Listed below are some of the ongoing projects in our lab.
(1) Structural Stigma and Mental Health
It has long been recognized that stigma exists at multiple levels, ranging from intrapersonal processes (e.g., internalized stigma) and interpersonal interactions (e.g., victimization) to structural factors (e.g., laws, institutional practices, and cultural norms). However, psychological research on stigma has focused almost exclusively on intra- and interpersonal stigma processes, despite repeated calls by psychologists (and others) to pay greater attention to structural factors that influence stigma. Our lab has begun to address this gap by introducing a novel structural/contextual approach to the psychological study of stigma. Specifically, we have been interested in documenting how structural forms of stigma—which we define as “societal-level conditions, cultural norms, and institutional policies and practices that constrain the opportunities, resources, and wellbeing of the stigmatized”—affect stigmatized populations, with a particular focus on the mental health consequences of structural stigma. We have triangulated evidence across a range of: (a) outcomes (e.g., psychiatric morbidity, suicide attempts, psychological distress); (b) measures of structural stigma (e.g., social policies, exposure to negative media campaigns during voter referendum); (c) stigmatized groups (e.g., sexual minorities, ethnic minorities); and (d) methodological approaches (i.e., observational, quasi-experimental, and laboratory designs). Having established this main effect relationship between structural stigma and mental health, we are now interested in examining several new research questions. For instance, what are the biological, psychological, and social mediators of the association between structural stigma and psychopathology? What factors protect members of stigmatized groups against the negative mental health consequences of exposure to structural stigma? What new measurement approaches can we incorporate from “big data” sources to reliably capture structural stigma? How do various levels of structural stigma (e.g., state, county, municipality) interrelate to produce adverse outcomes among the stigmatized? How can structural stigma theory and evidence advance intersectionality research? We are currently addressing these and other questions through a range of funded projects that use both existing datasets as well as data from a new, longitudinal, population-based sample that we are collecting called the National Survey of Stigma and Sexual Health.
- Flores, A.R., Hatzenbuehler, M.L., & Gates, G.J. (2018). Identifying psychological responses of stigmatized groups to referendums. Proceedings of the National Academy of Sciences (PNAS), 115, 3816-3821.
- Raifman, J., Moscoe, E., Austin, S.B., Hatzenbuehler, M.L., & Galea, S. (2018). State laws permitting denial of services to same-sex couples and mental distress among sexual minority adults: A difference-in-difference-in-differences analysis. JAMA Psychiatry, 75, 671-677.
- Hatzenbuehler, M.L., Prins, S.J., Flake, M., Philbin, M., Frazer, S., Hagen, D., & Hirsch, J. (2017). Immigration policies and mental health morbidity among Latinos: A state-level analysis. Social Science & Medicine, 174, 169-178.
- Hatzenbuehler, M.L. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71, 742-751.
- Hatzenbuehler, M.L., & McLaughlin, K.A. (2014). Structural stigma and hypothalamic–pituitary–adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Annals of Behavioral Medicine, 47, 39-47.
(2) Biopsychosocial Mechanisms Linking Stigma-Related Stress and Psychopathology
In addition to studying stigma at the structural level, we are interested in understanding the mental health consequences of individual and interpersonal stigma processes, and in identifying the mechanisms through which these processes contribute to psychopathology. To address this question, we developed and tested a theoretical model, published in Psychological Bulletin, that identifies the psychological (e.g., emotion regulation, self-schemas) and social (e.g., isolation) mechanisms through which stigma-related stress contributes to psychopathology. Although this model was originally developed to study sexual minority stigma, it has been expanded to elucidate psychosocial mechanisms explaining the stigma-health association for members of other stigmatized groups, including weight-related stigma. In one project currently funded by the National Institute of Mental Health, we are creating a new prospective, representative cohort of sexual minority and heterosexual young adults ages 18-34 in order to more robustly evaluate our model. We are administering an online battery of self-report and behavioral/implicit measures of internalizing psychopathology and of proposed psychosocial mechanisms (e.g., negative self-schemas, attentional threat bias, social avoidance) for four years annually. We are also collecting biomarkers that will capture stress-sensitive inflammatory and immune processes (C-reactive protein, IL-6, TNFa) implicated in internalizing psychopathology. This investigation permits one of the most comprehensive tests to date of how biopsychosocial mechanisms operate independently and synergistically to explain relationships between stigma and mental health.
