI = 1.81–2.48), were associated with greater odds of depressed mood. We observed the same patterns with anticipation of police brutality. Unadjusted odds of generalized anxiety were higher among those who sometimes worry about police brutality (OR = 1.66, 95% CI = 1.42–1.90) compared with their counterparts who never worry about police brutality and highest for those who always worried about police brutality (OR = 2.54, 95% CI = 2.12–3.02).

Table 3 shows the adjusted relationships between police encounters and odds of depressed mood. In model 1, we explored the relationship between individual exposure to police brutality and depressed mood, controlling for sociodemographic and health characteristics of respondents. Respondents who had negative personal experiences with the police had greater odds of depressed mood compared with those who reported no negative encounters. Specifically, compared with persons without negative encounters, those who had experienced police brutality even though they evaluated these actions as necessary had 37 percent greater odds of depressed mood (OR = 1.37, 95% CI = 1.15–1.62). The odds among those who evaluated police actions as unnecessary were 73 percent greater than those with no exposure to police brutality (OR = 1.73, 95% CI = 1.45–2.07). Race and ethnicity and education were not associated with depressed mood. However, compared with persons between the ages of 18 and 24, those 35 and older had lower odds of depressed mood. Gender-fluid individuals were more likely to have a depressed mood compared with men, and odds of depressed mood were higher among unemployed persons compared with persons not in the work force.

In model 2, we removed individual encounters with the police and added anticipation of police brutality. Compared with respondents who never worried about police brutality, odds of depressed mood were higher among those who sometimes worried about police brutality (OR = 1.32, 95% CI = 1.11–1.56) and highest among those who always worried that they or someone close to them would be a victim of police brutality (OR = 2.13, 95% CI = 1.68–2.70). The relationships between the covariates and depressed mood in model 2 were like those in model 1, except for education. In model 2, having some college education or higher was

Table 3. Adjusted Odds of Depressed Mood by Experiences of Police Brutality, Controlling for Covariates.

OR	Model 1 p	SE	OR	Model 2 p	SE		Model 3
						OR	p	SE
Personal encounter with police (reference: no negative encounter)
Negative necessary encounter 1.37	*******	.12				1.30	**	.11
Negative unnecessary encounter 1.73 Anticipation of police brutality (reference: never)	*******	.15				1.56	*******	.14
Sometimes				1.32	*******	.11	1.19	**	.10
Always Race and ethnicity (reference: White)				2.13	*******	.25	1.87	*******	.32
Non-Hispanic Black	.97		.10	.89		.09	.82		.09
Hispanic/Latinx	.98		.11	.87		.10	.88		.10
American Indian/Alaska Native	1.14		.33	1.12		.32	1.08		.31
Asian	.94		.19	.84		.17	.87		.17
Other/multiple Age category (y) (reference: 18–24)	.90		.15	.83		.14	.81		.13
25–34	.83		.08	.87		.07	.84		.08
35–44	.80	*	.09	.85		.08	.82		.09
45–54	.65	*******	.08	.70	**	.09	.68	**	.08
55–64	.33	*******	.05	.37	*******	.05	.36	*	.06
≥65 Gender (reference: male)	.23	*******	.05	.25	*******	.05	.25	*******	.06
Female	1.16		.11	1.15		.06	1.19	*	.10
Fluid Education (reference: no high school)	1.87	**	.38	1.83	*******	.15	1.85	**	.38
High school or GED	.91		.13	.91		.13	.91		.13
Some college/associate degree, technical/vocational school	.75		.10	.75	*	.11	.76		.11
Bachelor’s degree or higher	.71		.11	.68	*	.11	.71		.11
Employment status (reference: not in labor force)
Unemployed, looking for work 1.94	*******	.21	1.76	*******	.21	1.76	*******	.21
Working part-time .99		.12	1.01		.12	.98		.12
Working full-time 1.11		.10	1.13		.11	1.10		.10
Limitations (reference: none) 3.22 Self-rated health (reference: excellent)	*******	.24	3.12	*******	.23	3.11	*******	.23

Very good .87 .11 .91

Good 1.35 *** .16 1.46

Fair 2.15 *** .23 2.34 Poor 5.22 *** 1.02 5.55

Note: OR = odds ratio.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

associated with lower odds of depressed mood. In model 3, we included both individual encounters with the police and anticipation of police brutality. Both variables were significantly associated with depressed mood, but the effects were slightly less than when the variables were included independently. Odds of depressed mood were greater among women and gender-fluid persons compared men. As in model 1, education was not associated with depressed mood.

