Stigma and Health is a peer-reviewed journal published by the American Psychological Association (APA) that focuses exclusively on how stigma, prejudice, and discrimination affect physical and mental health. Launched in 2016, it fills a niche that older psychology and public-health journals only touched on occasionally, giving researchers a dedicated venue to study everything from the cortisol spikes triggered by weight-based prejudice to the employment losses tied to a psychiatric diagnosis. The field the journal represents has grown rapidly, drawing on social psychology, clinical science, epidemiology, and health policy, and the findings published in its pages have real consequences for how clinicians, institutions, and everyday people think about the link between social exclusion and disease.
What the Journal Publishes and Why It Exists
Before Stigma and Health existed, research on health-related stigma was scattered across dozens of specialty journals. A study on HIV stigma might land in an infectious-disease outlet, work on mental-illness discrimination in a psychiatry journal, and weight-stigma research in a behavioral-medicine publication. The APA created Stigma and Health to pull those threads together under one editorial roof. The journal accepts empirical studies, meta-analyses, and theoretical papers that examine how being a target of stigma shapes health outcomes, health behavior, and access to care. It also publishes work on the people and systems doing the stigmatizing, including clinicians, employers, and policymakers.
A recent example of the kind of study it features is research showing that women in larger bodies are more likely to switch doctors frequently and have less communication with providers about sexual and reproductive health, a pattern the authors attribute to weight stigma and implicit bias in clinical settings.1PubMed Central. Weight Stigma and Implicit Bias in Healthcare: Investigating the Impact of Women’s Body Size on Continuity of Care and Communication About Sexual and Reproductive Health That kind of work sits at the intersection of social psychology and health services research, and it typifies the journal’s scope.
Key Theoretical Frameworks in the Field
Research published in and around Stigma and Health draws on several overlapping frameworks. One foundational distinction is between public stigma and self-stigma. Public stigma refers to the discrimination and devaluation directed at someone by others, while self-stigma (sometimes called internalized stigma) refers to a person absorbing those negative stereotypes and applying them to themselves.2PubMed. Public stigma and self-stigma: differential association with attitudes toward formal and informal help seeking The two operate differently. Public stigma can block someone from getting a job or a fair medical evaluation. Self-stigma can stop them from even trying, convincing them they do not deserve help or that asking for it confirms something shameful about who they are.
Another influential lens is minority stress theory, which was first articulated as an integrative framework in 2003 to explain mental-health disparities among sexual minority populations. The model has since expanded to apply to other marginalized groups and has become a workhorse theory in the field.3PubMed Central. Minority stress theory: Application, critique, and continued relevance It connects chronic exposure to prejudice and discrimination to elevated stress, which in turn drives poorer health outcomes.
More recently, researchers have pushed toward intersectional approaches. The idea, borrowed from critical social theory, is that stigma rarely comes in a single flavor. A person living with HIV who is also poor and gender-nonconforming faces overlapping stigmas that interact in ways a single-axis model cannot capture. This concept of intersectional stigma has gained traction, though scholars acknowledge there is still little consensus on how best to measure or intervene on it.4PubMed Central. Challenges and opportunities in examining and addressing intersectional stigma and health Work from Indonesia, for instance, illustrates how health-related stigma intersects with gender, sexuality, and poverty to produce compounded disadvantage that no single framework fully explains.5PubMed Central. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia
How Stigma Gets Under the Skin Psychologically
A substantial share of the research in this space documents the mental-health toll of being stigmatized. The link between internalized or anticipated stigma and depression is one of the most studied relationships in the field. A 2024 systematic review found that roughly three-quarters of cross-sectional studies supported a straightforward positive association between internalized or anticipated stigma and depression, though only about 40% of longitudinal studies did the same, suggesting the relationship may be more complex over time than a single snapshot reveals.6PubMed. The link between anticipated and internalized stigma and depression: A systematic review
