Psychological research has provided essential insights into how stigma operates to disadvantage those who are targeted by it. At the same time, stigma research has been criticized for being too ...focused on the perceptions of stigmatized individuals and on microlevel interactions, rather than attending to structural forms of stigma. This article describes the relatively new field of research on structural stigma, which is defined as societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized. I review emerging evidence that structural stigma related to mental illness and sexual orientation (a) exerts direct and synergistic effects on stigma processes that have long been the focus of psychological inquiry (e.g., concealment, rejection sensitivity), (b) serves as a contextual moderator of the efficacy of psychological interventions, and (c) contributes to numerous adverse health outcomes for members of stigmatized groups-ranging from dysregulated physiological stress responses to premature mortality-indicating that structural stigma represents an underrecognized mechanism producing health inequalities. Each of these pieces of evidence suggests that structural stigma is relevant to psychology and therefore deserves the attention of psychological scientists interested in understanding and ultimately reducing the negative effects of stigma.
Psychological research has made significant advancements in the study of stigma but has tended to focus on individual and interpersonal stigma processes. Recently, researchers have expanded the ...stigma construct to consider how broader, macrosocial forms of stigma—termed structural stigma—also disadvantage stigmatized individuals. In this article, I review cross-sectional, quasi-experimental, and longitudinal studies demonstrating that structural stigma is a risk indicator for psychiatric and physical-health morbidities among lesbian, gay, and bisexual populations. As this work is still in its infancy, the next generation of research will benefit from identifying mediators and moderators of the structural stigma–health association and from examining direct and synergistic relationships between structural and individual forms of stigma.
Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific ...minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol-use disorders.
To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.
A ...total of 31 852 11th grade students (1413 4.4% lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.
Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 95% confidence interval: 0.96-0.99).
This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts.
In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss ...different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.
Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full ...significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
Psychological research on stigma has focused largely on the perceptions of stigmatized individuals and their interpersonal interactions with the nonstigmatized. This work has been critical in ...documenting many of the ways in which stigma operates to harm those who are targeted. However, this research has also tended to overlook broader structural forms of stigma, which refer to societal-level conditions, cultural norms, and institutional policies and practices that constrain the lives of the stigmatized. In this article I describe the emerging field of research on structural stigma and review evidence documenting the harmful consequences of structural stigma for the mental/behavioral health of lesbian, gay, and bisexual youth. This research demonstrates that structural stigma represents an important, but thus far largely underrecognized, mechanism underlying mental health disparities related to sexual orientation among youth. I offer several suggestions to advance research in this area, including (a) adopting a life-course approach to the study of structural stigma; (b) developing novel measures of structural stigma; (c) expanding both the range of methods used for studying structural stigma and the sequelae of structural stigma that are evaluated; (d) identifying potential mediators and moderators of the structural stigma-health relationship; (e) examining intersectionalities; and (f) testing generalizability of structural stigma across other groups, with a particular focus on transgender youth. The implications of this research for preventive interventions and for public policy are also discussed.
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Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among ...Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Purpose To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual ...youths. Methods A total of 31,852 11th-grade public school students (1,413 lesbian, gay, and bisexual individuals; 4.4%) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. The independent variable was the proportion of school districts in the 34 counties participating in the Oregon Healthy Teens survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. We stratified results by sexual orientation. Results Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% confidence interval CI, 1.13–4.49) more likely to have attempted suicide in the past year compared with those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths, even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (odds ratio, .18; 95% CI, .03–.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (odds ratio, .38; 95% CI, .02–7.33). Conclusions Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts.
Researchers have long recognized that stigma is a global, multi-level phenomenon requiring intervention approaches that target multiple levels including individual, interpersonal, community, and ...structural levels. While existing interventions have produced modest reductions in stigma, their full reach and impact remain limited by a nearly exclusive focus targeting only one level of analysis.
We conducted the first systematic review of original research on multi-level stigma-reduction interventions. We used the following eligibility criteria for inclusion: (1) peer-reviewed, (2) contained original research, (3) published prior to initiation of search on November 30, 2017, (4) evaluated interventions that operated on more than one level, and (5) examined stigma as an outcome. We stratified and analyzed articles by several domains, including whether the research was conducted in a low-, middle-, or high-income country.
Twenty-four articles met the inclusion criteria. The articles included a range of countries (low, middle, and high income), stigmatized conditions/populations (e.g., HIV, mental health, leprosy), intervention targets (e.g., people living with a stigmatized condition, health care workers, family, and community members), and stigma reduction strategies (e.g., contact, social marketing, counseling, faith, problem solving), with most using education-based approaches. A total of 12 (50%) articles examined community-level interventions alongside interpersonal and/or intrapersonal levels, but only 1 (4%) combined a structural-level intervention with another level. Of the 24 studies, only 6 (25%) were randomized controlled trials. While most studies (17 of 24) reported statistically significant declines in at least one measure of stigma, fewer than half reported measures of practical significance (i.e., effect size); those that were reported varied widely in magnitude and were typically in the small-to-moderate range.
While there has been progress over the past decade in the development and evaluation of multi-level stigma interventions, much work remains to strengthen and expand this approach. We highlight several opportunities for new research and program development.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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