US researchers found that in states where same-sex marriage became legal, there was a drop in suicide attempts by high school students, especially among sexual minority students.
Enacting policies that promote equality, like same-sex marriage laws, may ease the mental burdens on lesbian, gay and bisexual young people, Reuters Health reports a US study suggests.
"I hope policymakers and the public are aware that the social policies that govern LGBT rights can have an impact on child welfare and wellbeing," said lead author Julia Raifman, a public health researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
The first state to legalise same-sex marriage was Massachusetts, in 2003. Thirty-five states had done so by June 2015, when the US Supreme Court made it legal nationwide.
"I was really interested in how equal rights for LGBT populations affected health outcomes," Raifman is quoted in the report as saying. The staggered implementation of same-sex marriage in different states offered an opportunity to examine the relationship between policy changes and health outcomes, she added.
Suicide is the second most common cause of death among people between 15 and 24 years old, Raifman's team writes, and lesbian, gay and bisexual (LGB) teens are at a significantly heightened risk for suicide attempts.
In the 2015 version of the nationally representative Youth Risk Behaviour Surveillance System (YRBSS) survey, 29% of gay, lesbian and bisexual high school students reported having attempted suicide in the past year, compared to 6% of their heterosexual peers.
For the new study, the researchers used data collected from US public high school students in grades 9 through 12 by the YRBSS between January 1999 and December 2015. Researchers compared rates of reported suicide attempts in 32 states before and after same-sex marriage implementation to reported attempts in 15 states without legalisation.
Almost 9% of all respondents and nearly 29% of students who identified as sexual minorities reported a suicide attempt before same-sex marriage implementation, researchers found. Implementing same-sex marriage was linked to a 7% reduction in the number of high schoolers attempting to kill themselves. This reduced risk was concentrated among students who identified as sexual minorities. The researchers estimate that same-sex marriage legalisation is tied to 134,000 fewer suicide attempts each year.
The report says the new study can't say why legalising same-sex marriage is associated with fewer suicide attempts, but Raifman said there could be a number of reasons. For example, legalisation may change the outlook of gay, lesbian and bisexual teens or it may change how other people treat sexual minorities. "We only have evidence on the relationship between state same-sex marriage policies, but I think it’s possible other policies may affect adolescent wellbeing," she said.
Currently, no comprehensive suicide prevention program backed by science exists for teens who are sexual minorities, Mark Hatzenbuehler writes in an editorial accompanying the new study. "Although no single factor can fully explain a complex behaviour such as suicide, the study by Raifman and colleagues suggests that structural stigma – in the form of state laws – represents a potentially consequential but thus far largely overlooked contextual factor underlying suicidality in LGB youth," writes Hatzenbuehler, an associate professor of socio-medical sciences at Columbia University’s Mailman School of Public Health in New York City.
Abstract
Importance: Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts.
Objective: To evaluate the association between state same-sex marriage policies and adolescent suicide attempts.
Design, Setting, and Participants: This study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies.
Interventions: Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection.
Main Outcomes and Measures: Self-report of 1 or more suicide attempts within the past 12 months.
Results: Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6% of all high school students and 28.5% of 231 413 students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6–percentage point (95% CI, –1.2 to –0.01 percentage points) reduction in suicide attempts, representing a 7% relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities.
Conclusions and Relevance: State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes.
Authors
Julia Raifman; Ellen Moscoe; S Bryn Austin; Margaret McConnell
[link url="http://www.reuters.com/article/us-health-pediatrics-suicide-lgbt-idUSKBN1612SP"]Reuters Health report[/link]
[link url="http://jamanetwork.com/journals/jamapediatrics/fullarticle/2604258"]JAMA Pediatrics abstract[/link]
[link url="http://jamanetwork.com/journals/jamapediatrics/article-abstract/2604254"]JAMA Pediatrics editorial[/link]