Beyond depression specifically, internalized stigma is tied to broader drops in well-being. One study of people with mental health conditions found that internalized stigma was negatively correlated with both psychological well-being and subjective well-being, including how satisfied people felt with their lives and their overall balance of positive and negative emotions. The effect on life satisfaction and mood appeared to work partly through psychological well-being, meaning stigma may first erode a person’s sense of purpose and self-acceptance, which then drags down day-to-day happiness.7PubMed. Internalized mental illness stigma and subjective well-being: The mediating role of psychological well-being
Whether a stigmatized identity is visible or hidden matters too. Research on concealable stigmatized identities, such as a history of mental illness, an undisclosed sexual orientation, or a criminal record, shows that people who spend cognitive energy hiding a devalued identity tend to experience greater psychological distress. However, when the identity feels less central to a person’s self-concept, that distress appears somewhat buffered.8PubMed Central. Concealable Stigmatized Identities and Psychological Well-Being
The Body’s Response to Prejudice
One of the more striking lines of evidence in this field shows that stigma is not just a psychological experience; it registers in the body’s stress systems. In a controlled experiment, participants exposed to a stigmatizing condition showed significantly greater cortisol reactivity compared with those in a neutral condition, regardless of their body weight.9Psychosomatic Medicine. The Stress of Stigma: Exploring the Effect of Weight Stigma on Cortisol Reactivity Cortisol is the hormone the body releases in response to threat, and chronic elevation of it is linked to a range of health problems including weakened immunity and metabolic disruption.
Similar physiological signatures have been observed in the context of racial and ethnic stigma. A study of Black and Latina community members found that greater perceived stigmatization was associated with higher levels of interleukin-6, an immune marker tied to inflammation and disease risk. On the flip side, stronger feelings of pride in one’s racial or ethnic group were linked to higher levels of DHEA, a hormone associated with cellular resilience. These associations held even after accounting for general stress, personal experiences with discrimination, age, and income.10Social Psychological and Personality Science. Perceived Stigmatization, Ingroup Pride, and Immune and Endocrine Activity
Research on gay men has revealed another troubling pattern: not just elevated cortisol, but a failure to habituate to repeated stress. In most people, the cortisol response dampens with repeated exposure to the same stressor. In gay men facing minority stress, that dampening did not occur, and the sustained cortisol elevation was predicted by minority stressors specifically. Researchers have proposed that this non-habituation could be a physiological pathway linking stigma to long-term adverse health outcomes.11PubMed. Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men
Stigma as a Barrier to Getting Care
Perhaps the most immediately consequential finding in this literature is that stigma keeps people from seeking help. Across cultures and health systems, stigma in psychiatric care deters people from getting timely treatment, increases how sick they become before they do seek help, and diminishes their quality of life.12PubMed Central. Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review Review after review arrives at the same basic finding: stigma around mental health is present nearly everywhere and represents a significant barrier to people accessing medical help.13PubMed Central. Stigma in Mental Health: The Status and Future Direction
The barrier is not just about patients hesitating to walk through the door. It also operates at the level of individual clinicians. A phenomenon known as diagnostic overshadowing occurs when a healthcare provider misattributes a patient’s physical symptoms to an existing psychiatric diagnosis, essentially assuming the person’s complaints are “in their head.” This misattribution compromises care and likely contributes to the increased mortality experienced by people with mental illness.14PubMed Central. Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses A study of 210 mental health providers found that clinical experience mattered in predicting this bias: providers with doctoral degrees and those who held formal diagnostic responsibilities in their roles tended to show less overshadowing, while older providers and those with more trauma-exposed clients sometimes showed more.15PubMed. Predictors of trauma-related diagnostic overshadowing bias
The problem extends beyond mental health. A scoping review examining bias in the clinical decision-making of primary care physicians, medical students, and nurses confirmed that healthcare provider bias against people with serious mental illness exists and negatively affects clinical decisions regarding cardiovascular disease, diabetes, and cancer.16PubMed Central. The Role of Bias in Clinical Decision-Making of People with Serious Mental Illness and Medical Co-morbidities: a Scoping Review In other words, having a psychiatric label can mean receiving worse care for entirely unrelated physical conditions.
