# Research #### Current Projects Current projects fall within 5 broad areas: 1) documenting the health consequences of structural stigma; 2) identifying mechanisms linking stigma to psychopathology; 3) examining when and how structural stigma undermines the efficacy of mental health interventions; 4) exploring associations between social and economic inequality and neural outcomes; and 5) elucidating why stigma persists over time. Below, I describe ongoing research in each of these areas. **(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, current projects are examining several new research questions. For instance, what are the biological, psychological, and social mediators of the association between structural stigma and psychopathology? 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? Recent Sample Publications: 1. Hatzenbuehler, M.L., Lattanner, M.R., McKetta, S., & Pachankis, J.E. (2024). Structural stigma and LGBTQ+ health: A narrative review of quantitative studies. *Lancet Public Health*, *9,* e109-127. 2. Hollinsaid, N.L., Pachankis, J.E., Mair, P., & Hatzenbuehler, M.L. (2023). Incorporating macro-social contexts into emotion research: Longitudinal associations between structural stigma and emotion processes among gay and bisxual men. *Emotion, 23,* 1796-1801. 3. Everett, B., Limburg, A., McKetta, S., & Hatzenbuehler, M.L. (2022). State-level regulations regarding the protection of sexual minorities and birth outcomes: Results from a population-based cohort study. *Psychosomatic Medicine, 84,* 658-668. 4. Lattanner, M.R., Ford, J., Bo, N., Tu, W., Pachankis, J.E., Dodge, B., & Hatzenbuehler, M.L. (2021). A contextual approach to the psychological study of identity concealment: Examining direct, interactive, and indirect effects of structural stigma on concealment motivation across proximal and distal levels. *Psychological Science, 32,* 1684-1696. 5. Pachankis, J.E., Hatzenbuehler, M.L., Bränström, R., Schmidt, A.J., Berg, R.C., Jonas, K., Pitoňák, M., Baros, S., & Weatherburn, P. (2021). Structural stigma and sexual minority men’s depression and suicidality: A multi-level examination of mechanisms and mobility across 48 countries. *Journal of Abnormal Psychology, 130,* 713-726. **(2) Biopsychosocial Mechanisms Linking Stigma-Related Stress and Psychopathology** In addition to studying stigma at the structural level, we are interested in identifying the mechanisms through which individual and interpersonal stigma processes contribute to psychopathology. To address this question, we developed a theoretical model known as the Psychological Mediation Framework, published in 2009 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. Current projects are expanding the Framework in several ways, including: 1) identifying new mechanisms (e.g., hypervigilance, thwarted belongingness, inflammation); 2) expanding stigma-related exposures to include structural stigma; 3) incorporating novel behavioral tasks (e.g., self-schemas) to measure hypothesized mechanisms; 4) testing a wider range of mechanisms (e.g., emotion regulation); and 5) using longitudinal, population-based designs. Recent Sample Publications: 1. Bränström, R., Hatzenbuehler, M.L., Lattanner, M.R., Hollinsaid, N.L., McDade, T.W., & Pachankis, J.E. (in press). Threats to social safety and neuro-inflammatory mechanisms underlying sexual orientation disparities in depression symptom severity: A prospective cohort study of young adults. *Brain, Behavior, and Immunity*. 2. Hollinsaid, N.L., Pachankis, J.E., Bränström, R., & Hatzenbuehler, M.L. (2023). Hypervigilance: An understudied mediator of the longitudinal relationship between stigma and internalizing psychopathology among sexual minority young adults. *Clinical Psychological Science, 11,* 954-973. 3. Bränström, R., Pachankis, J.E., Klein, D.N., & Hatzenbuehler, M.L. (2023). Self-schemas and information processing biases as mechanisms underlying sexual orientation disparities in depressive symptoms: Results from a longitudinal, population-based study. *Journal of Psychopathology and Clinical Science, 132,* 681-693. 4. Hollinsaid, N.L., Pachankis, J.E., Mair, P., & Hatzenbuehler, M.L. (2023). Incorporating macro-social contexts into emotion research: Longitudinal associations between structural stigma and emotion processes among gay and bisexual men. *Emotion*. Advance online publication. 5. Lattanner, M.R., & Hatzenbuehler, M.L. (2023). Thwarted belonging needs: A mechanism prospectively linking multiple levels of stigma and interpersonal outcomes among sexual minorities. *Journal of Social Issues, 79,* 410-445. 6. Lattanner, M.R., Pachankis, J.E., & Hatzenbuehler, M.L. (2022). Mechanisms linking minority stress and depressive symptoms in a longitudinal, population-based study of gay men: A test and extension of the psychological mediation framework. *Journal of Consulting and Clinical Psychology, 90,* 638-646. \*Selected as an *Editor’s Choice* paper, which “features the most exciting new findings in psychological science selected by American Psychological Association (APA) Journal Editors.” **(3) Context Effects on Psychotherapy Interventions: The Role of Stigma in Predicting Treatment Effect Heterogeneity** In a recent line of work, we have been examining whether structural stigma undermines 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. Current projects are examining generalizability of these findings to different stigmatized groups (e.g., sexual minorities) and identifying mechanisms and moderators of the relationship between structural stigma and intervention efficacy. Recent Sample Publications: 1. Hollinsaid, N.L., Pachankis, J.P., & Hazenbuehler, ML. (in prep). Does structural stigma moderate the efficacy of mental and behavioral health interventions for sexual minorities? OSF 2023*;* . 