Probable depression and suicidal ideation in Hong Kong amid massive civil unrest.

PURPOSE: This study examined prevalence and correlates of probable depression and suicidal ideation among Hong Kong Chinese residents amidst the anti-extradition bill protests. METHODS: Random digit dialing recruited a population-representative sample of Hong Kong residents aged 15 years or older during the first three weeks of July, 2019. Respondents reported current depressive symptoms and suicidal ideation, participation in protest activities, attitudes and perceived stress, disruptions to daily routines, and demographics. RESULTS: Among 1112 respondents, 25.7% reported probable depression, and 9.1% reported suicidal ideation. Multivariable logistic regression showed that persons with higher odds of probable depression had primary education and high disruptions to regular routines of eating, sleep, socializing, and leisure activities. Persons who were at higher odds of suicidal ideation had lower household income, used social media to engage in the protests, and had medium or high disruptions to regular eating and sleep. CONCLUSIONS: During the anti-extradition bill protests, the prevalence of probable depression and suicidal ideation were substantially higher than would be expected and higher than during the Umbrella Movement of 2014. Psychiatric morbidity may be a consequence of massive social movements, particularly among persons with limited protective resources whose daily life is disrupted by these events.

On order and disorder during the COVID-19 pandemic.

In this paper, we analyse the conditions under which the COVID-19 pandemic will lead either to social order (adherence to measures put in place by authorities to control the pandemic) or to social disorder (resistance to such measures and the emergence of open conflict). Using examples from different countries (principally the United Kingdom, the United States, and France), we first isolate three factors which determine whether people accept or reject control measures. These are the historical context of state-public relations, the nature of leadership during the pandemic and procedural justice in the development and operation of these measures. Second, we analyse the way the crisis is policed and how forms of policing determine whether dissent will escalate into open conflict. We conclude by considering the prospects for order/disorder as the pandemic unfolds.

Stress-Related Outcomes after a Period of Unrest in Two Low-Income African American Communities.

We examined the association of civil unrest with potentially stress-related outcomes among two low-income, African American communities in Baltimore following the death of Freddie Gray in police custody and whether neighborhood proximity to unrest moderated these associations. We leveraged data from a cross-sectional survey of randomly selected households in two public housing communities (n=342) collected before, during, and after the civil unrest (August 2014 to August 2015). We used multivariate regression to explore the association of unrest with depressive symptoms and elevated blood pressure adjusting for potential confounders and community attributes. After the 2015 civil unrest event in Baltimore, those living in a low-income community near the epicenter demonstrated higher rates of depressive symptoms, but not elevated blood pressure, compared with those living in a comparable neighborhood three miles away. Low-income communities in Baltimore could benefit from mental health services after periods of civil unrest.

Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study.

BACKGROUND: Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. METHODS: In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist-Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. FINDINGS: After the two baseline surveys, we followed up random subsets of 1213-1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8-12·7) of participants in 2019, compared with 1·9% (1·6-2·1) during 2009-14 and 6·5% (5·3-7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2-14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. INTERPRETATION: We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally. FUNDING: Research Grants Council, University Grants Committee of Hong Kong, Hong Kong Jockey Club Charities Trust.

The effects of political protests on youth human capital and well-being in Egypt.

Protests are one of the most common expressions of modern political conflict, and the wave of demonstrations that marked the onset of the Arab Spring contributed to a global increase in protest activity. Yet few studies have examined the effects of exposure to protests on population well-being even though such exposure may have profound and lasting effects, especially if experienced at critical stages of development over the life course. The aim of our study is to estimate the effects of exposure to political protests on the human capital accumulation and well-being of youth during the tumultuous political transition experienced in Egypt from 2011 to 2014. For a nationally representative panel of youth captured in the 2009 and 2013/2014 waves of the Survey of Young People in Egypt (SYPE), we exploit exogenous geospatial variation in the occurrence of political protests from the Armed Conflict Location & Event Data (ACLED) Project to estimate individual-level changes in social trust, uncertainty, education, and health outcomes for youth exposed to protests. In our panel, 31.1% of the sample lived in districts where riots or protests occurred. Exposure to protests increased overall perceptions of uncertainty about the future. Young men ever exposed to protests were slightly more likely to report good overall health, but experienced sizable worsening in mental health compared to young women ever exposed. Differences by own and family participation in protest events were found for perceptions of uncertainty and mental health. In the aftermath of the Arab Spring and other mass protest movements around the globe, these findings highlight the importance of examining the population-level impacts of different forms of political conflict, particularly as substantial numbers of youth in Middle East and North Africa and elsewhere progress to adulthood under conditions of political instability.

