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Researchers and psychiatrists who commented on the study for Psychiatric News say the report points to how social policy that reflects greater tolerance and reduced stigma may improve mental health.
Julia Raifman, Sc.D., of the Johns Hopkins Bloomberg School of Public Health and colleagues analyzed data on more than 700,000 public high school students who participated in the Youth Risk Behavior Surveillance System (YRBSS) from 1999 through 2015. The authors looked at changes in suicide attempts among the students before and after the implementation of state policies in 32 states permitting same-sex marriage and year-to-year changes in suicide attempts in 15 states without such policies. A secondary analysis examined how same sex-marriage laws affected suicide attempts among high school students who self-identified as belonging to a “sexual minority.”
Same-sex marriage policies were associated with a 0.6 percentage point reduction in suicide attempts—equivalent to a 7% decline in the proportion of all high school students reporting a suicide attempt within the past year. Among students who identified as belonging to a sexual minority, the absolute decrease in suicide was 4.0 percentage points—equivalent to a 14% relative decline in the proportion of adolescents who were sexual minorities reporting suicide attempts in the past year.
Marshall Forstein, M.D. (pictured above), president of the APA Assembly Caucus of Lesbian, Gay, Bisexual, Transgender and Questioning/Queer Psychiatrists, said he believes marriage-equality laws are a marker for a host of social factors that create a more tolerant atmosphere for sexual minority youth, which, in turn, can help to diminish stigma and reduce the risk of suicide. “Marriage equality is a proxy for many changes in attitudes that create a matrix of social support for LGBT young people,” he said. “Increasing social tolerance creates the environment for increasing self-esteem.”
Brian Hurley, M.D., representative to the AMA Section Council on Psychiatry from GLMA: Health Professionals Advancing LGBT Equality, agreed. He noted that while most LGBT people are not suicidal, the study demonstrates the important role of sexual identity in mental health outcomes. “[O]ne implication of the study for individual psychiatrists is that speaking to patients about their sexual identity is a relevant part of a safety assessment and is clinically important,” he said.
For related information, see the Psychiatric News article “Clinician Insight Can Help Meet MH Care Needs of LGBT People.”