In Table 4, we show associations between police brutality and generalized anxiety. Model 1 indicates that having a negative but perceived necessary encounter with the police was associated with higher odds of anxiety (OR = 1.43, 95% CI = 1.20–1.70), and these odds were even greater if the encounter was perceived to be unnecessary (OR = 1.72, 95% CI = 1.44–2.04). Asians had slightly lower odds of anxiety compared with Whites. Persons 35 and older had greater odds of anxiety compared with those ages 18 to 24. Being unemployed, having an activity limitation, and having poor overall health were all associated with greater odds of anxiety. As shown in model 2, the anticipation of police brutality was associated with greater odds of anxiety. Compared with respondents who were never concerned about police brutality, respondents who sometimes worried that they would be victims of police brutality had 40 percent

Table 4. Adjusted Odds of Generalized Anxiety by Experiences of Police Brutality, Controlling for Covariates.

OR	Model1 p	SE	OR	Model 2 p	SE		Model 3
						OR	p	SE
Personal encounter with police (reference: no negative encounter)
Negative necessary encounter 1.43	*******	.12				1.35	**	.11
Negative unnecessary encounter 1.72 Anticipation of police brutality (reference: never)	*******	.15				1.51	*******	.14
Sometimes				1.40	*******	.12	1.28	**	.11
Always Race and ethnicity (reference: White)				2.38	*******	.28	2.11	*******	.26
Non-Hispanic Black	.85		.09	.67	*******	.07	.68	**	.08
Hispanic/Latinx	.88		.11	.76	*	.88	.77	**	.09
American Indian/Alaska Native	.88		.26	.84		.24	.81		.23
Asian	.63	*	.13	.55	**	.12	.57	*******	.12
Other/multiple Age category (y) (reference: 18–24)	.90		.14	.79		.13	.77	*******	.12
25–34	1.02		.10	1.08		.08	1.05		.08
35–44	.74	*	.08	.80	*	.08	.77	*	.08
45–54	.60	*******	.07	.67	**	.10	.65	**	.24
55–64	.32	*******	.05	.36	*******	.11	.36	*******	.12
≥65 Gender (reference: male)	.18	*******	.04	.21	*******	.14	.21	*******	.12
Female	1.13		.1	1.13		.10	1.17		.10
Fluid Education (reference: no high school)	1.42		.29	1.37		.28	1.39		.28
High school or GED	1.09		.15	1.09		.15	1.10		.16
Some college/associate degree, technical/vocational school	1.01		.14	1.02		.15	1.03		.15
Bachelor’s degree or higher	1.11		.17	1.09		.17	1.12		.18
Employment status (reference: not in labor force)
Unemployed, looking for work 1.32	*	.16	1.35	*	.16	1.35	*	.16
Working part-time 1.03		.12	1.04		.12	1.02		.12
Working full-time .90		.07	.92		.09	.89		.08
Limitations (reference: none) 3.10 Self-reported health (reference: excellent)	*******	.27	3.13	*******	.23	3.06	*******	.23

Note: OR = odds ratio.

*p ≤ 0.05. **p ≤ 0.01. ***p ≤ 0.001.

greater odds of generalized anxiety (OR = 1.40, 95% CI = 1.18–1.66). Those who always worried about police brutality had more than two times greater odds of anxiety compared with those who never worried about police brutality (OR = 2.38, 95% CI = 1.87–3.01). Other than race, whereby Black and Latinx respondents, in addition to Asians, had lower odds of anxiety compared with White respondents, the associations of other covariates with odds of generalized anxiety were similar in model 2 as in model 1. In model 3, both individual encounters with the police and stressful anticipation of police brutality were significantly associated with greater odds of anxiety. The relationships between

other covariates and anxiety in model 3 were similar as in model 2 except for race, for which persons who belong to the multiple/other racial category had lower odds of anxiety compared with Whites.

Interaction effects from a fully adjusted model that includes an interaction between race/ethnicity and personal encounters with the police are shown in Table 5. The only significant interaction categories were Black and perceived necessary negative police encounter (OR = 1.89, 95% CI = 1.12–3.19), Latinx and perceived necessary police encounter (OR = 2.63, 95% CI = 1.53–4.52), and Latinx and perceived unnecessary encounter (OR = 1.72, 95% CI = 1.01–2.97).

Very good .92 .14 .98

Good 1.40 *** .16 1.55

Fair 2.23 *** .28 2.46

Poor 3.63 *** .67 4.01

Table 5. Adjusted Odds of Depressed Mood in Model with Police Encounter and Race Interactions.

Encounter with Police

Race/

Ethnicity

Negative encounter necessary
Black	1.89**	.50
Latinx	2.63***	.72
American Indian/Alaska Native	.71	.53
Asian	.88	.43
Other/multiple	1.26	.51
Negative encounter not necessary

Black 1.43

Latinx 1.72**

American Indian/Alaska Native

Asian

Other/multiple

Note: odds ratio. **p .01. ***p .001.

