Effect of Awareness of Excessive Use of Force on the Psychological Well-being and Workplace Environment of Emergency Physicians: A Pilot Study

Abstract

Introduction Excessive use of force by law enforcement officers is a critical public health issue linked to serious health consequences such as hypertension, post-traumatic stress disorder (PTSD), and depression. While emergency physicians (EP) are often the first to treat patients with excessive use of force-related injuries, the work-life and psychological toll of witnessing these incidents remains underexplored. In this study, we examine how awareness of and exposure to excessive use of force affects the psychological well-being and professional environment of EPs. Methods An observational cross-sectional survey was developed by EPs and psychiatrists to assess work-life and psychological impacts of awareness of excessive use of force on EPs. The survey included multiple-choice and Likert-scale questions and used the Impact of Event Scale–Revised (IES-R). It was distributed anonymously to EPs at three Texas academic institutions. We used the Fisher exact test and the Wilcoxon rank-sum test to compare groups. Our primary outcome measure was psychological distress, assessed with the IES-R. Secondary outcome measures included self-reported effects of awareness of excessive use of force on subjects’ work environments, patient care, and interactions with law enforcement. Results Of 282 surveys sent to EPs, 43 responded (15%). Eighteen of 40 (45%) reported experiencing work-life impacts and 15 of 40 (37.5%) experienced psychological distress; three did not comment. Abnormal IES-R scores were found in seven (19.6%) of 35 participants; eight did not respond. Participants who noted work-life effects of excessive use of force were more likely than those whose work-life was not affected to report modified patient care approaches (61% vs 0%,< .001), altered interactions with law enforcement (83% vs 0%,< .001), and altered interactions with patients (50% vs 0%,< .001). Psychological distress was more prevalent among participants with personal exposure to excessive use of force compared to those without personal exposure (47% vs 12%,= .02), and among those with second-hand exposure compared to those without second-hand exposure to excessive use of force (80% vs 56%,= .04). Conclusion This pilot study demonstrates that exposure to excessive use of force is associated with psychological distress and professional impact among emergency physicians, influencing interactions with patients and law enforcement. These findings underscore the need for further characterization of the effects of awareness of and exposure to excessive use of force on EPs. This, in turn, may inform institutional interventions and national protocols aimed at mitigating psychological burden, supporting physician resilience, and promoting high-quality, equitable patient care.