Structural Stigma and Larger Health Consequences
The field has increasingly moved beyond individual-level stigma to consider structural stigma, the societal-level conditions, norms, and policies that constrain the opportunities and well-being of stigmatized groups. A review in American Psychologist argued that structural stigma related to mental illness and sexual orientation contributes to outcomes ranging from disrupted physiological stress responses to premature death, and that it represents an underrecognized mechanism producing health inequalities.17PubMed Central. Structural stigma: Research evidence and implications for psychological science Structural stigma also interacts with the individual-level processes researchers have long studied, amplifying things like concealment behavior and rejection sensitivity. For example, living in a region with anti-gay legislation does not just change the legal landscape; it changes how anxious a gay person feels about being identified and how they respond to ambiguous social cues.
The economic dimension of structural stigma is substantial. About a third of people with mental health problems reported having decided not to apply for a job at some point because they felt discrimination would prevent them from being hired. Roughly a quarter felt that discrimination had led colleagues to treat them unfairly or had blocked career progression. Those who worked fewer hours than they wanted reported working an average of 14 fewer hours per week than their colleagues.18PubMed Central. Measuring the economic costs of discrimination experienced by people with mental health problems: development of the Costs of Discrimination Assessment (CODA) A systematic review examining the economic impact more broadly concluded that mental-illness stigma and discrimination negatively affect employment, income, public views about resource allocation, and healthcare costs.19Epidemiologia e Psichiatria Sociale. The economic impact of mental health stigma and discrimination: A systematic review
Measuring Stigma Reliably
A recurring challenge in stigma research, and one that Stigma and Health frequently publishes on, is measurement. How do you reliably quantify something as subjective and context-dependent as the experience of being devalued? Researchers have developed condition-specific scales for decades, but these make it hard to compare findings across diseases. A newer approach has been to create transdiagnostic instruments. The I-HEARTS Scale, for example, was developed and validated to measure internalized health-related stigma across different physical health conditions. It yielded three subscales covering perceived and anticipated stigma, stereotype application and self-devaluation, and stigma resistance, with strong reliability.20PubMed Central. Measuring internalized health-related stigma across health conditions: development and validation of the I-HEARTS Scale
On the provider side, measurement is equally important. A recently validated scale for healthcare professionals working with patients who have persistent somatic symptoms captures three dimensions of stigma: othering, uneasiness in interaction, and non-disclosure. Providers who scored higher on this measure held significantly less positive regard toward their patients, confirming that the scale is picking up something meaningful about the clinical relationship.21Journal of Psychosomatic Research. Validation of the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP) Condition-specific scales continue to be developed as new stigmas emerge. A stigma scale for mpox was validated in 2024, reflecting how quickly the field moves to measure discrimination around newly prominent health threats.22PubMed Central. Development and validation of the mpox stigma scale (MSS) and mpox knowledge scale (MKS)
What Works to Reduce Stigma, and What Does Not
Stigma-reduction interventions are a major focus of the journal and the broader field. The two most studied approaches are education, which provides factual information to counter stereotypes, and contact, which arranges direct or indirect interaction between the general public and people with stigmatized conditions. A meta-analysis comparing these approaches found that intergroup contact was effective in reducing mental health stigma, and the effectiveness did not differ based on whether the contact was paired with an educational component, the medium of contact, or the specific mental illness involved.23PubMed. Intergroup contact and mental health stigma: A comparative effectiveness meta-analysis
But the durability of these effects is a real question. A pilot randomized trial in Beijing found that combining education with contact produced greater immediate improvements in stigma-related attitudes and intended behavior among community health staff than education alone. By one month and three months after the intervention, however, the difference between the two groups had disappeared.24PubMed. Effect of a contact-based education intervention on reducing stigma among community health and care staff in Beijing, China: Pilot randomized controlled study And at least one web-based trial testing education and contact-based interventions for reducing public stigma around suicide found no stronger effects in the intervention groups compared with controls.25PubMed Central. A web-based pilot randomized controlled trial to test the efficacy of education and contact-based interventions in reducing public suicide stigma The evidence, in other words, is decidedly mixed once you look past immediate post-intervention surveys.
