Highly public anti-Black violence is associated with poor mental health days for Black Americans

IntroductionAdequate sleep is vital for maintaining mental and physical health. In the United States, a substantial proportion of adults report sleep durations that fall outside the recommended range. Prior research has associated insufficient or excessive sleep with adverse health outcomes; however, few studies have systematically quantified these associations across multiple health indicators using nationally representative data.ObjectiveThis study aims to evaluate the impact of short sleep duration on four key health outcomes: depression diagnosis, number of self-reported poor mental health days, number of physically unhealthy days, and self-rated general health status, using nationally representative U.S. data.Methodology: MethodsWe analyzed nationally representative data from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2016 and 2023. Sleep duration was self-reported and categorized into three groups: short sleep (≤5 hours), recommended sleep (6–8 hours), and long sleep (≥9 hours), with short sleep serving as the reference category. The primary health outcomes included: (1) self-reported diagnosis of depression, (2) number of poor mental health days, (3) number of poor physical health days, and (4) self-rated general health, measured on a 5-point Likert scale from excellent to poor. To estimate the effect of sleep duration on these outcomes, we applied Inverse Probability Weighting (IPW) to derive the Average Treatment Effect (ATE), adjusting for key demographic and socioeconomic covariates. All analyses incorporated BRFSS complex survey weights to ensure national representativeness.ResultsThe study included 318,000 adults (63.3% female; 74.5% White) with a mean age of 51.3 ± 18.4 years. Among individuals with recommended sleep duration (6–8 hours), the baseline prevalence of depression was 39.5% (95% CI: 39.4%–39.7%). Compared to this group, short sleep duration (≤5 hours) was associated with a 14.1 percentage point increase in depression incidence (95% CI: 13.8%–14.4%), while long sleep duration (≥9 hours) was linked to a 12.9 percentage point increase (95% CI: 12.5%–13.3%). Those with short sleep reported an average of 5.3 poor mental health days (95% CI: 5.3–5.4), 4.4 poor physical health days (95% CI: 4.3–4.4), and a higher prevalence of poor general health, 10.0% (0.1, 95% CI: 9.7%–10.2%), compared to individuals with recommended sleep. Similarly, individuals with long sleep duration (≥9 hours) also reported more poor mental (4.6 days, 95% CI: 4.5–4.7) and physical health days (3.2 days, 95% CI: 3.1–3.3), along with a higher prevalence of poor general health, 20.3% (20.3%%, 95% CI 19.4%–21.3%) compared to those with recommended sleep.ConclusionBoth short (≤5 hours) and long (≥9 hours) sleep durations are significantly associated with increased risk of depression, more days of poor mental and physical health, and worse self-rated general health compared to recommended sleep (6–8 hours). Promoting optimal sleep duration through targeted public health interventions, education, and screening may improve population well-being and reduce sleep-related health disparities.