To ease interpretation, we plotted predicted probabilities of depressed mood from the model that included significant interactions. As shown in Figure 1, it is possible that having an encounter that is perceived as necessary (compared with having no negative encounter) increases the probability of depressed mood for Latinx and Black respondents relative to White respondents. And having an encounter that is perceived as not necessary (compared with having no encounter) might significantly increase the probability of depressed mood among Latinxs relative to Whites. Among those with no negative encounters with the police, odds of depressed mood were higher among White than among Black and Latinx respondents. Interactions between personal encounters with the police and race/ethnicity for predicting generalized anxiety were not significant. Similarly, interactions between stressful anticipation of police brutality and race for predicting both depressed mood and generalized anxiety were not significant.

Discussion

Negative encounters with the police are stressors that are associated with poor mental health outcomes. One mechanism that connects these encounters with mental health is trauma. The trauma from experiencing police brutality, like any other form of violence, can directly cause distressing and upsetting emotions, including sadness, anxiety, fear, anger, hypervigilance, and feelings of worthlessness, or hopelessness. People who experience violence and trauma can also feel disconnected to others and might not want to participate in activities they previously enjoyed (Briere and Hedges 2010; May and Wisco 2016). Police brutality might be particularly harmful for mental health because it is state sanctioned, police officers are ubiquitous, there is usually little or no accountability for harm caused by the police, and victims have little or no chances of obtaining justice (DeVylder, Fedina, and Link 2020).

Negative police encounters can also be associated with depression and anxiety indirectly because they worsen other social circumstances, including material conditions, which then increase risks for poor mental health. For example, negative experiences with the police might cause impairment of day-to-day functioning in social roles including employment and productivity. These encounters might also lead to loss of financial resources in legal battles or medical bills, all of which matter for mental health. Therefore, police brutality exacerbates the stressful conditions of everyday life among populations that are already disproportionately exposed to negative encounters with the police.

Regardless of whether people perceive police actions to be necessary, it matters for mental health. In some of the most publicized cases of police brutality, there has been public debate about whether the actions of the police were necessary. For example, it was questionable whether Officer Darren Wilson needed to fire his weapon 12 times at Michael Brown, shooting him a total of 6 times, or that Wilson believed that Brown looked like a demon and was going to kill him (Calamur 2014). To some police officers, courts, and members of the public, police violence is justified when the lives of others, including officers, are at risk (Harmon 2008; Holmes, Painter, and Smith 2019). We do not debate the necessity of police actions in this article, although we believe that police actions that dehumanize others constitute brutality. Instead, we highlight the findings from our analysis that harmful police actions are associated with poor mental health even if victims themselves think of these actions as justified. And when perceived as unnecessary, the impact of police action on mental health is magnified.

0.2

0.25

0.3

0.35

0.4

0.45

No negave encounter

Negave encounter

necessary

Negave encounter not

necessary

PROBABLITY OF DEPRESSED

MOOD

PERSONAL EXPOSURE TO POLICE BRUTALITY

White

Black

Hispanic/Lanx

Nave American

Asian

Other/Mulple

Figure 1. Predicted probabilities of depressed mood by race/ethnicity and police encounters.

Our hypothesis that the anticipation of police brutality matters for mental health beyond personal exposure to police brutality was supported. Those who were often stressed about the possibility that they could become victims of police brutality had greater odds of depressed mood and generalized anxiety compared with persons who never worried about police brutality. This finding is consistent with those from a study among Black pregnant women in Atlanta (Jackson, James, and Owens, 2017). The authors found that the anticipation of negative encounters between youth and police increased the odds of antenatal depression and that this effect was exacerbated among women who already had young children at home. Similarly, avoiding the police because of forecasted negative encounters was associated with depressive symptoms among Black men in Washington, D.C. (Bowleg et al. 2020). The anticipation of experiencing a stressor results from both group and individual circumstances, social conditions, statuses, and identities that increase the likelihood of stress exposure (DeAngelis 2020; Grace 2020; Pearlin and Bierman 2013). Living in a context in which exposure to police brutality is likely or anticipated matters for individual well-being even if individuals themselves are not personally exposed. For example, multilevel analyses suggest that living in a neighborhood where police frequently use force and where police stops are more likely to result in frisking is associated with poor psychological and physical health, regardless of firsthand personal experiences of aggressive policing (Sewell and Jefferson 2016; Sewell et al. forthcoming)

The evaluation and appraisal of stressors is shaped by access to and availability of coping resources and responses (Jones, Cross, and DeFour 2007; Folkman 2013; Thoits 2013). Consequently, persons who frequently worry about police brutality are likely to believe that there is something about their circumstances that puts them at greater risk for experiencing police brutality and that makes it harder for them to cope with such experiences. For instance, one might worry that in addition to potential loss of life that might result from police brutality, the likelihood of nonindictment of the perpetrator may lead to feelings of denied justice, causing further psychological harm and ultimately increasing the stress associated with anticipating negative encounters with the police. We know that adverse physiological and emotional responses are associated with the anticipation of stressors such as discrimination (Sawyer et al. 2012). These responses are likely to be associated with the anticipation of police brutality and consequently with poor mental health, as shown by our analyses.