This inconsistency has pushed the field toward structural interventions. A realist review of efforts to dismantle structural stigma in healthcare settings found that sustainable change required organizations to embrace power sharing, co-design processes with stigmatized communities, and embed reforms into existing policy and governance structures. When these elements were present, outcomes included reduced coercion, improved trust, and lasting practice change.26SSM – Mental Health. A realist review of interventions to dismantle mental health and substance use related structural stigma in healthcare settings The implication is that individual-level attitude change may not stick unless the systems people work in actually change too.
The Role of Social Media
Digital environments are an increasingly important arena for stigma research, and Stigma and Health has published work on how online content shapes attitudes. Social media platforms are saturated with both stigmatizing and trivializing content about mental health, and researchers have documented that both types are prevalent in public posts.27PubMed Central. Measuring attitudes towards mental health using social media: investigating stigma and trivialisation Trivializing content, which uses clinical terms casually or as jokes, is a distinct problem from outright stigma but can similarly undermine how seriously people take mental health conditions.
An experimental study tested what happens when people are exposed to tweets that derogate mental health treatment. Among men and among women who strongly endorsed traditional feminine gender roles, the stigmatizing posts had no measurable effect. But among women who did not strongly identify with traditional feminine roles, even brief exposure to five derogatory tweets significantly increased their stigmatization of mental health services.28Social Media + Society. The Power of Social Media: Stigmatizing Content Affects Perceptions of Mental Health Care The finding is a useful reminder that vulnerability to stigma messaging is not uniform. Who the audience is, and how they relate to the social identities involved, shapes whether the message lands.
Evolutionary Roots of Stigmatization
Some researchers have looked beyond culture and individual psychology to ask whether stigma has evolutionary origins. One prominent account argues that many forms of stigmatization reflect the activation of a disease-avoidance system, a deeply conserved behavioral tendency to steer clear of individuals who display cues of illness. The system appears across species, not just humans, and disease-related stigma targets tend to be avoided across most human cultures, suggesting it is not purely a learned response.29PubMed Central. Disease avoidance as a functional basis for stigmatization
The catch is that this disease-avoidance system is dramatically over-inclusive. It responds to visible cues that merely suggest illness, regardless of whether the person actually poses any infection risk. Experimental work has confirmed that cues of substandard health arouse heightened discomfort with physical contact even when no actual health threat is present.30PubMed. Disease-avoidance processes and stigmatization: cues of substandard health arouse heightened discomfort with physical contact This over-firing helps explain why stigma attaches so stubbornly to conditions like skin disorders, physical disabilities, and obesity that pose no contagion risk at all. The ancient system does not bother distinguishing between a real infection threat and a harmless cosmetic difference. From a practical standpoint, understanding this evolutionary misfiring may help anti-stigma campaigns by framing stigma not as a moral failing but as a cognitive bias everyone carries and can learn to override.
Why Culture-Specific Research Matters
A persistent gap in the stigma literature is that most research has been conducted in high-income Western countries, yet stigma operates differently across cultural and economic contexts. Researchers have emphasized that effective stigma research needs to account for the particular features of the health problem being studied and the specific social, cultural, and economic settings in which it occurs, especially in lower-income countries where healthcare access and social structures differ sharply from those in North America or Europe.31PubMed. Health-related stigma: rethinking concepts and interventions In some settings, for example, mental illness is attributed to spiritual causes, and the stigma associated with it may be bound up with religious community dynamics in ways that a Western clinical framework would miss entirely. Stigma and Health has increasingly called for and published cross-cultural work to address this imbalance, though the field still has considerable ground to cover.