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Primary Submission Category: Structural factors

A qualitative meta-synthesis of structural stigma toward mental health conditions and substance use

Authors:  Evan Eschliman, Long Jie Huang, Karen Choe, Jonathan Zhu, Ohemaa Poku,

Presenting Author: Evan Eschliman*

The qualitative literature documenting lived experiences and perceptions of stigma’s structural manifestations has rarely been characterized. This study aimed to synthesize the existing qualitative research on structural stigma toward mental health conditions and/or substance use. A systematic search of five databases (PubMed, PsycINFO, Embase, CINAHL, Web of Science) identified peer-reviewed English-language articles using the term “structural stigma” published before January 1, 2025. Results from articles that reported qualitative research on structural stigma toward mental health conditions and/or substance use were organized using qualitative meta-synthesis methods into four conceptual domains from an established structural-level stigma mechanisms framework (legal, institutional, social, and physical/built environments). Thirty-nine articles were identified, with 19 on structural stigma toward mental health conditions, 17 on structural stigma toward substance use, and 3 on structural stigma toward both mental health conditions and substance use. Most of the studies were in the United States (n=13) or Canada (n=12). Participants and researchers in these studies identified structural-level stigma mechanisms across all four domains as well as strategies to navigate and resist structural stigma. The qualitative literature on structural stigma toward mental health conditions and/or substance use is robust and has identified key structural-level stigma mechanisms that can be further explored, measured, and intervened upon. Future qualitative research can further explore people’s perceptions of laws and policies. Quantitative research measuring structural stigma can attend to the lived experiences and perceptions of structural stigma documented in qualitative research to date. Integrating the qualitative and quantitative literatures on these negative structural forces will best inform the development and implementation of structural-level stigma interventions.