Axiological-Identitary Collective Action Model (AICAM): A new integrative perspective in the analysis of protest.

Current predictive models of collective action have devoted little attention to personal values, such as morals or ideology. The present research addresses this issue by incorporating a new axiological path in a novel predictive model of collective action, named AICAM. The axiological path is formed by two constructs: ideology and moral obligation. The model has been tested for real normative participation (Study 1) and intentional non-normative participation (Study 2). The sample for Study 1 included 531 randomly selected demonstrators and non-demonstrators at the time of a protest that took place in Madrid, May 2017. Study 2 comprised 607 randomly selected participants who filled out an online questionnaire. Structural equation modelling analysis was performed in order to examine the fit and predictive power of the model. Results show that the model is a good fit in both studies. It has also been observed that the new model entails a significant addition of overall effect size when compared with alternative models, including SIMCA. The present research contributes to the literature of collective action by unearthing a new, independent path towards collective action that is nonetheless compatible with previous motives. Implications for future research are discussed, mainly stressing the need to include moral and ideological motives in the study of collective action engagement.

Civil conflict, domestic violence, and poverty as predictors of corporal punishment in Colombia.

BACKGROUND: With lingering effects from more than 50 years of war, young children in Colombia are exposed to multiple risk factors such as poverty, civil conflict, and domestic violence. In addition to these environmental stressors, public and legal support for corporal punishment remains high, which is shown by the high prevalence of young children exposed to corporal punishment in Colombia. OBJECTIVE: The purpose of this study is to identify individual, family, and municipality-level predictors of corporal punishment (i.e., hitting with objects and spanking) in Colombia in order to inform prevention and intervention strategies. PARTICIPANTS AND SETTING: We use information gathered in 2015 from a representative sample of 11,759 mothers of children younger than five in Colombia. METHODS: We employed multi-level models to account for the clustering of families in 217 municipalities. RESULTS: Results show that mothers' prior exposure to corporal punishment by their own parents (ß=0.229;p<0.01), attitudes towards domestic violence ß=0.013;p<0.05, municipality homicide rates ß=0.028;p<0.05 and presence of armed groups ß=0.031;p<0.05, household poverty ß=0.030;p<0.01 and poverty of the municipality ß=0.022;p<0.05 predicted mothers' hitting their young children with an object. However, family ß=-0.028;p<0.05 and municipality poverty ß=-0.016;p<0.05 had a negative association with mothers' use of spanking. CONCLUSIONS: These findings suggest that both family and neighborhood level factors have simultaneous associations with parents' use of corporal punishment. Given the accumulating evidence concerning the adverse effects of corporal punishment on child well-being and development, legislative efforts aimed at reducing and ultimately banning corporal punishment are warranted.

Suicidal Risk evolution in Tunisia, five years after the Jasmine Revolution.

INTRODUCTION: Since the revolution of January 2011, there was an increase in suicide and attempted suicide in Tunisia, particularly among young people. AIM: To establish the suicide risk rate evolution eleven years after the SMPG 2005 survey in Tunisia, which was used to estimate the prevalence of suicide risk at 13.9%. METHODS: We reproduce the survey SMPG of 2005. A sample of 300 people representative of Ariana's area was determined by the method of quotas according to gender, age and level of education. The questionnaire consisted of sociodemographic data and the Mini International Neuropsychiatric Interview (M.I.N.I) in its portion suicidal risk. RESULTS: The sex ratio was 1.01. The mean age was 42 ±2.26 years. The prevalence of suicide risk was 22.7%: mild (90%), medium (6%) and high (4%). The suicide risk's prevalence had increased by 8.8% compared to the first survey SMPG in 2005. The suicide risk rate was higher among women (p = 0.01), among the unemployed (0,008) and those with an income below 850 Tunisian Dinar / month (p = 0.01). CONCLUSION: Given the increase in suicide risk between 2005 and 2016, specific preventive measures should be implemented by the Tunisian authorities to reduce this risk.

Trayvon Martin: Racial Profiling, Black Male Stigma, and Social Work Practice.

