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Structural Stigma: Research Evidence and Implications for Psychological Science

November 2016
American Psychologist 71(8)

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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.

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Structural Stigma: Research Evidence and Implications for Psychological

Science

Mark L. Hatzenbuehler

Columbia University

Psychological research has provided essential insights into how stigma operates to disadvan-

tage 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 under-

recognized 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.

Keywords: stigma, social policies, sexual orientation, mental illness, health disparities

Psychologists have provided crucial insights into the ways in

which stigmatized individuals perceive and react to stigma as

well as the adverse consequences of stigma across several

important life domains, such as educational attainment and

health (Major & O’Brien, 2005). Despite these significant

advancements, stigma research has been criticized for being

too focused on individual and interpersonal processes, thereby

overlooking broader, structural forms of stigma (Link &

Phelan, 2001). Although this criticism largely emanates from

other disciplines, psychologists themselves have argued

that more attention should be paid to structural issues that

influence the stigma process (e.g., Fiske, 1998). In the

last decade, psychologists have responded to this charge

by conducting theoretical and empirical research on the

role of structural stigma in shaping the lives of the

stigmatized.

This article reviews the relatively new field of research on

structural stigma as it relates to mental illness and sexual

orientation through addressing four specific issues: (1) defining

structural stigma and discussing various measurement ap-

proaches that have been employed to study it, (2) evaluating

evidence bearing on the important consequences of struc-

tural stigma for individual-level stigma processes (e.g.,

concealment, rejection sensitivity), for psychological in-

terventions and for health inequalities, (3) describing

how the field has addressed the challenge of establishing

causal inferences regarding associations between struc-

tural stigma and health, and (4) outlining future direc-

tions to advance this emerging literature.

What Is Structural Stigma, and How

Is It Measured?

Stigma exists at individual, interpersonal, and structural

levels (Link & Phelan, 2001). Individual stigma refers to the

psychological processes in which individuals engage in

Editor’s note. Mark L. Hatzenbuehler received the 2016 APA Award

for Distinguished Early Career Contributions to Psychology in the Public

Interest. This article is based on his invited presentation at the 124th

Annual Convention of the American Psychological Association, held Au-

gust 4 –7, 2016, in Denver, Colorado.

Author’s note. Mark L. Hatzenbuehler, Department of Sociomedical

Sciences, Center for the Study of Social Inequalities and Health, Mailman

School of Public Health, Columbia University.

Research on this article was supported by National Institutes of Health

Grant K01DA032558.

Correspondence concerning this article should be addressed to Mark L.

Hatzenbuehler, Department of Sociomedical Sciences, Columbia Univer-

sity, Mailman School of Public Health, 722 West 168th Street, Room

549.B, New York, NY 10032. E-mail: mlh2101@cumc.columbia.edu

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

2016, Vol. 71, No. 8, 742–751 0003-066X/16/$12.00 http://dx.doi.org/10.1037/amp0000068

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