Police use of force during street protests: A pressing public mental health concern.

Abstract

Street protests are a common means of civic expression and occur across the globe. In the past few years, millions of citizens have attended street protests worldwide. Sometimes however, street protests can constitute significantly stressful and violent contexts. Research has highlighted the physical health impact of street protests due to clashes between protesters and law enforcement or use of CS gas [[1]Dimitroglou Y. Rachiotis G. Hadjichristodoulou C Exposure to the riot control agent CS and potential health effects: a systematic review of the evidence.Int J Environ Res Public Health. 2015; 12: 1397-1411Crossref PubMed Scopus (16) Google Scholar]. In addition, police use of less-lethal weapons, such as rubber pellet launchers, is known to cause severe ocular injuries [[2]Chauvin A. Bourges J.L. Korobelnik J.F Ocular injuries caused by less-lethal weapons in France.Lancet. 2019; 394: 1616-1617Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar]. Besides these physical health effects, research has recently shifted focus on the mental health aspects of streets protests. For instance, the 2019 Hong-Kong anti-extradition bill protests is responsible for increased probable depression and suspected PTSD prevalence rates among the Hong-Kong population [[3]Ni M.Y. Yao X.I. Leung K.S.M. et al.Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study.Lancet. 2020; https://doi.org/10.1016/S0140-6736(19)33160-5Summary Full Text Full Text PDF Scopus (76) Google Scholar]. These mental health consequences were attributed to the stressful context of mass street protests as they happened in Hong-Kong (e.g. lootings). Yet, increased use of force by Hong Kong law enforcement in 2019 (e.g. 16,000 rounds of teargas fired vs. 87 in the Occupy Central protests of 2014 [[4]2,393 students arrested since June; 16,000 rounds of tear gas fired 2019. Available from: https://www.thestandard.com.hk/breaking-news/section/3/138217/2,393-students-arrested-since-June;-16,000-rounds-of-tear-gas-fired [Accessed 23rd January 2020].Google Scholar]), could partly explain the rise in probable PTSD and depression cases. Besides physical health consequences, the traumatic nature of police use of force may have lasting mental health consequences on citizens. Thus, police use of force may constitute a risk factor for public mental health, but the issue remains under-researched. In a recent study conducted among 523 Yellow Vests protesters in France, we assessed self-reported exposure to police violence-related traumas (yes/no items; physical abuse, rubber pellet ammunitions), to other protest-related traumas (e.g. physical injury, custody) as well as post-traumatic stress and depression symptoms [[5]Celebi E. Adam-Troian J. Mahfud Y. Positive links between exposure to police violence, PTSD, and depression symptoms among yellow vests protesters in France.J Interpers Violence. 2020; (Advance Online Publication)PubMed Google Scholar]. Across analyses and despite adjustment on a range of potential confounds (demographics, political orientation, custody and hospitalization) a systematic negative association between exposure to police violence and mental health symptoms was observed. More specifically, compared to non-exposed protesters, those exposed to at least one form of police violence were 1.54 times more likely to suffer from severe depressive symptoms and 2.58 more likely to meet the criteria for a tentative PTSD diagnosis. Therefore, we argue that police use of force during street protests may have mental health consequences for exposed individuals. Epidemiological investigations should be conducted using longitudinal designs to assess whether police use of force is a risk factor for population mental health. Given the prevalence of police use of force during street protests, there could be important implications for public mental health. All authors designed the study and revised the manuscript. JAT and YM collected the data. JAT and EC analysed the data. JAT drafted the manuscript. None. Ethic approval was obtained from Sehir University ethics board (n°29–2019).