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ViewAttendees 6

Symposia

LGBTQ+

LGBTQ+ Structural Stigma and Health: Advancing the State of the Science Through New Meta-Analytic, Methodological, and Mechanistic Insights

1 - (SYM 16) LGBTQ+ Structural Stigma and Individual-level Stigma Processes and Interpersonal-level Stigma Experiences: A Meta-analysis

Friday, November 21, 2025
5:06 PM - 5:27 PM CST
Location: Imperial 12, Level 4
Keywords: LGBTQ+, Stigma, Mental Health Disparities
Recommended Readings: Lattanner, M. R., et al. (2024). State of the science of structural stigma and LGBTQ+ health: Meta-analytic evidence, research gaps, and future directions. Annual Review of Public Health. https://doi.org/10.1146/annurev-publhealth-071723-013336,   Hatzenbuehler, M. L., et al. (2024). Structural stigma and LGBTQ+ health: A narrative review of quantitative studies. The Lancet Public Health, 9(2), e109–e127. https://doi.org/10.1016/s2468-2667(23)00312-2,   Ford, J. V., et al. (2024). (Re)conceptualizing structural stigma: Insights from a qualitative study of sexual minority men in a longitudinal, population-based cohort. Stigma and Health. https://doi.org/10.1037/sah0000571,   Hollinsaid, N. L., et al. (2023). Incorporating macro-social contexts into emotion research: Longitudinal associations between structural stigma and emotion processes among gay and bisexual men. Emotion, 23(6), 1796–1801. https://doi.org/10.1037/emo0001198,   Burger, J., & Pachankis, J. E. (2024). State of the science: LGBTQ-affirmative psychotherapy. Behavior Therapy,55(6), 1318–1334. https://doi.org/10.1016/j.beth.2024.02.011
Abstract Body
Scholarship has increasingly evaluated whether structural stigma—defined as societal-level policies, attitudes, and conditions that restrict rights and opportunities—contributes to significant health burdens among LGBTQ+ people. A recent meta-analysis of this literature found an effect size comparable to other well-established social determinants of health at the macro level (e.g., residential segregation). A remaining question, then, is why structural stigma confers this risk. Prominent theories suggest that living in a high-stigma context may activate individual stigma processes and increase exposure to interpersonal stigma. However, research on LGBTQ+ structural stigma and health has rarely tested these mechanisms. Moreover, extant studies are heterogenous with respect to methodological and measurement approaches, limiting generalizability and causal inference.

To begin to address this gap, we systematically identified 58 studies testing associations between structural stigma and individual stigma processes or interpersonal stigma experiences among LGBTQ+ people. As part of an ongoing meta-analysis of these studies, we extracted effect sizes quantifying the strength of these associations as well as candidate moderators including sample and methodological characteristics. Most studies examined identity concealment or self-stigma at the individual level and discrimination or victimization at the interpersonal level. Preliminary extraction efforts generally demonstrated small, positive associations between LGBTQ+ structural stigma and these outcomes, yet null and even negative associations suggest that demographic characteristics (e.g., age, gender, LGBTQ+ identity) may represent key sources of heterogeneity. Methodological limitations included a reliance on cross-sectional designs, convenience samples, and structural stigma measures capturing a single indicator.
These insights offer initial support for theories positing that LGBTQ+ people’s exposure to structural stigma may influence stigma-related processes and experiences, which are linked to adverse health outcomes. Longitudinal, population-based studies—and a wider range of structural stigma measures—are needed to provide more formal tests of whether LGBTQ+ structural stigma confers risk for poor health through these mechanisms. Such work can inform targets of affirmative CBT interventions, particularly for LGBTQ+ people in high-stigma environments, as well as societal efforts to address structural stigma and its sequelae.