To address a critical gap in the social work literature, this article examines the deleterious effects of racial profiling as it pertains to police targeting of male African Americans. The authors use the Trayvon Martin court case to exemplify how racial profiling and black male stigma help perpetuate social inequality and injustice for black men. A racism-centered perspective is examined historically and contemporarily as a theoretical approach to understanding the role that race plays in social injustice through racial profiling. Implications for social work research design and practice aimed at increasing the social work knowledge base on racial profiling are discussed. The authors call for attention and advocacy by major social work organizations in the reduction of black male stigma and racial profiling.

Exposure to Trauma and Mental Health Service Engagement Among Adults Who Were Children of the Northern Ireland Troubles of 1968 to 1998.

Northern Ireland is an appropriate region to examine the impact of traumatic experiences, owing to the many years of civil violence that have characterized its recent history, known colloquially as the "Troubles." Given the prominence of traumatic experiences among the aging population of Northern Ireland (NI), an evidence base is required to inform the planning and provision of effective mental health and other services. We analyzed the follow-up interviews (n = 225) of individuals from the Northern Ireland Study of Health and Stress (NISHS), aged 45 years and older, who experienced one or more conflict-related traumatic events. This study demonstrated that in NI traumatic events, such as being involved in an explosion, seeing someone killed or seriously injured, and living in a region of terror were most likely to be related to the Troubles. However, event types that we had not previously known to be related to conflict (such as the sudden death of a loved one), were also often related to the Troubles. Two-thirds of participants (67.1%) reported exposure to a Troubles-related event, and 57.8% reported being a civilian in a region of terror. The vast majority (85.9%) of participants who experienced a Troubles-related trauma never sought help, despite 59.1% meeting the criteria for a lifetime mental disorder. The reasons for not seeking help and sources of help are outlined. Policy makers must address Troubles-related mental health effects, in terms of how they carry forward into aging, and consider ways of improving engagement with services and treatments.

Experiencing Civil Unrest: Elder Voices on Ferguson.

Ferguson, Missouri became the center of the nation's attention when an unarmed African American teenager was killed by a Caucasian police officer. Civic unrest continued for weeks. The aim of this study was to learn how older adults experienced the social unrest. Ten focus groups were conducted with 73 participants. Eight themes were identified. Issues related to safety were most commonly discussed. Participants reported a breakdown in intergenerational communications and expressed a desire for more exchange. Findings are being discussed with relevant organizations to increase the involvement of older adults in on-going community development efforts and to provide opportunities for intergenerational dialogue.

Senseless Violence Against Central American Unaccompanied Minors: Historical Background and Call for Help.

The southwestern U.S. border has recently seen a significant increase in the number of unaccompanied children from Honduras, Guatemala, and El Salvador illegally crossing the Mexican border into the United States. Many of these children leave home to flee violence, starvation, impoverished living conditions, or other life-threatening situations. The treatment of acute stress, anxiety, and depression associated with traumatic events is crucial in helping these children address these negative psychological events they have experienced so that they can move forward with their lives. Untreated, traumatic events experienced by this population can develop into Post Traumatic Stress Disorder, a potentially life-changing and physically threatening psychological and medical issue. The United States needs to effectively address the serious matter of responding to mental health issues facing refugees from war-torn or impoverished nations so as to help them to successfully adjust to American systems. There is a need for researchers in the mental health field to focus efforts in designing, implementing, and evaluating methodologies that can help these children develop healthy strategies for living with a very difficult and complex past.

How risk perception shapes collective action intentions in repressive contexts: A study of Egyptian activists during the 2013 post-coup uprising.

Social psychological research has overlooked collective action in repressive contexts, where activists face substantial personal risks. This paper examines the social psychological processes motivating activists to engage in collective action in risky contexts. We investigate the idea that perceived risks due to government sanctions can galvanize action through fuelling anger, shaping efficacy beliefs, and increasing identification with the movement. We also argue that anger, efficacy, and identification motivate action intentions directly and indirectly through reducing the personal importance activists attach to these risks. We tested our hypotheses within a sample of Egyptian activists (N = 146) from two protest movements who protested against Morsi's government and the military interventions, respectively, during the 2013 anticoup uprising. In line with our hypotheses, the perceived likelihood of risks was positively associated with anger and identity consolidation efficacy and positively predicted action intentions indirectly through these variables. Risk was also associated with increased political efficacy, but only among antimilitary protesters. Anger and political efficacy predicted action intentions directly and indirectly through reduced risk importance. Results also highlighted differential significance of emotional and instrumental motives for the two protest movements. We discuss directions for future research on the motivators of collective action in repressive contexts.

