Category: LGBTQ+
Nathan Hollinsaid, B.S. (he/him/his)
Clinical Science Doctoral Student
Department of Psychology, Harvard University
Cambridge, Massachusetts
Mark Hatzenbuehler, Ph.D. (he/him/his)
John L Loeb Associate Professor of the Social Sciences
Harvard University
Cambridge, Massachusetts
Nathan Hollinsaid, B.S. (he/him/his)
Clinical Science Doctoral Student
Department of Psychology, Harvard University
Cambridge, Massachusetts
Richard Bränström, Ph.D. (he/him/his)
Associate professor, licensed psychologist
Karolinska Institutet
Stockholm, Stockholms Lan, Sweden
John Pachankis, Ph.D.
Susan Dwight Bliss Associate Professor of Public Health (Social and Behavioral Sciences)
Yale School of Public Health
New Haven, Connecticut
Micah Lattanner, PhD
Post-doctoral Fellow
Harvard University
Cambridge, Massachusetts
For more than a decade, the psychological mediation framework (Hatzenbuehler, 2009) has served as an important field manual for clinicians and interventionists working with sexual minority (e.g., lesbian, gay, bisexual) clients. This framework posits that stigma-related stressors “get under the skin” by creating elevations in cognitive (e.g., rumination), affective (e.g., emotion dysregulation), and social (e.g., isolation) risk factors for psychopathology. These mechanisms, in turn, have been targeted by interventions adapted for sexual minorities, leading to promising reductions in this population’s inequitable burden of mental and behavioral health morbidity (e.g., Pachankis et al., 2015, 2020). Although researchers have extensively validated various aspects of the framework (e.g., Lattanner et al., 2022), many of the mediating mechanisms and pathways originally posited by Hatzenbuehler (2009)—as well as their biological and behavioral correlates—are heretofore unexamined.
To remedy this gap, our symposium highlights four sets of studies conducted with diverse sexual minority samples that comprehensively expand upon the psychological mediation framework. This research, led by interdisciplinary scholars at varying career stages, integrates multifaceted stigma conceptualizations (i.e., internalized, interpersonal, and structural stigma)—along with novel measures (e.g., LGBTQ-specific hypervigilance) and innovative measurement approaches (e.g., implicit shame, inflammatory biomarkers)—into longitudinal, population-based studies in the US and abroad. Together, these studies suggest that stigma operates at multiple levels and over the lifespan to undermine sexual minorities’ psychological and relational wellbeing via a host of previously understudied biopsychosocial processes. Specifically, findings implicate shame, hypervigilance, inflammation, and thwarted belonging needs as important mechanisms prospectively linking sexual minorities’ stigma experiences to adverse individual (e.g., anxiety, depression, suicidality) and interpersonal (e.g., loneliness) outcomes.
After these four talks, our discussant will draw on their extensive experience studying the role of stigma in shaping population health inequalities to reflect on the decade-plus of research progress following the publication of the psychological mediation framework and to offer future directions for uncovering additional biopsychosocial mechanisms that imperil wellbeing among sexual minorities and other stigmatized populations. The following topics will be discussed: (1) leveraging methodological and measurement advancements to elucidate optimal treatment targets to reduce stigma’s deleterious health effects; (2) refining existing cognitive-behavioral interventions for sexual minorities to explicitly address the biopsychosocial mechanisms identified in this symposium; and (3) enhancing the understanding of how stigma-related experiences and stressors engender these more general biopsychosocial stress processes.
