3 - (SYM 16) State of the Science of Structural Stigma and LGBTQ+ Health: Meta-analytic Evidence, Research Gaps, and Future Directions

Abstract Body
Over the past two decades, shifts in laws, policies, and social attitudes toward LGBTQ+ populations have provided an opportunity to empirically assess the health consequences of structural stigma. This talk synthesizes findings from two major reviews: a meta-analysis quantifying the health impact of LGBTQ+ structural stigma (Lattanner et al., 2024) and a narrative review assessing methodological gaps and research trends from this literature (Hatzenbuehler et al., 2024). Together, these works provide a comprehensive evaluation of the evidence linking structural stigma to LGBTQ+ health outcomes. The evidence indicates that structural stigma is consistently linked to increased risk for mental health disorders, substance use, and adverse physical health among LGBTQ+ people, with an effect size comparable to established structural risk factors such as income inequality, racial residential segregation, and neighborhood socioeconomic deprivation. However, critical gaps remain that must be addressed to inform effective and evidence-based multilevel intervention approaches. First, few studies have examined potential moderators or formally tested mediators of the effects of LGBTQ+ structural stigma on health. Second, most research has focused on distal geographic contexts (e.g., state and national levels), with less attention to LGBTQ+ structural stigma operating in more proximal institutional and geographic contexts (e.g., universities, workplaces, counties). Third, current measures have assessed structural forms of stigma that are common across LGBTQ+ individuals, necessitating measures that capture structural factors unique to LGBTQ+ subgroups. Finally, although measuring LGBTQ+ structural stigma objectively has methodological strengths, there has been limited focus on measuring individual perceptions of structural stigma—a psychological mechanism defined as the belief that one’s rights, opportunities, and inclusion within society are restricted due to the laws, policies, and normative climate of the social environment (Lattanner et al., 2021). Addressing these gaps is crucial for developing and implementing structural interventions and targeted cognitive-behavioral therapies to reduce stigma-related LGBTQ+ health disparities.