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Friday, March 17, 2017

Does Gay Marriage Cut Youth Suicide?

Suicide down 14% in gay teens from legal same-sex marriage, researchers suggest Suicide down 14% in gay teens from legal same-sex marriage, researchers suggest

New Johns Hopkins Bloomberg School of Public Health research suggests that the implementation of state laws legalizing same-sex marriage was associated with a significant reduction in the rate of suicide attempts among high school students, and an even greater reduction among gay, lesbian, and bisexual (GLB) adolescents.

The researchers estimate that state-level same-sex marriage policies were associated with more than 134,000 fewer adolescent suicide attempts per year. The study compared states that passed laws allowing same-sex marriage through January 2015 to states that did not enact state-level legalization. A Supreme Court decision made same-sex marriage federal law in June 2015.

The paper titled “Difference-in-Differences Analysis of the Association between State Same-Sex Marriage Policies and Adolescent Suicide Attempts” was written by Julia Raifman, Ellen Moscoe, Bryn Austin, and Margaret McConnell.

The researchers point out the effect that social policies can have on behavior. “These are high school students, so they aren’t getting married any time soon, for the most part,” says study leader Julia Raifman, a post-doctoral fellow in the department of epidemiology at the Bloomberg School. “Still, permitting same-sex marriage reduces structural stigma associated with sexual orientation. There may be something about having equal rights, even if they have no immediate plans to take advantage of them, that makes students feel less stigmatized and more hopeful for the future.”

Suicide is the second-most common cause of death among people ages 15 to 24 in the United States, trailing only unintentional injury. U.S. suicide rates have been rising, and data indicate that rates of suicide attempts requiring medical attention among adolescents increased 47 percent between 2009 and 2015.

GLB high school students are at particular risk. In the new study, 29 percent of GLB high school students reported attempting suicide in the previous year as compared to six percent of heterosexual teens.

For the study, Raifman and her colleagues analyzed data from the Youth Risk Behavior Surveillance System, a survey supported by the Centers for Disease Control and Prevention. The data included 32 of the 35 states that enacted same-sex marriage policies between 2004 and 2015. The researchers used data from 1999 through 2015 to capture trends in suicide attempts five years before the first same-sex marriage policy went into effect in Massachusetts. They were also able to compare data with states that did not enact same-sex marriage laws. They conducted state-by-state analyses, comparing, for example, suicide attempt rates in a state like Massachusetts before same-sex marriage was legalized to the period right after.

State same-sex marriage legalization policies were associated with a seven percent reduction in suicide attempts among high school students generally. The association was concentrated in sexual minorities, with a 14 percent reduction in suicide attempts among GLB adolescents. The effects persisted for at least two years. The states that did not implement same-sex marriage saw no reduction in suicide attempts among high school students.

It’s unclear whether the political campaigns surrounding same-sex marriage legalization or the laws themselves were behind the reduction in suicide attempts. Still, the researchers found that the reduction in suicide attempts wasn’t realized until after a law was enacted. In a state that would go on to pass a law two years in the future, when there was likely to be much conversation in the public about it, suicide attempts remained flat before passage.

Despite the large reduction in suicide attempts among GLB high school students, they still attempt suicide at higher rates than their straight peers.

“It’s not easy to be an adolescent, and for adolescents who are just realizing they are sexual minorities, it can be even harder. That’s what the data on disparities affecting GLB adolescents tell us,” Raifman says.

Despite evidence of disparities, Raifman says there are no population-level programs aimed at reducing suicide attempts in GLB students. She says schools and medical providers must understand that students who are sexual minorities are at higher risk and be on high alert.

While Raifman found that legalizing same-sex marriage appears to be positively associated with reducing suicide attempts, policies that take away rights or add to stigma could have the opposite effect.

“We can all agree that reducing adolescent suicide attempts is a good thing, regardless of our political views. Policymakers need to be aware that policies on sexual minority rights can have a real effect on the mental health of adolescents. The policies at the top can dictate in ways both positive and negative what happens further down.”

The research was supported by grants from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; and the Maternal and Child Health Bureau, Health Resources and Services Administration at the United States Department of Health and Human Services.

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