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.

Large-Scale Urban Riots and Residential Segregation: A Case Study of the 1960s U.S. Riots.

Despite a well-established literature investigating race-related predictors of riot incidence, the racial aftermath of riots remains unexamined. In this study, I use the 1960s U.S. race riots to investigate trends in black residential segregation levels following large-scale riot activity in seven major U.S. cities. I use a novel approach--namely, synthetic control matching--to select a group of cities against which segregation trends can be compared. I find that levels of black segregation rose in 1970 for four of the seven cities, but these increases disappeared in 1980 and 1990 except in Detroit. These results mask differential trends at lower geographic levels: suburban neighborhoods in affected areas experienced larger and longer-term increases in segregation, particularly in traditionally hypersegregated cities in the Midwest and Northeast.

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.

Enhanced threat detection in experienced riot police officers: cognitive evidence from the face-in-the-crowd effect.

We explored how varying levels of professional expertise in hostile crowd management could enhance threat detection capabilities as assessed by the face in the crowd paradigm. Trainee police officers and more experienced police officers specialized in, and having extensive experience with, riot control, were compared with participants with no experience in hostile crowd management on their search times and accuracy levels in detecting angry and happy face targets against a display of emotional and neutral distractor faces. The experienced officers relative to their trainee counterparts and nonpolice controls showed enhanced detection for threatening faces in both types of display along with a greater degree of inhibitory control over angry face distractors. These findings help to reinforce the ecological validity of the face in the crowd paradigm and provide a new theoretical link for the role of individual differences on the attentional processing of socially relevant stimuli.

Differential effects of exposure to social violence and natural disaster on children's mental health.

Disaster mental health, particularly postdisaster child mental health, is neglected in India. This study compares the impact of a natural disaster versus a spate of communal riots that occurred in Gujarat, India on January 26, 2001, and February 2002 to June 2002, respectively. Children aged 8-15 years from highly exposed earthquake sites (n = 128) and riot sites (n = 171) were approached for participation. A matching control sample of 351 nontrauma-exposed children was sought to compare with the trauma groups. Trauma and postdisaster adversities were studied using the UCLA disaster trauma tool; Goodman's Strengths and Difficulties Questionnaire was used to assess adjustment difficulties. Spearman's correlations were calculated to find associations between trauma items on UCLA's brief trauma scale and Strengths and Difficulties Questionnaire items. Results suggest that 7.6% of the earthquake sample and 38.7% from the riots sample manifested clinically significant mental health problems. The earthquake sample had 24.8% of those above clinical cutoff for probable posttraumatic stress disorder and the riots sample had 27.3% children who displayed posttraumatic stress symptoms. Children exposed to violence were psychologically more affected and in the presence of postdisaster adversities, posttraumatic stress symptoms persisted long term. This finding should enable development of differential psychotherapeutic interventions for children exposed to extreme events.

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 battles­both physical and legal­reveal 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 responses­self-defense, legal redress, and journalists' remonstrations­as 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.

Comparing alternative factor models of PTSD symptoms across earthquake victims and violent riot witnesses in China: evidence for a five-factor model proposed by Elhai et al. (2011).

The present study investigated the factor structure of posttraumatic stress disorder (PTSD) symptoms measured by the PTSD Checklist (PCL) in two large samples exposed to different traumatic events (an earthquake and a violent riot) from China. Despite the samples' difference in type of trauma, demographics, symptom severity, and elapsed time since trauma exposure, the results of a series of confirmatory factor analyses indicate that a five-factor intercorrelated model (intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal) fit the data significantly better than the other alternative models including: the three-factor DSM-IV model, the four-factor numbing model (King et al., 1998), and the four-factor dysphoria model (Simms et al., 2002) in both samples. Implications and limitations regarding the results are discussed.

"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.

Epidemiological characteristics of human stampedes.

OBJECTIVE: The potential for deadly human stampedes to occur at any mass gathering event highlights this unique form of crowd disaster as deserving of special attention from both scientific and planning perspectives. Improved understanding of human stampedes is indispensable in the mitigation of this type of mass casualty. With relatively few peer-reviewed reports on deadly human stampedes, information from news reports and the Internet is essential to increased collective understanding. Without incorporating nontraditional sources, no other way to reasonably acquire sufficient data is available. This study analyzed human stampede events from 1980 to 2007 to identify epidemiological characteristics associated with increased mortality. METHODS: A LexisNexis search was followed by sequential searches of multiple Internet-based English-language news agencies. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Bivariate analyses of number of deaths or injuries were conducted using a nonparametric Wilcoxon rank test. Multivariate regression was performed to determine the factors associated with increased number of fatalities during stampede events. RESULTS: A total of 215 human stampede events were reported from 1980 to 2007, resulting in 7069 deaths and at least 14,078 injuries from 213 events with available fatality information and 179 events with injury information. In bivariate analysis, stampedes occurring in the Middle East, in developing countries, outdoors, or associated with religious events had the highest median number of deaths. In multivariate analysis, events that occurred in developing countries and outdoors were associated with increased number of fatalities. Stampedes that occurred in the context of sports, religious, music, and political events, or that had a unidirectional mechanism, also increased the relative number of deaths. CONCLUSIONS: Several epidemiological features of human stampedes associated with increased mortality are identified. Standardized collection of epidemiological data pertaining to human stampedes is strongly recommended, and further study of this recurrent, distinctive disaster is warranted.