Racism is a stressor that affects mental health (Clark et al. 1999). Racism is also associated with police brutality (Alang 2018; Boyd 2018; Chaney and Robertson 2013). We found in this research that among those with negative experiences with the police, Black people and Latinxs had greater odds of depressed mood than Whites. This is similar to findings from a panel study showing that exposure to stressors explains more variance in depression symptomatology among Black than among White populations (George and Lynch 2003). Therefore, our finding may reflect disproportionate exposure to police brutality (an indicator of racism) among Black and Latinx respondents relative to Whites. It might also reflect racial differences in the meanings that people give to their experiences with the police. When stressors are attributed to or are grounded in racism, their effects on mental health of populations that experience racism are amplified (Brown 2008). Elevated odds of depressed mood among Black and Latinx respondents compared with White peers who experience police brutality may indicate combined effects of racism and police brutality. However, the reasons we see racial differences in the effects of police encounters on depression but not anxiety are unclear and require further investigation.

Our findings should be considered along with several limitations. First, the nonprobabilistic sampling design of the survey might cause our estimates to be sensitive to systematic errors, as survey respondents might differ from nonrespondents in ways that matter for the generalizability of our findings. The SHUR used quota sampling to match the urban population of the United States by age, race, and ethnicity (Alang et al. forthcoming). This is presumed to reduce some selection biases in a nonprobability sample (Baker et al. 2013). In addition, the current study does not seek to approximate point estimates that are generalizable to urban populations. Instead, we examine relationships between variables. Our findings in this light are noteworthy. Patterns of relationships are likely to be similar in probability and nonprobability samples if the composition of the nonprobability sample matches the composition of the population (Ansolabehere and Schaffner 2014; Blair and Zinkhan 2006; Pasek 2016).

A second limitation is lack of contextual data. Data on the timing, frequency, and causes of police encounters, as well as dimensions of appraisal of encounters such as threat, centrality, racial attributions, and controllability, would have informed our analyses of the relationships between evaluations of encounters with the police and mental health outcomes. Future studies should examine the role contextual characteristics of police encounters play in mental health outcomes.

Third, our data are not longitudinal, and our analyses are not causal. We only measure associations of police brutality with depressed mood and anxiety. It is possible that respondents may have depressive and anxiety symptoms that precede encounters with the police and that are caused by other exposures or sources of stress, such as racism and criminal involvement. Symptoms of depression and anxiety may also expose respondents to police encounters and might increase the frequency of worrying about being a victim of police brutality. We are unable to disentangle these relationships and model mental health outcomes before and after exposure to police brutality using our data. However, previous studies have used several cross-sectional surveys (Yimgang et al. 2017; Bor et al. 2018) and a two-wave survey (Geller, Fagan, and Tyler 2017) to model changes in mental health outcomes after community exposure to police violence and individual police encounters. Their findings suggest that exposure to police brutality leads to worse mental health. Therefore, we believe that higher odds of anxiety and depression among persons who have had negative encounters with the police compared with those who report no negative police encounters in our analyses are caused, in part, by exposure to police brutality.

Finally, there are caveats to conclusions we can make from using interactions in logistic regression models. The assumption that unobserved heterogeneity is similar when we estimate the models across race might not be met, making interpretations of interactions less straightforward (Mood 2010). For example, although higher odds of depression among Black and Latinx respondents with experiences of police brutality can mean that the effect of police brutality on depression is stronger among Black and Latinx persons than among Whites, it can also mean that one or more of our covariates are more important than police brutality for predicting depression among Black and Latinx populations.

Conclusion

Despite the limitations of this study, our findings have important implications. We argue that police encounters are stressors consistent with the stress process paradigm and that exposure to negative police encounters is associated with depressed mood and generalized anxiety. As for most stressors, social structures determine who is likely to be exposed to police brutality, and who is likely to be severely affected. Police brutality is tied to the social experiences of different racial groups, both historically and contemporarily. Being White offers some protection against police use of force (Kahn et al. 2016), signifying that White phenotypic features might be resources to limit exposure to stress. This should alarm us. It should also challenge us to engage theoretically and analytically with stressors (such as police brutality) and resources (such as being White) that have not received sufficient research attention because they are rendered normal, are entrenched in ordinary circumstances, yet create and exacerbate inequities in morbidity and mortality. Future research directions might also include identifying mediators that lie on the pathway between police brutality and poor mental health, as well as moderators that buffer the effects of negative police encounters on mental health.