Adequate sleep is vital for maintaining mental and physical health. In the United States, a substantial proportion of adults report sleep durations that fall outside the recommended range. Prior research has associated insufficient or excessive sleep with adverse health outcomes; however, few studies have systematically quantified these associations across multiple health indicators using nationally representative data. This study aims to evaluate the impact of short sleep duration on four key health outcomes: depression diagnosis, number of self-reported poor mental health days, number of physically unhealthy days, and self-rated general health status, using nationally representative U.S. data. We analyzed nationally representative data from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2016 and 2023. Sleep duration was self-reported and categorized into three groups: short sleep (≤5 hours), recommended sleep (6-8 hours), and long sleep (≥9 hours), with short sleep serving as the reference category. The primary health outcomes included: (1) self-reported diagnosis of depression, (2) number of poor mental health days, (3) number of poor physical health days, and (4) self-rated general health, measured on a 5-point Likert scale from excellent to poor. To estimate the effect of sleep duration on these outcomes, we applied Inverse Probability Weighting (IPW) to derive the Average Treatment Effect (ATE), adjusting for key demographic and socioeconomic covariates. All analyses incorporated BRFSS complex survey weights to ensure national representativeness. The study included 318,000 adults (63.3% female; 74.5% White) with a mean age of 51.3 ± 18.4 years. Among individuals with recommended sleep duration (6-8 hours), the baseline prevalence of depression was 39.5% (95% CI: 39.4%-39.7%). Compared to this group, short sleep duration (≤5 hours) was associated with a 14.1 percentage point increase in depression incidence (95% CI: 13.8%-14.4%), while long sleep duration (≥9 hours) was linked to a 12.9 percentage point increase (95% CI: 12.5%-13.3%). Those with short sleep reported an average of 5.3 poor mental health days (95% CI: 5.3-5.4), 4.4 poor physical health days (95% CI: 4.3-4.4), and a higher prevalence of poor general health, 10.0% (0.1, 95% CI: 9.7%-10.2%), compared to individuals with recommended sleep. Similarly, individuals with long sleep duration (≥9 hours) also reported more poor mental (4.6 days, 95% CI: 4.5-4.7) and physical health days (3.2 days, 95% CI: 3.1-3.3), along with a higher prevalence of poor general health, 20.3% (20.3%%, 95% CI 19.4%-21.3%) compared to those with recommended sleep. Both short (≤5 hours) and long (≥9 hours) sleep durations are significantly associated with increased risk of depression, more days of poor mental and physical health, and worse self-rated general health compared to recommended sleep (6-8 hours). Promoting optimal sleep duration through targeted public health interventions, education, and screening may improve population well-being and reduce sleep-related health disparities.

Back to table of contents Previous article Next article Association NewsFull AccessStudy Exposes Mental Health Effects of Police Shootings on Black CommunitiesMark MoranMark MoranSearch for more papers by this authorPublished Online:31 Jul 2018https://doi.org/10.1176/appi.pn.2018.7b3AbstractThe adverse mental health effects were not observed among white respondents and resulted only from police killings of unarmed black Americans.Police shootings of unarmed black Americans have adverse effects on the mental health of other black Americans in the general population, according to a study published in the Lancet in June. Exposure to one or more police killings within a three-month period was associated with a 0.35-day increase in poor mental health days, according to the report, which combined data on police shootings with individual-level data from a nationally representative self-report survey on health. Adverse mental health effects were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans).“The observed adverse mental health spillover effects of police killings of unarmed black Americans could result from heightened perceptions of threat and vulnerability, lack of fairness, lower social status, lower beliefs about one’s own worth, activation of prior traumas, and identification with the deceased,” Jacob Bor, Sc.D., of Boston University School of Public Health and colleagues wrote. The report was released just two days after a police officer shot and killed Antwon Rose, an unarmed black teen who was fleeing a traffic stop in Pittsburgh.Bor and colleagues used self-reported race to identify black American respondents to the U.S. Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative telephone survey that collects health data from U.S. adults. Information collected from the 2013-2015 BRFSS was combined with available data on the timing of police killings as reported in the Mapping Police Violence database. This database has tracked police killings in the United States since 2013.The primary exposure was the number of police killings of unarmed black Americans occurring in the three months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which respondents to the survey reported that their mental health was “not good.”A total of 38,993 of the 103,710 black American respondents (49 percent) were exposed to one or more police killings of unarmed black Americans in their state of residence in the months prior to the survey. Each additional police killing of an unarmed black American in the respondent’s state of residence in the months prior to interview was associated with a 0.14-day increase in the number of poor mental health days. “Specifically, our estimates imply that police killings of unarmed black Americans could contribute 1.7 additional poor mental health days per person per year, or 55 million excess poor mental health days per year among black American adults in the [United States],” Bor and colleagues wrote. “Interventions are needed to reduce the prevalence of these killings and to support the mental health of communities affected when they do occur.”Rahn Bailey, M.D., is writing a book about police shootings in the African-American community.Rahn Bailey, M.D., the APA Assembly representative for the Caucus of Black Psychiatrists, told Psychiatric News he believes the study confirms what he and other black psychiatrists have observed anecdotally, both professionally and personally. He is writing a book about the subject of police killings of African Americans. “So many African Americans have the experience of hearing about these incidents that it inevitably starts to color how one thinks about law enforcement,” Bailey said. “The Lancet study is timely and convincing and has real-world impact.”Kimberly Gordon, M.D., president of APA’s Caucus of Black Psychiatrists, said she was only a child when a death from police brutality affected her extended family. “A lot of our patients may have this history of trauma related to vicarious exposure to police brutality,” she said. In an accompanying editorial, Rhea Boyd, M.D., of the Palo Alto Medical Foundation said the findings challenge the notion that health inequities among African Americans are only the delayed products of chronic exposures. Instead, Boyd wrote, Bor and colleagues demonstrate that a single exposure to news about a police killing can have a nearly immediate effect on health. “Their work to acknowledge and address the clinical impact of police killing black Americans sits within a broader clinical imperative to rigorously define and intervene in the relationship between structural racism and clinical outcomes,” she wrote. “This evidence should ignite inquiry into the broader health impacts of police violence and advance the challenge to confront racial health inequities as products of racism.” ■“Police Killings and Their Spillover Effects on the Mental Health of Black Americans: A Quasi-Experimental Study” can be accessed here. The commentary “Police Violence and the Built Harm of Structural Racism” is available here. ISSUES NewArchived

