Dissertation for doctoral degree (Ph.D.)
Karolinska Institutet, Sweden

Structural, interpersonal, and individual factors influencing sexual orientation-based disparities in mental health:

A socio-ecological perspective on sexual minority stigma


Media Coverage

Erasmus University Rotterdam – September 2021
Imagine talking to a therapist and instead of listening, they will tell you that there’s something innately wrong with you. This kind of ‘conversion therapy’ is still happening in the US and even in the Netherlands, mostly with LGBTQ+ youth. EUR alumnus Dr. Arjan van der Star (31) works as a postdoctoral researcher at San Diego State University and studies how harmful factors like these may help explain why LGBTQ+ individuals continue to report lower mental and physical health than the general population. His research also indicates that a supportive environment may undo the negative effects of stigma and prejudice, so health might be improved again.


Media Coverage

Karolinska Institutet – December 2020
It is a known fact that sexual minorities are at a higher risk of developing poor mental health, when compared to heterosexuals. The stigma that sexual minorities face has been regarded as potentially the primary cause of this. A new thesis from Karolinska Institutet offers an insight into how stigma-related factors may work in a broader socio-ecological system, considering the complex interaction between structural, interpersonal and individual factors.



Dr. Arjan van der Star, Ph.D., M.Sc. (he/him) is a social epidemiologist and public health researcher investigating sexual and gender minority mental health. Dr. Van der Star’s research focuses on the complex mechanisms underlying sexual orientation-based and gender identity-based mental health disparities by examining 1) how sexual and gender minority stigma and related stressors may explain disparities in mental health, 2) how such stigma may operate within a multi-level socio-ecological system surrounding sexual and gender minorities, and 3) how stigma-related factors may interact across these various levels of sexual and gender minority stigma. Hence, through his research, Dr. Van der Star primarily aims to further the theoretical understanding of what drives and causes adverse mental health among sexual and gender minorities, to inform effective policies on how to reduce the risk for such adverse mental health outcomes, but also, by illuminating the mechanisms underlying the link between sexual and gender minority stigma and poor mental health, to inform affirming psychotherapy tailored for sexual and gender minorities. 
Dr. Van der Star is currently a Research Assistant Professor in the Department of Psychology at San Diego State University and a Research Scientist with the San Diego State University Research Foundation. In that capacity, he is a Principal Investigator of two NIMH-funded research projects as well as the Project Director of an NIMH-funded suicide prevention study for sexual and gender minority youth and young adults. Currently, Dr. Van der Star also serves as the President of the Sexual and Gender Minority Health section of the European Public Health Association. He obtained a Ph.D. degree at Karolinska Institutet in September 2020, while working in close collaboration with researchers at the Yale School of Public Health, and B.Sc. and M.Sc. degrees at Erasmus University Rotterdam in 2011 and 2013, respectively.


Ph.D. in Public Health & Social Epidemiology, 2016-2020
Karolinska Institutet, Stockholm, Sweden
M.Sc. in Health Economics, Policy & Law, 2011-2013
Erasmus University Rotterdam, Rotterdam, The Netherlands
B.Sc. in Health Policy & Management, 2008-2011
Erasmus University Rotterdam, Rotterdam, The Netherlands


San Diego State University – Project Director – 2020-2026
Suicide Prevention for Sexual and Gender MInority Youth and Young Adults (NIMH R61/R33)
Sexual and gender minority (SGM) youth and emerging adults are at high risk of suicide attempts and death by suicide, and no known suicide prevention programs exist for this vulnerable population. The research project will adapt and test an intervention that integrates patient navigation with safety planning to prevent suicide. This intervention program for SGM youth and emerging adults is designed to target mechanisms that theoretically underlie suicide. 

San Diego State University – Principal Investigator – 2022-2024
The Mental Health Consequences of Life Course-Varying Exposure to Structural Sexual Minority Stigma: Advancing Causal Inference Using Longitudinal Models Moderated by Sexual Orientation (NIMH R03)
An expanding body of theory-driven research has consistently shown how factors related to sexual minority stigma, including structural, interpersonal, and intrapersonal factors, may drive sexual orientation-based mental health disparities. However, public health research has so far been unable to produce strong causal, longitudinal evidence on how structural forms of sexual minority stigma may jeopardize mental health outcomes among sexual minorities, including suicidal ideation, suicide attempts, and depressive symptoms. The proposed secondary analysis of a large public health dataset (Add Health) will include advanced three-level multi-membership longitudinal models to examine three key aspects yet missing to facilitate causal inferencing regarding the mental health sequelae of structural sexual minority stigma exposure. 

San Diego State University – Principal Investigator – 2023-2026
The Socioecology of Sexual Minority Stigma: Data Harmonization to Address Confounding Bias and Investigate Cross-Level Mental Health Effects (NIMH R01)
While an expanding body of theory-driven research has consistently shown how factors related to structural sexual minority stigma may drive sexual orientation-based mental health disparities, US-based evidence has been hampered by single stand-alone indicators of structural stigma, leading to important risks for confounding bias. Existing public health datasets have not independently been able to facilitate research that could fully account for such confounding bias, leading to distorted results. Together with newly developed comprehensive structural sexual minority stigma indices, the proposed harmonization and integration of large US public health datasets (i.e., NHIS, Add Health, YRBS, and ABCD) will enable advanced cross-sectional and longitudinal multilevel models to address the risks for confounding that currently bias evidence on how structural sexual minority stigma across both macro (i.e., state) and exo (i.e., county) levels drive and sustain sexual orientation- based disparities in depressive symptoms and suicidality outcomes. 


Examining the Association of Structural Stigmas with Body Image-Related Outcomes among Sexual Minority Individuals
Askew, A. J., Randall, A. B., Alvarez, J., Elbe, C. I., Caravelli, N., Gonzales IV, M., Van der Star, A., & Blashill, A. J. (2024) Body Image, 48.

Sexual orientation and mental health in a US cohort of children: A longitudinal mediation study
Feinstein, B. A., Van der Star, A., Dorrell, K., & Blashill, A. J. (2024). Journal of Child Psychology and Psychiatry, 65(2), 188-198.

Gender Identity-Based Disparities in Self-Injurious Thoughts and Behaviors Among United States Pre-Teens
Randall, A. B., Van der Star, A., Pennesi, J. L., Siegel, J. A. & Blashill, A. J. (2023). Suicide and Life-Threatening Behavior, 53(2), 241-249.

Lifecourse-varying exposure to structural stigma, minority stress reactions, and mental health among sexual minority male migrants
Van der Star, A., Bränström, R., & Pachankis, J. E. (2021). European Journal of Public Health, 31(4), 803–808.

Country-Level Structural Stigma, School-Based and Adulthood Victimization, and Life Satisfaction Among Sexual Minority Adults: A Life Course Approach
Van der Star, A., Pachankis, J. E., & Bränström, R. (2021). Journal of Youth and Adolescence, 50(1), 189–201.

Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality
Bränström, R., Van der Star, A., & Pachankis, J. E. (2019). Social Psychiatry and Psychiatric Epidemiology, 55(1), 89-99.

Sexual orientation openness and depression symptoms: A population-based study
Van der Star, A., Pachankis, J. E., & Bränström, R. (2019). Psychology of Sexual Orientation and Gender Diversity, 6(3), 369–381.

Acceptance of sexual minorities, discrimination, social capital and health and well-being: a cross-European study among members of same-sex and opposite-sex couples
Van der Star, A. & Bränström, R. (2015). BMC Public Health, 15(1), 812.