2. Price, M.A., Weisz, J.R., McKetta, S., Hollinsaid, N.L., Lattanner, M.R., Reid, A.E., & Hatzenbuehler, M.L. (2022). Meta-analysis: Are psychotherapies less effective for black youth in communities with higher levels of anti-black racism? *Journal of the American Academy of Child and Adolescent Psychiatry, 61,* 754-763. *\*Selected as an Editors’ Best Article of 2022*. 3. Hatzenbuehler, M.L., & Pachankis, J.E. (2021). Does stigma moderate the efficacy of mental and behavioral health interventions? Examining individual and contextual moderators of treatment effect heterogeneity. *Current Directions in Psychological Science, 30,* 476-484. 4. Price, M.A., McKetta, S., Weisz, J.R., Ford, J.V., Lattanner, M.R., Skov, H., Wolock, E., & Hatzenbuehler, M.L. (2021). Cultural sexism moderates efficacy of psychological therapy for girls: Results from a spatial meta-analysis. *Clinical Psychology: Science and Practice, 28,* 299-312. **(4) Context Effects on Neural Outcomes** The approach that we have used to study structural stigma provides a template for addressing questions that psychologists (and others) have begun to ask regarding whether contextual (i.e., structural) factors influence neural outcomes. 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 that is conducted across numerous sites that provide variation in social context: the Adolescent Brain and Cognitive Development Study. In two papers from this sample, we showed that structural stigma is associated with reduced hippocampal volume among Black and Latinx youth, and that state-level macroeconomic factors moderate the association of low income with brain structure. 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 used spatial meta-analyses—which capitalize on the distribution of studies across communities that differ in the contextual variable of interest—to demonstrate that community-level racial prejudice is associated with the degree of neural activation to Black (vs. White) faces in primarily White participants. Together, our findings are beginning to suggest that contextual approaches may yield new insights into social determinants of brain structure and function. Recent Sample Publications: 1. Hatzenbuehler, M.L., McLaughlin, K.A., Weissman, D.G., & Cikara, M. (2024). A research agenda for understanding how social inequality influences brain structure and function. *Nature Human Behavior, 8,* 20-31. 2. Weissman, D.G., Hatzenbuehler, M.L., Cikara, M., Barch, D.M., & McLaughlin, K.A. (2023). State-level macro-economic factors moderate the association of low income with brain structure and mental health in U.S. children. *Nature Communications, 14,* 2085. 3. Hatzenbuehler, M.L., McLaughlin, K.A., Weissman, D.G., & Cikara, M. (2022). Community-level explicit racial prejudice potentiates Whites’ neural responses to Black faces: A spatial meta-analysis. *Social Neuroscience, 17,* 508-519. 4. Hatzenbuehler, M.L., Weissman, D.G., McKetta, S., Lattanner, M.R., Ford, J.V., Barch, D.M., & McLaughlin, K.A. (2022). Smaller hippocampal volume among Black and Latinx youth living in high-stigma contexts. *Journal of the American Academy of Child and Adolescent Psychiatry, 61,* 809-819. **(5) Stigma as a Fundamental Cause** One framework that my colleagues and I have developed seeks to understand why stigma remains so durably associated with population health inequalities. To answer this question, we have drawn on the sociological concept of fundamental causes, which refer to social factors or circumstances that remain persistently associated with health inequalities over time despite dramatic changes in diseases, risk factors, and health interventions. With my sociologist colleagues Bruce Link and Jo Phelan, we have argued that stigma meets the characteristics of a fundamental cause. After our initial conceptual paper advancing this argument, we have set about empirically evaluating the theory. In recent work, led by Tessa Charlesworth, we are using machine learning techniques (i.e., Natural Language Processing) to develop datasets that capture stereotypes of multiple stigmatized groups as reflected in English-language text over sufficiently long time spans. Current projects are examining whether stereotypes towards 58 groups have persisted in negativity over the last 100 years and identifying factors that contribute to this reproducibility of stigmatization. Sample Publications: 1. Charlesworth, T.E.S., & Hatzenbuehler, M.L. (in press). Mechanisms upholding the persistence of stigma across 100 years of historical text. *Nature Scientific Reports.* 2. Charlesworth, T.E.S., Sanjeev., N., Hatzenbuehler, M.L., & Banaji, M.R. (2023). Identifying and predicting stereotype change in large language corpora: 72 groups, 115 years (1900-2015), and four text sources. *Journal of Personality and Social Psychology*. Advance online publication. 3. Bränström, R., Hatzenbuehler, M.L., Pachankis, J.E., & Link, B.G. (2016). Sexual orientation disparities in preventable disease: A fundamental cause perspective. *American Journal of Public Health, 106*, 1109-1115. 4. Hatzenbuehler, M. L., Phelan, J.C., Link, B.G. (2013). Stigma as a fundamental cause of population health inequalities. *American Journal of Public Health, 10,* 813-21.