Childhood trauma, including sexual assault (CSA), is a known risk factor for adverse mental health outcomes. This study quantifies the impact of CSA on the likelihood of being diagnosed with depression in adulthood, as well as its influence on poor mental and physical health days. We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) (2016-2023), comprising 321,106 respondents. The primary exposure was self-reported CSA, while the main outcomes were depression diagnosis, poor mental health days, and poor physical health days. Covariates included race, gender, marital status, employment, age, education, state, year, language spoken at home, metropolitan status, and urban residence. We employed Inverse Probability Weighting (IPW) to estimate the Average Treatment Effect (ATE), controlling for confounders and incorporating state and year fixed effects. Sampling weights ensured national representativeness, and robust standard errors accounted for clustering by state. In a matched cohort of 15,150 individuals with CSA and 15,150 controls, the CSA group had an average age of 50.3 ± 16.3 years, with most being White (69.3%) and female (76.7%). CSA was significantly associated with an increased risk of depression diagnosis, with a 22.1 percentage-point increase for those with one CSA experience (ATE = 0.221, 95% CI: 0.192-0.250, p < 0.001) and a 24.4 percentage-point increase for those with multiple CSA experiences (ATE = 0.244, 95% CI: 0.222-0.266, p < 0.001). CSA also impacted mental health. Those with a single CSA exposure reported 2.8 more days of poor mental health per month (ATE = 2.829, 95% CI: 2.096-3.398, p < 0.001), while those with multiple exposures reported 4.2 more days (ATE = 4.175, 95% CI: 3.609-4.740, p < 0.001) compared to controls. Regarding physical health, individuals with one CSA exposure reported 1.5 additional poor physical health days (ATE = 1.538, 95% CI: 0.788-2.289), while those with multiple exposures experienced 2.6 additional days (ATE = 2.587, 95% CI: 1.941-3.232). This study provides robust evidence that CSA significantly increases the likelihood of depression in adulthood and leads to more poor mental and physical health days. The findings underscore the cumulative impact of multiple CSA exposures on health outcomes and emphasize the need for trauma-informed healthcare, early intervention, and public health strategies to mitigate the long-term consequences of CSA.