More important, eliminating police brutality and addressing why anticipating police brutality is associated with both depressed mood and generalized anxiety are also important. That people worry about becoming victims of police brutality reflects vulnerability to police brutality and the severity of its impact. For some Black youth, this is their greatest worry (Smith Lee and Robinson 2019). Black people are disproportionately exposed to police violence when doing the most mundane activities, such as eating ice cream, driving to work, jogging, sleeping, or selling CDs. Victims of police brutality or persons disproportionately at risk for police brutality usually have no control over when they will experience police brutality and how its effects will be resolved. There is agreement among stress researchers that what makes a stressor characteristically chronic is that it is ongoing and open ended (Serido, Almeida, and Wethington 2004; Wheaton 1999). The stressful anticipation of police brutality is indicative of how individuals and communities view the value that the police and the broader society place on their lives. Ultimately, we need to fix systems that have continued to proliferate multiple enduring, overlapping and sometimes relatively unobserved stressors. Policing is one of these systems, and the anticipatory stress of police brutality is completely preventable. So are its effects.

ORCID iDs

Sirry Alang https://orcid.org/0000-0003-2049-5648

Donna McAlpine https://orcid.org/0000-0002-1855-6272

References

Alang, Sirry. 2018. “The More Things Change, the More Things Stay the Same: Race, Ethnicity, and Police Brutality.” American Journal of Public Health 108(9):1127–28.

Alang, Sirry, Donna McAlpine, and Rachel Hardeman. 2020. “Police Brutality and Mistrust in Medical Institutions.” Journal of Racial and Ethnic Health Disparities 7(4):760–68.

Alang, Sirry, Donna McAlpine, Ellen McCreedy, and Rachel Hardeman. 2017. “Police Brutality and Black Health: Setting the Agenda for Public Health Scholars.” American Journal of Public Health 107(5):662–65.

Alang, Sirry, Cynthia Pando, Malcolm McClain, Hasshan Batts, Abby Letcher, Janelle Hager, Taylor Person, et al. Forthcoming.

“Survey of the Health of Urban Residents: A CommunityDriven Assessment of Police Brutality and Conditions Salient to the Health of Populations Marginalized by Structural Inequalities in the United States.” Journal of Racial and Ethnic Health Disparities.

Aneshensel, Carol S. 2015. “Sociological Inquiry into Mental Health: The Legacy of Leonard I. Pearlin.” Journal of Health and Social Behavior 56(2):166–78.

Ansolabehere, Stephen, and Brian F. Schaffner. 2014. “Does Survey Mode Still Matter? Findings from a 2010 Multi-mode Comparison.” Political Analysis 22(3):285–303.

Baker, Reg, J. Michael Brick, Nancy A. Bates, Mike Battaglia, Mick P. Couper, Jill A. Dever, Krista J. Gile, et al. 2013. “Summary Report of the AAPOR Task Force on Non-probability Sampling.” Journal of Survey Statistics and Methodology 1(2):90–143.

Bandes, Susan. 1999. “Patterns of Injustice: Police Brutality in the Courts.” Buffalo Law Review 47:1275.

Barber, Catherine, Deborah Azrael, Amy Cohen, Matthew Miller, Deonza Thymes, David Enze Wang, and David Hemenway.

2016. “Homicides by Police: Comparing Counts from the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports.” American Journal of Public Health 106(5):922–27.

Beymer, Matthew R., Ian W. Holloway, and Christian Grov. 2018. “Comparing Self-Reported Demographic and Sexual Behavioral Factors among Men Who Have Sex with Men

Recruited through Mechanical Turk, Qualtrics, and a HIV/ STI Clinic-Based Sample: Implications for Researchers and Providers.” Archives of Sexual Behavior 47(1):133–42.

Blair, Edward, and George M. Zinkhan. 2006. “Nonresponse and Generalizability in Academic Research.” “Nonresponse and Generalizability in Academic Research,” Journal of the Academy of Marketing Science 34(1):4–7.

Bor, Jacob, Atheendar S. Venkataramani, David R. Williams, and Alexander C. Tsai. 2018. “Police Killings and Their Spillover Effects on the Mental Health of Black Americans: A Population-Based, Quasi-experimental Study.” The Lancet 392(10144):302–10.

Bowleg, Lisa, Ana del Río-González, Mary Mbaba, Cheriko A. Boone, and Sidney L. Holt. 2020. “Negative Police Encounters and Police Avoidance as Pathways to Depressive Symptoms Among US Black Men, 2015–2016.” American Journal of Public Health 110(Suppl. 1):S160–66.

Boyd, Rhea W. 2018. “Police Violence and the Built Harm of Structural Racism.” The Lancet 392(10144):258–59.

Briere, John, and Monica Hedges. 2010. “Trauma Symptom Inventory.” In The Corsini Encyclopedia of Psychology, edited by I. B. Weiner and W. E. Craighead. Hoboken, NJ: John Wiley.