Baltimore's Unrest: Perspectives From Public Health and Emergency Physician Leaders.

The tragic April 19, 2015, death of an African American man injured while in police custody spurred several days of protest and civil unrest in Baltimore City. This article outlines the opportunity and role for a local health department during civil unrest, from the perspective of 2 emergency physicians who also led the Baltimore City Health Department through these recent events. Between April 27 and May 8, 2015, the Health Department was a lead agency in the unrest response and recovery activities. Similar to an emergency medical situation, a "public health code" is proposed as a model for centralizing, reacting to, and debriefing after situations of civil unrest.

The Role of Public Health in Responding to and Recovering from Civil Unrest: Baltimore's Experience.

The death of an African-American man, injured while in police custody, led to protests and several days of civil unrest in Baltimore City beginning on April 27, 2015. This article discusses the role of the Baltimore City Health Department, during and after the initial protests and civil unrest, as the lead agency for ESF-8 response. We review and share initial response actions, short-term recovery operations, long-term recovery efforts, and lessons learned.

Causality in criminal forensic and in civil disability cases: Legal and psychological comparison.

Causality (or causation) is central to every legal case, yet its underlying philosophical, legal, and psychological definitions and conceptions vary. In the criminal context, it refers to establishing the responsibility of the perpetrator of the criminal act at issue in terms of the person's mental state (mens rea), and whether the insanity defense applies. In the forensic disability and related context, it refers to whether the index event is a material or contributing cause in the multifactorial array that led to the psychological condition at issue. In both the criminal and tort contexts, the legal test is a counterfactual one. For the former, it refers to whether the outcome involved would have resulted absent the act (e.g., in cases of simultaneous criminal lethal action, which one is the but-for responsible one). For the latter, it concerns whether the claimed psychological condition would be present only because of the incident at issue. The latter event at issue is distinguished from the criminal one by its negligence compared to the voluntary intent in the criminal case. The psychological state of the perpetrator of criminal conduct can be analyzed from a biopsychosocial perspective as much as the civil one. In this regard, in the civil case, such as in forensic disability and related assessments, pre-existing, precipitating, and perpetuating factors need to be considered causally, with personal and social resilience and protective factors added, as well. In the criminal context, the same biopsychosocial model applies, but with mental competence and voluntariness added as a critical factor. The advent of neurolaw has led to use of neuroscience in court, but it risks reducing the complexity of criminal cases to unifactorial, biological models.

Major depressive disorder seven years after the conflict in northern Uganda: burden, risk factors and impact on outcomes (The Wayo-Nero Study).

BACKGROUND: Major depressive disorder (MDD) is a major public health burden in conflict areas. However, it is not known for how long and by how much the observed high rates of MDD seen in conflict settings persist into the post-conflict period. METHODS: A cross sectional survey was employed seven years after the conflict in northern Uganda had ended in the three districts of Amuru, Gulu and Nwoya. RESULTS: The prevalence of major depressive disorder (MDD) was 24.7% (95% CI: 22.9%-26.4%). The distribution by gender was females 29.2% (95% CI: 14.6%-19.5%) and males 17.0% (95% CI: 26.9%-31.5%). The risk factors for MDD fell under the broad domains of socio-demographic factors (female gender, increasing age, being widowed and being separated/divorced); distal psychosocial vulnerability factors ( being HIV positive, low social support, increasing war trauma events previously experienced, war trauma stress scores previously experienced, past psychiatric history, family history of mental illness, negative coping style, increasing childhood trauma scores, life-time attempted suicide, PTSD, generalized anxiety disorder and alcohol dependency disorder) and the psychosocial stressors (food insufficiency, increasing negative life event scores, increasing stress scores). 'Not receiving anti-retroviral therapy' for those who were HIV positive was the only negative clinical and behavioral outcome associated with MDD. CONCLUSIONS: These findings indicate that post-conflict northern Uganda still has high rates for MDD. The risk factors are quite many (including psychiatric, psychological and social factors) hence the need for effective multi-sectoral programs to address the high rates of MDD in the region. These programs should be long term in order to address the long term effects of war. Longitudinal studies are recommended to continuously assess the trends of MDD in the region and remedial action taken.