BackgroundInformal caregiving, a common form of social support, can be a chronic stressor with health consequences for caregivers. It is unclear how varying restrictions during the COVID-19 pandemic affected caregivers’ physical and mental health. This study explores pre-post March 2020 differences in reported days of poor physical and mental health among informal caregivers.MethodsData from the 2019/2020 Behavioral Risk Factor Surveillance System survey were used to match, via propensity scores, informal caregivers who provided care during COVID-19 restrictions to those who provided care before the pandemic. Negative binomial weighted regression models estimated incidence rate ratios (IRRs) and differences by demographics of reporting days of poor physical and mental health. A sensitivity analysis including multiple imputation was also performed.ResultsThe sample included 9,240 informal caregivers, of whom 861 provided care during the COVID-19 pandemic. The incidence rate for days of poor physical health was 26% lower (p = 0.001) for those who provided care during the COVID-19 pandemic, though the incidence rates for days of poor mental health were not statistically different between groups. Informal caregivers with low educational attainment experienced significantly higher IRRs for days of poor physical and mental health. Younger informal caregivers had a significantly lower IRR for days of poor physical health, but higher IRR for days of poor mental health.ConclusionsThis study contends that the physical and mental health burden associated with informal caregiving in a period of great uncertainty may be heightened among certain populations. Policymakers should consider expanding access to resources through institutional mechanisms for informal caregivers, who may be likely to incur a higher physical and mental health burden during public health emergencies, especially those identified as higher risk.

Difference in the physical and mental health of informal caregivers pre- and post-COVID-19 National Emergency Declaration in the United States.

BackgroundTo test the hypothesis that among individuals in the 2020 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional anonymous health survey in the United States (US), after controlling for confounding, an increasing number of poor mental health (MH) days in the past month is associated with increasing odds of delayed oral health (OH) care utilization and poorer OH outcomes.MethodsAdjusted logistic regression models were developed with poor MH days as the exposure to examine the association with two dependent variables (DVs): Most recent dental visit longer than one year ago (yes/no), and having lost 6 or more teeth (yes/no).ResultsApproximately one third (32%) reported most recent dental visit more than one year ago, and 17% had lost 6 or more teeth. Those in the second quartile of poor MH days had 11% higher odds of delayed dental visit, and those in the highest quartile had 26% higher odds, compared to the reference group. For having lost 6 or more teeth, compared to the reference group, those in the third quartile had 8% higher odds and those in the fourth quartile had 18% higher odds.ConclusionsPoor MH days is independently associated with odds of poor OH utilization and OH in the US above and beyond diagnosed mental and physical conditions. Policymakers in the US should expand health insurance plans to include dental insurance, and should increase access to MH care, especially for the aging population, and those with chronic conditions.

Objective: The objective of this study was to examine how functional, mental, and physical health outcomes differ between younger (<age 50) and older (≥age 50) stroke survivors. Methods: Data from adult stroke survivors examined health-related outcomes (physical and mental health) over the past 30 days. Logistic regression models were used for binary functional outcomes, and Poisson regression models were used to estimate count outcomes for poor mental and physical health days. Results: Compared with older adults, younger stroke survivors were more likely to report difficulty concentrating or remembering (41.1% vs. 23.2%, p < 0.0001) and difficulty doing errands alone (27.11% vs. 23.67%, p = 0.00), but less likely to report difficulty walking or climbing stairs (34.3% vs. 47.6%, p < 0.0001). Additionally, younger adults with stroke reported significantly more poor mental health days (10.81 vs. 5.76, p < 0.0001) than older adults. In adjusted models, being out of work or out of the labor force was consistently associated with greater odds of functional limitations (e.g., OR for activity difficulty = 2.07, 95% CI: 1.56–2.75) and higher counts of poor mental and physical health days. Younger stroke survivors who were out of the labor force had significantly greater odds of difficulty concentrating (OR = 2.02, 95% CI: 1.17–3.48) and increased days of poor mental (IRR = 1.27, 95% CI: 1.19–1.70) and physical health (IRR = 1.26, 95% CI: 1.19–1.53). Conclusions: These findings highlight the intersection of age and employment on stroke outcomes. Younger stroke survivors face unique and disproportionate challenges in functional and mental health.