Brown, Tony N. 2008. “Race, Racism, and Mental Health: Elaboration of Critical Race Theory’s Contribution to the Sociology of Mental Health.” Contemporary Justice Review 11(1):53–62.

Bui, Anthony L., Matthew M. Coates, and Ellicott C. Matthay. 2018. “Years of Life Lost Due to Encounters with Law Enforcement in the USA, 2015–2016.” Journal of Epidemiology and Community Health 72(8):715–18.

Calamur, Krishnadev. 2014. “Ferguson Documents: Officer Darren Wilson’s Testimony.” National Public Radio, November 25. Retrieved February 17, 2021. https://www.npr.org/sections/ thetwo-way/2014/11/25/366519644/ferguson-docs-officer darren-wilsons-testimony.

Chaney, Cassandra, and Ray V. Robertson. 2013. “Racism and Police Brutality in America.” Journal of African American Studies 17(4):480–505.

Clark, Rodney, Norman B. Anderson, Vernessa R. Clark, and David R. Williams. 1999. “Racism as a Stressor for African

Americans: A Biopsychosocial Model.” American Psychologist 54(10):805–16.

Cooper, Hannah, Lisa Moore, Sofia Gruskin, and Nancy Krieger. 2004. “Characterizing Perceived Police Violence: Implications for Public Health.” American Journal of Public Health 94(7):1109–18.

Cooper, Hannah L. F. 2015. “War on Drugs Policing and Police Brutality.” Substance Use & Misuse 50(8–9):1188–94.

DeAngelis, Reed T. 2020. “Striving While Black: Race and the Psychophysiology of Goal Pursuit.” Journal of Health and Social Behavior 61(1):24–42.

DeVylder, Jordan E., Courtney Cogburn, Hans Y. Oh, Deidre Anglin, Melissa Edmondson Smith, Tanya Sharpe, Hyun-Jin Jun, et al. 2017. “Psychotic Experiences in the Context of Police Victimization: Data From the Survey of Police–Public Encounters.” Schizophrenia Bulletin 43(5):993–1001.

DeVylder, Jordan E., Jodi J. Frey, Courtney D. Cogburn, Holly C. Wilcox, Tanya L. Sharpe, Hans Y. Oh, Boyoung Nam, et al. 2017. “Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA.” Journal of Urban Health 94(5):629–36.

DeVylder, Jordan, Lisa Fedina, and Bruce Link. 2020. “Impact of Police Violence on Mental Health: A Theoretical Framework.” American Journal of Public Health 110(11):1704–10.

English, Devin, Lisa Bowleg, Ana Maria del Río-González, Jeanne M. Tschann, Robert P. Agans, and David J. Malebranche. 2017. “Measuring Black Men’s Police-Based Discrimination Experiences: Development and Validation of the Police and Law Enforcement (PLE) Scale.” Cultural Diversity and Ethnic Minority Psychology 23(2):185.

Fedina, Lisa, Bethany L. Backes, Hyun-Jin Jun, Roma Shah, Boyoung Nam, Bruce G. Link, and Jordan E. DeVylder. 2018. “Police Violence among Women in Four U.S. Cities.” Preventive Medicine 106:150–56.

Feldman, Justin M., Jarvis T. Chen, Pamela D. Waterman, and Nancy Krieger. 2016. “Temporal Trends and Racial/ Ethnic Inequalities for Legal Intervention Injuries Treated in Emergency Departments: US Men and Women Age 15–34, 2001–2014.” Journal of Urban Health 93(5):797–807.

Folkman, Susan. 2013. Stress: Appraisal and Coping. New York: Springer.

Geller, Amanda, Jeffrey Fagan, and Tom Tyler. 2017. “Police Contact and Mental Health.” Columbia Public Law Research Paper No. 14-571. Retrieved January 3, 2020. https://ssrn.com/ abstract=3096076.

Geller, Amanda, Jeffrey Fagan, Tom Tyler, and Bruce G. Link. 2014. “Aggressive Policing and the Mental Health of Young Urban Men.” American Journal of Public Health 104(12):2321–27.

George, Linda K., and Scott M. Lynch. 2003. “Race Differences in Depressive Symptoms: A Dynamic Perspective on Stress Exposure and Vulnerability.” Journal of Health and Social Behavior 44(3):353–69.

Grace, Matthew K. 2020. “Status Variation in Anticipatory Stressors and Their Associations with Depressive Symptoms.” Journal of Health and Social Behavior 61(2):170–89.

Harmon, Rachel A. 2008. “When Is Police Violence Justified?” Northwestern University Law Review 102:1119.

Holmes, Malcolm D., Matthew A. Painter, and Brad W. Smith. 2019. “Race, Place, and Police-Caused Homicide in US Municipalities.” Justice Quarterly 36(5):751–86.

