Black emergency department visits for schizophrenia/psychosis following the police killing of George Floyd: An empirical test of “protest psychosis”

Abstract

In the United States, there exists a large disparity in the diagnosis of schizophrenia between Black and White individuals. Some of the symptoms associated with schizophrenia, such as agitation, delusions, and non-compliance, were previously linked to a now-discontinued condition known as “Protest Psychosis.” This proposed subtype of schizophrenia diagnosis emerged during the 1950s and 1960s in response to racial tensions during the Civil Rights movement and preceded an increase in schizophrenia diagnosis among Black populations, potentially leading to racial disparities in this psychiatric condition that continue to permeate the modern context.

In May 2020, the police killing of George Floyd sparked widespread protests through the Black Lives Matter Movement. Given the historical precedence of “protest psychosis” in response to the Civil Rights Movement, we examined disparities in Emergency Department (ED) visits diagnosed as schizophrenia/psychosis immediately following the police killing of George Floyd in May 2020. We used monthly data on ED visits from January 2016 to December 2020 across 5 University of California health systems. We used ARIMA (Autoregressive Integrated Moving Average) time-series analysis to derive the residual values of ED visits diagnosed as schizophrenia/psychosis among Black persons and examined whether these residuals increased selectively among Black persons in June 2020. Results from time-series analyses indicate 34 additional ED visits above expected levels diagnosed as schizophrenia/psychosis among Black persons in June 2020 (p < 0.05), amounting to a 25% increase in these visits among Black persons. These results indicate a perpetuation of historical trends and cohere with expectations from the legacy of “Protest Psychosis”.