# The Socioecology of Sexual Minority Stigma: Data Harmonization to Address Confounding Bias and Investigate Cross-Level MentalHealth Effects

> **NIH NIH R01** · SAN DIEGO STATE UNIVERSITY · 2024 · $447,178

## Abstract

PROJECT SUMMARY/ABSTRACT
Sexual minorities (i.e., individuals who do not identify as heterosexual, or who are attracted to, have romantic
relationships with, or have sexual contact with, people of the same or diverse genders) in the US are at a near
three-fold increased odds for depression and a two to seven-fold increased risk for lifetime report of suicide
attempts, compared with heterosexual individuals. Structural sexual minority stigma exposure across various
levels (e.g., macro and exo levels) has been purported as a cause underlying and driving these sexual
orientation-based disparities in mental health. While structural forms of sexual minority stigma, including
discriminatory laws, inequitable policies, and negative population attitudes, have been associated with adverse
sexual minority mental health, evidence from US-based studies, depending on single stand-alone indicators of
structural stigma, has been hampered by risks for confounding bias through common causes from other 1)
higher-level and 2) same-level structural stigma-related factors, as well as 3) often-overlooked structural factors
outside of the stigma paradigm. Large existing US public health surveys do not independently allow for analyses
that can fully account for such confounding bias. But data harmonization and integration across datasets (i.e.,
NHIS, Add Health, YRBS, and ABCD) will enable complex models with newly developed comprehensive macro-
(i.e., state) and exo-level (i.e., county) structural sexual minority stigma predictors of individual-level mental
health outcomes, sufficient clusters, and large-enough mean cluster sizes. With data collected during a
transformational period for sexual minorities in the US (from 2001 to 2021; e.g., changes in population attitudes
and the step-wise introduction of same-gender marriage), the NHIS, Add Health, YRBS, and ABCD, together,
provide a once-in-a-generation and timely opportunity to harmonize and integrate these datasets to enable
complex multilevel models that account for the risks of confounding bias and aid to further strengthen causal
inferencing. Therefore, this proposed study will 1) harmonize and pool high-quality data from up to 42,000 sexual
minority and 1.4 million heterosexual individuals, 2) comprehensively quantify the level of structural sexual
minority stigma exposure in US states and counties between 2001 and 2021, and 3) examine the cross-sectional
and longitudinal associations between cross-level (i.e., macro to exo) effects of structural sexual minority stigma
and depressive symptoms and suicidality outcomes (namely, suicidal ideation and suicidal behaviors). Findings
from the proposed study may have direct theoretical and applied implications as it addresses important
confounding issues currently distorting findings on how macro- and exo-level structural sexual minority stigma
shape sexual minorities’ mental health. Results may further contribute to health equity by facilitating targeted
advocacy and t...

## Key facts

- **NIH application ID:** 10870024
- **Project number:** 5R01MH133821-02
- **Recipient organization:** SAN DIEGO STATE UNIVERSITY
- **Principal Investigator:** Arjan van der Star
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $447,178
- **Award type:** 5
- **Project period:** 2023-06-16 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10870024

## Citation

> US National Institutes of Health, RePORTER application 10870024, The Socioecology of Sexual Minority Stigma: Data Harmonization to Address Confounding Bias and Investigate Cross-Level MentalHealth Effects (5R01MH133821-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10870024. Licensed CC0.

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