January 28, 2022

Health of LGBQ youth did not improve after Obergefell v Hodges: study

“It is too soon to conclude that the legalization of SSM reduces suicide attempts among LGBQ-identifying youths”

“Same-sex marriage leads to a host of social and even public health benefits, including a range of advantages for mental health and wellbeing. The benefits accrue to society as a whole, whether you are in a same-sex relationship or not.” This was the prediction of a supporter of SSM a few months before it was legalised in Australia.

This was the expectation just about everywhere, and especially in the United States, where SSM became legal after the 2015 Supreme Court case Obergefell v Hodges. It is widely believed that marriage equality generate important health benefits not only for adult same-sex couples, but also for LGBQ-identifying youths. 

Well, that was four years ago for Americans. Has the health of LGBQ youths improved?

Apparently not.

Three economists, Mark Anderson, Kyutaro Matsuzawa and Joseph J. Sabia, have just published an important working paper in the National Bureau of Economic Research series, “Marriage Equality Laws and Youth Suicidal Behaviors”. Using data from the State Youth Risk Behavior Surveys, they explore the relationship between marriage equality and suicidal behaviours among LGBQ-identifying youths.

Their shock conclusion is that “Despite previous research suggesting otherwise, we find little evidence that SSM laws have reduced suicide attempts among teen sexual minorities, nor have they decreased the likelihood of suicide planning, suicide ideation, or depression.”

But the message of the economists is even worse: “we find some evidence that SSM legalization via judicial mandate is associated with worse mental health for these individuals, consistent with a story of social backlash.”

In other words, the US Supreme Court having effectively imposed this novel notion of marriage upon the states overnight, its decision on SSM bypassed the democratic process. Because it was not seen to win fair and square in the public arena, it remains tainted by the suspicion that it is illegitimate. For some people – unfairly – this might increase their hostility towards gay people.

LGBQ hopes of entering broad, sunlit uplands (apologies to Winston Churchill) after the legalisation of SSM are supported by some academic research. In fact the main target of the NBER article is a 2017 article in JAMA Pediatrics by Juiia Raifman and colleagues. It was the highest-impact article of the year for the journal. They found that “implementation of same-sex marriage policies reduced adolescent suicide attempts.”

The counter-argument by Anderson and his colleagues involves a very detailed statistical analysis based in large part on deficiencies in the data available to Raifman. One intriguing conclusion was that the mental health of LGBQ-identifying adolescents varied with the pathway to legalisation.

In particular, we find that court-ordered SSM legalization has worse mental health effects on LGBQ-identifying youths than legislatively enacted SSM legalization. This result is consistent with the hypothesis that LGBQ-identifying youths may face harsher social backlash in places where SSM is less popular and hence not enacted by the state’s popularly elected representatives. Interestingly, when we disaggregate court-ordered legalization by whether it occurred at the state versus federal level, we find that Obergefell v. Hodges [ie, the federal level] is associated with the largest adverse mental health effect. However, this latter effect is identified off of only four states in our sample, suggesting caution in interpretation.

In another interesting observation, Anderson’s group found that legalisation did not reduce risky health behaviours:

SSM legalization was associated with a 3.4 percentage-point increase in binge drinking among self-identifying LGBQ youths. Moreover, we also find little evidence that SSM legalization reduced bullying victimization among LGBQ-identifying youths. In summary, there is little support for the hypothesis that SSM legalization reduced adolescent risky health behaviors or bullying victimization at school, outcomes strongly related to youth mental health.

The claim made by Anderson’s group is modest – “it is too soon to conclude that the legalization of SSM reduces suicide attempts among LGBQ-identifying youths” – but it is important. It ought to make supporters of LGBQ teens very tentative about predicting that more supportive government policies guarantee that “it gets better”.

Michael Cook is editor of BioEdge

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