Jackson, Fleda Mask, Sherman A. James, and Tracy Curry Owens.

2017. “Anticipated Negative Police-Youth Encounters and Depressive Symptoms among Pregnant African American Women: A Brief Report.” Journal of Urban Health 94(2): 259–65.

Jones, Hollie L., William E. Cross, Jr., and Darlene C. DeFour. 2007. “Race-Related Stress, Racial Identity Attitudes, and Mental Health among Black Women.” Journal of Black Psychology 33(2):208–31.

Kahn, Kimberly Barsamian, Phillip Atiba Goff, J. Katherine Lee, and Diane Motamed. 2016. “Protecting Whiteness: White Phenotypic Racial Stereotypicality Reduces Police Use of Force.” Social Psychological and Personality Science 7(5):403–11.

Kroenke, Kurt, Robert L. Spitzer, and Janet B. W. Williams. 2003. “The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener.” Medical Care 41(11):1284–92.

Kroenke, Kurt, Robert L. Spitzer, Janet B. W. Williams, Patrick O. Monahan, and Bernd Löwe. 2007. “Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection.” Annals of Internal Medicine 146(5):317–25.

Kwate, Naa Oyo A., and Melody S. Goodman. 2015. “CrossSectional and Longitudinal Effects of Racism on Mental Health among Residents of Black Neighborhoods in New York City.” American Journal of Public Health 105(4):711–18.

Lee, Hedwig, and Margaret Takako Hicken. 2016. “Death by a Thousand Cuts: The Health Implications of Black Respectability Politics.” Souls 18(2–4):421–45.

Louie, Patricia, and Blair Wheaton. 2019. “The Black-White Paradox Revisited: Understanding the Role of Counterbalancing Mechanisms during Adolescence.” Journal of Health and Social Behavior 60(2):169–87.

Mallory, Christy, Amira Hasenbush, and Brad Sears. 2015. “Discrimination and Harassment by Law Enforcement Officers in the LGBT Community.” The Williams Institute, University of California, Los Angeles. Retrieved December 31, 2020. https://escholarship.org/content/qt5663q0w1/qt5663q0w1_ noSplash_68b80ce3636746d6c945b5a2e66d03f2.pdf.

May, Casey L., and Blair E. Wisco. 2016. “Defining Trauma: How Level of Exposure and Proximity Affect Risk for Posttraumatic Stress Disorder.” Psychological Trauma: Theory, Research, Practice, and Policy 8(2):233–40.

McCauley, Erin J. 2017. “The Cumulative Probability of Arrest by

Age 28 Years in the United States by Disability Status, Race/ Ethnicity, and Gender. American Journal of Public Health 107(12):1977–81.

McLeod, Jane D. 2012. “The Meanings of Stress Expanding the Stress Process Model.” Society and Mental Health 2(3): 172–86.

McLeod, Melissa N., Daliah Heller, Meredith G. Manze, and Sandra E. Echeverria. 2020. “Police Interactions and the Mental Health of Black Americans: A Systematic Review.” Journal of Racial and Ethnic Health Disparities 7(1):10–27.

Miller, Ted R., Bruce A. Lawrence, Nancy N. Carlson, Delia Hendrie, Sean Randall, Ian R. H. Rockett, and Rebecca S. Spicer. 2017. “Perils of Police Action: A Cautionary Tale from US Data Sets.” Injury Prevention 23(1):27–32.

Mood, Carina. 2010. “Logistic Regression: Why We Cannot Do What We Think We Can Do, and What We Can Do about It.” European Sociological Review 26(1):67–82.

Nix, Justin, Bradley A. Campbell, Edward H. Byers, and Geoffrey Alpert. 2017. “A Bird’s Eye View of Civilians Killed by Police in 2015: Further Evidence of Implicit Bias.” Criminology & Public Policy 16(1):309–40.

Pasek, Josh. 2016. “When Will Nonprobability Surveys Mirror Probability Surveys? Considering Types of Inference and Weighting Strategies as Criteria for Correspondence.” International Journal of Public Opinion Research 28(2): 269–91.

Pearlin, Leonard I. 1989. “The Sociological Study of Stress.” Journal of Health and Social Behavior 30(3):241–56.

Pearlin, Leonard I., Carol S. Aneshensel, and Allen J. LeBlanc. 1997. “The Forms and Mechanisms of Stress Proliferation: The Case of AIDS Caregivers.” Journal of Health and Social Behavior 38(3):223–36.

Pearlin, Leonard I., and Alex Bierman. 2013. “Current Issues and Future Directions in Research into the Stress Process.” Pp. 325–40 in Handbook of the Sociology of Mental Health, edited by C. S. Aneshensel, J. C. Phelan, and A. Bierman. New York: Springer.