- Hatzenbuehler, M.L., Lattanner, M.R., Dodge, B., Bo, N., & Tu, W. (under review). Mechanisms linking stigma and depression in a longitudinal, population-based study of gay men: An integration of three theoretical models.
- Hatzenbuehler, M.L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707-730.
- Hatzenbuehler, M.L., Nolen-Hoeksema, S., & Dovidio, J. (2009). How does stigma “get under the skin”? The mediating role of emotion regulation. Psychological Science, 20, 1282-1289.
(3) Psychological Interventions to Reduce Stigma-Based Mental Health Inequalities
In another line of work, we are interested in drawing on the insights from our basic research to inform the development and evaluation of psychological interventions that reduce stigma-based mental health inequalities. One unique aspect of the model that we developed (mentioned above) is that it provided the theoretical framework that led to the development of an intervention, called ESTEEM (Effective Skills to Empower Effective Men), which targets the psychosocial mechanisms that link stigma to adverse mental and behavioral health outcomes. Our pilot data, supported by a grant from the NIMH (R34 MH096607; PI: Pachankis), indicated initial efficacy of the intervention, which became the first evidence-based psychosocial treatment that reduces the mental health sequelae of stigma-related stress among sexual minorities by addressing the psychosocial mechanisms that I identified in the model. I am currently a Co-Investigator on an R01 grant from the NIMH (MH109413; PI: Pachankis) that is testing this intervention in a large randomized controlled trial.
- Pachankis, J.E., McConocha, E.M., Reynolds, J., Winston, R., Adeyinka, O., Eldahan, A., Harkness, A., Behari, K., Sullivan, T.J., Esserman, D., Hatzenbuehler, M.L., & Safren, S.A. (2019). Project ESTEEM: A randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health. BMC Public Health, 19, 1086.
- Pachankis, J.E., Hatzenbuehler, M.L., Rendina, H.J., Safren, S. A., & Parsons, J. T.(2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83, 875-889.
(4) Context Effects on Psychotherapy Interventions: The Role of Structural Stigma in Undermining Intervention Efficacy
Integrating these two lines of research on structural stigma and on mental health interventions has led us to ask the following question: Might structural stigma undermine the efficacy of psychotherapy interventions among the stigmatized? Answering this question not only has implications for the stigma literature, but also for the broader field of psychotherapy research. Indeed, one of the most pressing issues in psychotherapy is understanding treatment effect heterogeneity—that is, identifying for whom, and under what conditions, mental health is improved among those who receive the intervention. To date, studies have focused almost exclusively on the identification of individual (e.g., gender, race) and study-specific (e.g., type of treatment modality) characteristics that moderate intervention efficacy. Consequently, it remains largely unknown whether contextual features of the broader social environment in which therapies occur amplify or undermine intervention efficacy. Our current research is focused on addressing this gap by focusing on structural stigma as one contextual factor that may explain heterogeneity in responses to mental health interventions. In two recent studies, we used a spatial meta-analysis of psychotherapy trials among youth and showed that girls and African American youth living in communities with higher (vs. lower) levels of sexism and racism, respectively, derived less benefit from psychotherapy. In another methodological approach, we are using data from the ESTEEM randomized controlled trial mentioned above to determine whether prior exposure to structural stigma is associated with reduced intervention efficacy among sexual minorities. Together, these findings raise new questions that we hope to explore regarding how to augment mental health interventions in high-stigma contexts, even as we continue to target structural stigma at its source.
- Price, M., Weisz, J.R., McKetta, S., Ford, J.V., Lattanner, M.R., Skov, H., Wolock, E., & Hatzenbuehler, M.L. (under review). Structural sexism moderates efficacy of psychological therapy for girls: Results from a spatial meta-analysis.
- Price, M., Weisz, J.R., McKetta, S., Lattanner, M.R., Skov, H., Wolock, E., & Hatzenbuehler, M.L. (in preparation). Psychotherapy interventions among African American youth are less effective in communities with high levels of racial prejudice.
