Journal of consulting and clinical psychology · 2026
The impact of state- and county-level anti-sexual and gender minority structural stigma on psychotherapy outcomes among a national sample of college students.
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Keefe John R, Lattanner Micah R, Franz Peter J, Breslow Aaron Samuel
Аннотация
OBJECTIVE: While structural stigma against sexual and gender minorities (SGMs) has been well-established to negatively impact SGM mental health, its influence on therapy outcomes for SGM living in more stigmatizing environments remains unclear.
METHOD: Using the Center for Collegiate Mental Health Standardized Data Set (student n = 416,339; institution n = 216), we examined the impact of stigma on baseline symptoms, treatment attendance, and psychotherapy outcomes among SGM compared with non-SGM students. The self-report Counseling Center Assessment of Psychological Symptoms Distress Index, a measure of general psychiatric symptoms, was our primary outcome. We examined outcomes and attendance across eight sessions of psychotherapy, using multilevel modeling. Time-varying (years 2012-2022) sexual and gender-based structural stigma composites for the institutions' states and counties were calculated using data on both public opinion and laws and policies impacting SGM individuals.
RESULTS: SGM students entered treatment with more severe Counseling Center Assessment of Psychological Symptoms Distress Index symptoms compared to non-SGM students (ds = 0.36-0.41). Higher county-level gender-related stigma predicted more severe symptoms among gender-diverse students (ps = .025-.010). SGM students attended relatively more psychotherapy sessions in counties with greater sexual structural stigma (p < .001). However, SGM students did not demonstrate meaningfully different symptom change trajectories relative to non-SGM compared to non-SGM students, and structural stigma was not associated with changes in Counseling Center Assessment of Psychological Symptoms Distress Index scores when accounting for SGM identity (all ps > .250).
CONCLUSION: Structural stigma was not associated with poorer treatment outcomes for SGM students receiving naturalistic psychotherapy at collegiate counseling centers. Rather, these results highlight the potential resilience-building effects of psychotherapy, even within stigmatizing contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
METHOD: Using the Center for Collegiate Mental Health Standardized Data Set (student n = 416,339; institution n = 216), we examined the impact of stigma on baseline symptoms, treatment attendance, and psychotherapy outcomes among SGM compared with non-SGM students. The self-report Counseling Center Assessment of Psychological Symptoms Distress Index, a measure of general psychiatric symptoms, was our primary outcome. We examined outcomes and attendance across eight sessions of psychotherapy, using multilevel modeling. Time-varying (years 2012-2022) sexual and gender-based structural stigma composites for the institutions' states and counties were calculated using data on both public opinion and laws and policies impacting SGM individuals.
RESULTS: SGM students entered treatment with more severe Counseling Center Assessment of Psychological Symptoms Distress Index symptoms compared to non-SGM students (ds = 0.36-0.41). Higher county-level gender-related stigma predicted more severe symptoms among gender-diverse students (ps = .025-.010). SGM students attended relatively more psychotherapy sessions in counties with greater sexual structural stigma (p < .001). However, SGM students did not demonstrate meaningfully different symptom change trajectories relative to non-SGM compared to non-SGM students, and structural stigma was not associated with changes in Counseling Center Assessment of Psychological Symptoms Distress Index scores when accounting for SGM identity (all ps > .250).
CONCLUSION: Structural stigma was not associated with poorer treatment outcomes for SGM students receiving naturalistic psychotherapy at collegiate counseling centers. Rather, these results highlight the potential resilience-building effects of psychotherapy, even within stigmatizing contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).