The relationship of physical activity to mental health: A 2015 behavioral risk factor surveillance system data analysis

Caregivers of individuals with Alzheimer’s Disease and Related Dementias (ADRD) experience substantial physical and mental health burdens, often shaped by structural factors such as policy environments. This study examines whether state safety net policies—Medicaid expansion, Medicaid generosity, unemployment benefits, and paid sick leave (PSL)—affect the health of ADRD caregivers, and whether these associations differ by caregiving complexity and sex. We identified ADRD caregivers across 47 states from the U.S. Behavioral Risk Factor Surveillance System (2021–2022; N = 12,025 representing 7,480,376 nationally) and obtained policy data from the State Policy and Politics Database (2020). Outcomes included caregivers’ self-reported poor physical and mental health days in the last month. Negative binomial regression models assessed policy associations with healthy days and tested interactions by caregiving complexity and sex. Northeastern and West Coast states ranked higher in policy generosity, and most Southern and some Midwestern states ranked lower. More generous policies were associated with 0.1-0.5 fewer poor physical and 0.2-0.5 fewer poor mental health days per month among ADRD caregivers, though effects were not statistically significant. Greater Medicaid generosity, unemployment benefits, and PSL were linked to 1–3 and 2–6 fewer days of poor physical and mental health, respectively, among caregivers providing personal care (not significant). However, caregivers providing high care hours without personal care experienced 7–13 more poor mental health days in states with vs. without PSL and Medicaid expansion. No significant sex differences were observed. This suggests targeted state policy efforts are needed to address health risks faced by ADRD caregivers providing high-intensity care.

With the proliferation of anti-transgender policies in some U.S. jurisdictions, this study examines the general, mental, and physical health of transgender and cisgender populations. Data from the 2020-2023 Behavioral Risk Factor Surveillance System were analyzed to examine associations between gender identity and health outcomes. Propensity score weighting was used to address potential imbalances among group characteristics. We conducted logistic regression for the binary outcome of self-rated health and quasi-Poisson regression for the number of days reporting poor mental and physical health. Results reveal significant disparities in health outcomes, with transgender individuals reporting lower proportions of good general health and more days of poor mental and physical health compared to cisgender individuals. In the adjusted analyses, transgender individuals were significantly less likely to report good general health compared to cisgender peers (OR = 0.60, 95% CI = 0.52-0.69). Gender nonconforming (GNC), male-to-female (MTF), and female-to-male (FTM) individuals had lower odds of reporting good general health compared to cisgender individuals (GNC, OR = 0.46, 95% CI = 0.35-0.61; MTF, OR = 0.67, 95% CI = 0.53-0.85; FTM, OR = 0.71, 95% CI = 0.57-0.87). GNC individuals had an 86% higher frequency of poor mental health days (IRR = 1.86, 95% CI = 1.57-2.21) and a 37% higher frequency of poor physical health days (IRR = 1.37, 95% CI = 1.15-1.63) compared to cisgender counterparts. Similarly, MTF and FTM individuals had significantly higher frequencies of poor mental and physical health days. The study highlights significant health disparities faced by transgender individuals, who report poorer general, mental, and physical health. These findings underscore the need to address the unique challenges and improve health outcomes within the transgender community.