- Hatzenbuehler, M.L., Safren, S.A., & Pachankis, J.E. (in preparation). Structural stigma and the efficacy of a mental health intervention among sexual minority young adults: Results from a randomized controlled trial.
- Hatzenbuehler, M.L., & Pachankis, J.E. (in preparation). Where and for whom should mental and behavioral health interventions be adapted for minority group members? Insights from stigma research.
(5) Context Effects on Neural Development
The approach that we have used to study structural stigma provides a template for addressing questions that psychologists have begun to ask regarding whether contextual (i.e., structural) factors influence brain development. One of the methodological challenges to evaluating this question is that most neuroimaging studies are conducted in one (or a small number) of communities. In such designs, respondents are similarly exposed to the same macro-social context, precluding the possibility of linking contextual variation with neural outcomes. We have capitalized on two recent methodological advancements that have enabled us to begin to address this limitation. The first is the use of a large-scale, collaborative neuroimaging study conducted across numerous sites that provide variation in social context: the Adolescent Brain and Cognitive Development Study. In a paper from this sample, we showed that African American and U.S.-born Latinx youth in higher structural stigma environments have smaller hippocampal volume, controlling for demographics and family socioeconomic status. Because these multi-site neuroimaging studies are currently rare, it is necessary to employ additional strategies for studying contextual factors in neuroscience. Thus, in a second approach, we are using spatial meta-analyses—which capitalize on the distribution of studies across communities that differ in the contextual variable of interest—in order to explore contextual influences (e.g., social safety net, prejudice) on neural outcomes. Together, our findings are beginning to suggest that contextual approaches may yield new insights into social determinants of brain development.
- Hatzenbuehler, M.L., Weissman, D.G., McKetta, S., Lattanner, M.R., Ford, J.V., Barch, D.M., & McLaughlin, K.A. (under review). Altered neural development among children raised in stigmatizing contexts.
- Hatzenbuehler, M.L., McLaughlin, K.A., & Cikara, M. (in preparation). Methodological and conceptual considerations in studying contextual influences on neurodevelopment: Advancing the emerging subfield of contextual cognitive neuroscience.
(6) Contextual Approaches to Understanding and Reducing Bias-Based Bullying
Bias-based bullying—defined as attacks motivated by a victim’s actual or perceived membership in a socially marginalized group—is a common experience among youth. For instance, data from the 2008 California Healthy Kids Study (CHKS) found that 40% of youth reported bias-based bullying related to sexual orientation, race/ethnicity, religion, gender, or physical/mental disability in the past 12 months. Bias-based bullying is also associated with more adverse mental health outcomes than bullying that is not due to bias. For instance, youth in the CHKS who reported experiencing bias-based bullying were two times more likely to report past-year depression than youth who reported bullying that was unrelated to bias. However, there is limited research into the factors that predict bias-based bullying, especially at the contextual level, as well as the factors that might reduce it. Our work has begun to address these questions. In one study, we used a quasi-experimental design in a sample of nearly 5 million youth to examine the effects of a voter referendum (Proposition 8, which restricted marriage to heterosexuals in California) on homophobic bullying among youth. We documented accelerated rates of homophobic bullying in California during Proposition 8, even as trends in other types of bullying related to race/ethnicity, religion, and gender declined. This study provides some of the first empirical evidence that voter referendums that promote stigma confer risk for bias-based bullying among youth. In a follow-up project currently funded by the William T. Grant Foundation, we are examining whether litigation—a commonly used structural approach for addressing stigma-related harms—can effectively reduce bias-based bullying among youth, and whether there may be unintended consequences to the use of litigation.
- Hatzenbuehler, M.L., Shen, Y., Vandewater, E.A., & Russell, S.T. (2019). Proposition 8 and homophobic bullying in California. Pediatrics, 143, e20182116.
- Hatzenbuehler, M.L., McKetta, S., Kim, R., Leung, S., & Russell, S.T. (in preparation). Can litigation reduce bias-based bullying among youth? Evidence from a quasi-experimental study.