Being a teenager isn't easy, and for adolescents just coming into their identity as sexual minorities, it can be even more daunting. But researchers at Johns Hopkins University may have identified one factor that could be making things easier.
Analyzing survey data collected by the Centers for Disease Control and Prevention (CDC), Julia Raifman, a post-doctoral fellow at the Bloomberg School for Public Health, found a significant reduction in suicide attempts among gay, lesbian and bisexual adolescents in states where gay marriage had been legalized.
Conducting a state-by-state analysis of adolescent suicide attempt rates, Raifman found that after same-sex marriage policies had been put into place, there was a seven percent decline in suicide attempts among all high school students, while rates among gay, lesbian, and bisexual teens dropped by 14 percent.
Annually, the policies are estimated to reduce suicide attempts by 134,000. States that did not implement same-sex marriage, by comparison, saw no reduction in suicide attempts among high school students.
"These are high school students so they aren't getting married any time soon, for the most part," Raifman said in a statement. "Still, permitting same-sex marriage reduces structural stigma associated with sexual orientation."
The study appears in JAMA Pediatrics.
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Suicide is currently the second most common cause of death among people between the ages of 15 and 24 in the United States, according to CDC statistics. Those rates have been rising in recent years, with data indicating that suicide attempts requiring medical attention among adolescents increased 47 percent between 2009 and 2015. The rate among gay, lesbian and bisexual adolescents is nearly five times higher than that of heterosexual teens.
While Raifman said it was unclear whether political campaigns surrounding the legalization of same-sex marriage could have contributed to the drop in suicide attempts, the observed reduction took place only after the law had been enacted, not in years leading up to the change. And by looking at a shift in rates within each state, rather by comparing states to one another, they were able to control for cultural differences that could affect data.
Public support for gay marriage has steadily increased nationwide over the past 15 years. While only 35 percent of Americans supported gay marriage in 2001, in 2016 that number had jumped to 55 percent, according to the Pew Research Center.
Her team also found that the means by which the policy was enacted - by legislative or judicial decision - made no difference in terms of the data. In 2015, the U.S. Supreme Court ruled that same-sex marriage was a legal right throughout the United States. But in the years leading up to that decision, state legislatures passed same-sex marriage laws in 11 states while judicial decisions established it as legal in another 25 states, according to the National Conference on State Legislatures (NCSL).
Phillip Gordon, a literature professor at the University of Wisconsin–Plateville who studies popular representations of lesbian, gay, bisexual and transgender (LGBT) culture, celebrated the findings.
"Data points like this are extremely important," he said. "It's important to note that it's not just the fact that the states were debating, or that same-sex marriage was part of a national conversation - it seems to be specifically related of the enactment of same-sex marriage laws in these states."
He is, however, worried about how transgender youth could fit into the picture, a concern that Raifman shares.
Gordon notes that often, marriage laws that are widely celebrated in gay communities have little effect on transgender life. Currently, survey data on gender identity are not collected, making it impossible to determine how such policies could affect trans youth differently from those identifying as gay, lesbian and bisexual.
"Marriage equality can normalize lesbian, gay, and bisexual lives, where trans people are peripheral to that, at best," he added. "Once gay marriage was settled, trans identity became the new frontier."
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Gordon also worries that as same-sex marriage becomes more accepted, attacks on the trans community could increase, calling bathroom bills the "rallying cry for anti-LGBT" forces. As of 2017, legislators in 14 states had proposed some version of a bathroom bill intended to restrict access to multiuser restrooms, according to NCSL.
While a poll conducted by Pew Research Center found that two-thirds of adults under 30 believe transgender people should be allowed to use the restroom that match their gender identity, adults in their 30s and 40s are evenly split on the question, and adults over 50 believe they should be required to use the bathroom of the gender assigned at birth.
"I wonder, in the couple of years, what the effect of some new laws will be on those who are non-gender conforming," Gordon added.
It's one of the many areas, Raifman said, where more research is needed.
"From this study, there are a lot of implications - in terms of research, it is important to know how social policies and equal rights effect health outcomes," Raifman said, noting the potential impact of religious freedom bills pending across the country.
In coming years, she is planning more research into the ways that social policies affect the health of LGBT youth. Gay, lesbian and bisexual adolescents are also at increased risk of substance abuse, depression, and HIV, she added.
"Policymakers need to be aware that policies on sexual minority rights can have a real effect on the mental health of adolescents," Raifman said in a statement. "The policies at the top can dictate in ways both positive and negative what happens further down."
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