In the 2020 Bostock v Clayton County decision, the US Supreme Court extended employment nondiscrimination protection to sexual minority adults. The health impacts of this ruling and similar policies related to sexual orientation-based discrimination are not currently known. To estimate changes in mental health following the Bostock decision among sexual minority adults in states that gained employment nondiscrimination protection (intervention states) compared with those in states with protections already in place (control states). This cross-sectional study used 2018-2022 data from the Behavioral Risk Factor Surveillance System and a difference-in-differences approach to evaluate changes in mental health after the Bostock decision by comparing sexual minority adults (aged ≥18 years and identifying as lesbian, gay, or bisexual) in 12 intervention states with those residing in 9 control states. Models were estimated for all participants and separately for employed participants. Data were analyzed between February and September 2024. Residing in a state that gained employment nondiscrimination protection after the Bostock decision. The primary outcome was number of poor mental health days during the past 30 days, and the secondary outcome was severe mental distress (defined as 14 or more past-month poor mental health days). Of 597 462 participants (306 365 in intervention states [77.7% aged 18-64 years and 22.3% aged ≥65 years; 51.7% female] and 291 097 in control states [77.5% aged 18-64 years and 22.5% aged ≥65 years; 50.6% female]), 5.1% in intervention states and 6.0% in control states self-identified as sexual minority adults. The mean (SE) number of past-month poor mental health days was unchanged after the Bostock decision among sexual minority adults in both intervention (from 8.70 [0.27] to 9.59 [0.24] days; adjusted difference, 0.57 [95% CI, -1.02 to 2.16] days) and control (from 8.53 [0.21] to 10.15 [0.20] days; adjusted difference, 1.17 [95% CI, -0.46 to 2.79] days) states, resulting in no differential change between the 2 groups (difference-in-differences, -0.60 days; 95% CI, -1.25 to 0.06 days). Among the subset of employed sexual minority adults, the mean (SE) number of poor mental health days did not change in intervention states (from 7.99 [0.38] to 8.83 [0.30] days; adjusted difference, 0.87 [95% CI, -0.49 to 2.22] days) but increased in control states (from 7.75 [0.27] to 9.75 [0.26] days; adjusted difference, 1.84 [95% CI, 0.44-3.24] days). These findings corresponded to a significant relative reduction in poor mental health days among employed sexual minority adults in intervention vs control states (difference-in-differences, -0.97 days; 95% CI, -1.74 to -0.21 days). Mean (SE) rates of severe mental distress increased less among employed sexual minority adults in intervention (from 26.35% [1.59%] to 29.92% [1.46%]; adjusted difference, 6.81% [95% CI, 2.20%-11.42%]) vs control (from 26.53% [1.27%] to 34.26% [1.16%]; adjusted difference, 10.30% [95% CI, 5.99%-14.61%) states, also corresponding to a significant relative reduction among employed sexual minority adults (difference-in-differences, -3.49%; 95% CI, -6.71% to -0.27%). These findings show significant relative reductions in past-month poor mental health days and severe mental distress among employed sexual minority adults after the implementation of a federal ban on employment discrimination based on sexual orientation. Larger and more consistent mental health benefits observed among sexual minority adults in the workforce underscore the importance of broadening protections to other social domains.

Symbolic disempowerment and Donald Trump's 2016 presidential election: Mental health responses among Latinx and white populations

Aim:This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.Background:Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.Methods:We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.Findings:Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days – a statistically significant association (AOR: 1.25; 95% CI: 1.09–1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14–1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

The purpose of this study was to determine whether patients receiving care from the Department of Veterans Affairs (VA) reported more mental distress as the war in Iraq began or reintensified compared with other respondents to national health surveys. Data from the 2000 and 2003 Behavioral Risk Factor Surveillance System (BRFSS) health surveys were analyzed. Unlike in other years, these particular surveys asked respondents whether they were military veterans. As in other years' surveys, these surveys also asked whether respondents used VA medical care. Male respondents were stratified by age and separated into three groups: VA patients, other veterans, and nonveterans. The proportions of respondents who reported five or more recent days of poor mental or physical health were analyzed with chi square tests. Although the number of recent days of poor mental health among nonveterans, other veterans, and older VA patients were stable from 2000 to 2003, younger VA patients in 2003 reported substantially more days of poor mental health in two intervals: during the Iraq war buildup and invasion, and later, when resistance on the ground reintensified. Comparable changes in physical health complaints were not observed. In times of war, the VA may anticipate more mental health problems among its current patients, particularly younger veterans.