Pearlin, Leonard I., Elizabeth G. Menaghan, Morton A. Lieberman, and Joseph T. Mullan. 1981. “The Stress Process.” Journal of Health and Social Behavior 22(4):337–56.

Pearlin, Leonard I., Scott Schieman, Elena M. Fazio, and Stephen C. Meersman. 2005. “Stress, Health, and the Life Course: Some Conceptual Perspectives.” Journal of Health and Social Behavior 46(2):205–19.

Ross, Cody T. 2015. “A Multi-level Bayesian Analysis of Racial Bias in Police Shootings at the County-Level in the United States, 2011–2014.” PLoS ONE 10(11):e0141854.

Sawyer, Pamela J., Brenda Major, Bettina J. Casad, Sarah S. M. Townsend, and Wendy Berry Mendes. 2012. “Discrimination and the Stress Response: Psychological and Physiological Consequences of Anticipating Prejudice in Interethnic Interactions.” American Journal of Public Health 102(5): 1020–26.

Serido, Joyce, David M. Almeida, and Elaine Wethington. 2004. “Chronic Stressors and Daily Hassles: Unique and Interactive Relationships with Psychological Distress.” Journal of Health and Social Behavior 45(1):17–33.

Sewell, Abigail A., and Kevin A. Jefferson. 2016. “Collateral Damage: The Health Effects of Invasive Police Encounters in New York City.” Journal of Urban Health 93(1):42–67.

Sewell, Abigail A., Kevin A. Jefferson, and Hedwig Lee. 2016. “Living Under Surveillance: Gender, Psychological Distress, and Stop-Question-and-Frisk Policing in New York City.” Social Science & Medicine 159:1–13.

Sewell, Alyasah Ali, Justin M. Feldman, Rashawn Ray, Keon L. Gilbert, Kevin A. Jefferson, and Hedwig Lee. Forthcoming. “Illness Spillovers of Lethal Police Violence: The Significance of Gendered Marginalization.” Ethnic and Racial Studies.

Smith Lee, Jocelyn R., and Michael A. Robinson. 2019. “‘That’s My Number One Fear in Life. It’s the Police’: Examining Young Black Men’s Exposures to Trauma and Loss Resulting from Police Violence and Police Killings.” Journal of Black Psychology 45(3):143–84.

Thoits, Peggy A. 2006. “Personal Agency in the Stress Process.” Journal of Health and Social Behavior 47(4):309–23.

Thoits, Peggy A. 2013. “Self, Identity, Stress, and Mental Health.” Pp. 357–77 in Handbook of the Sociology of Mental Health, edited by C. S. Aneshensel, J. C. Phelan, and A. Bierman. New York: Springer.

Turner, R. Jay, and Donald A. Lloyd. 1999. “The Stress Process and the Social Distribution of Depression.” Journal of Health and Social Behavior 40(4):374–404.

Turner, R. Jay, Donald A. Lloyd, and John Taylor. 2006. “Physical Disability and Mental Health: An Epidemiology of Psychiatric and Substance Disorders.” Rehabilitation Psychology 51(3):214–23.

Turner, R. Jay, Blair Wheaton, and Donald A. Lloyd. 1995. “The Epidemiology of Social Stress.” American Sociological Review 6(1):104–25.

Wheaton, Blair. 1994. “Sampling the Stress Universe.” Pp. 77– 114 in Stress and Mental Health: Contemporary Issues and Prospects for the Future, edited by W. R. Avison and I. H. Gotlib. New York: Springer.

Wheaton, Blair. 1999. “The Nature of Stressors.” Pp. 176–97 in A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems, edited by A. V. Horwitz and T. L. Scheid. Cambridge, UK: Cambridge University Press.

Williams, David R., Yan Yu, James S. Jackson, and Norman B. Anderson. 1997. “Racial Differences in Physical and Mental Health: Socio-economic Status, Stress and Discrimination.” Journal of Health Psychology 2(3):335–51.

Yimgang, Doris P., Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black. 2017. “Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms.” American Journal of Public Health 107(9):

1455–62.

Author Biographies

Sirry Alang is an associate professor of sociology and health, medicine, and society at Lehigh University. Her research examines the role of social structures and institutions in shaping health over the life course. Her work has appeared in journals such as Society & Mental Health, American Journal of Public Health, Social Science & Medicine, and Health Services Research.

Donna McAlpine is a medical sociologist and an associate professor in the division of health policy and management at the University of Minnesota School of Public Health. Her research focuses on alcohol, drug, and mental health care and racial and ethnic disparities in health outcomes and treatment. Her recent work has appeared in the Journal of Health and Social Behavior, Society & Mental Health, and Medical Care.

Malcolm McClain is a recent graduate of Lehigh University’s MA program in sociology. He is interested in how city-level structural conditions shape local policies and how these policies shape the well-being of populations. His work has appeared in the Journal of Racial and Ethnic Health Disparities.