Mar 062017

Lesbian, gay and bisexual (LGB) high school students are at higher risk for suicide than their heterosexual peers. The reasons are complex. The facts are simple. In the US in 2015, 29% of LGB youth report attempting suicide in the past year compared to 6% of their heterosexual peers. LGB youth also have higher rates of depression, anxiety, and non-suicidal self injury. Why? One of the main culprits is stigma.

It is still not a “good” or “normal” thing to be LGB in the United States. LGB people are very much in the minority. They are targets for discrimination and violence. All of this is part of stigma. There are different types of stigma. Structural stigma is policy, rule, and law based discrimination. Marriage inequality was one of the most talked-about forms of structural stigma.

If poor mental health outcomes like suicide attempts are partially because of stigma then we would expect changes in those mental health outcomes after a change in stigma. In other words, if marriage inequality is one way that society says “LGB is bad” and drives adolescents toward suicide, then when marriage inequality goes away adolescents should have fewer suicide attempts.

And that’s what the researchers in this week’s study looked at. They asked: Did youth suicide attempts go down after legalization of marriage equality?

The Study

The researchers looked at data from the Youth Risk Behavior Surveillance System (YRBSS). The YRBSS is a survey done by the Centers for Disease Control every 2 years. It’s conducted in 47 of the 50 United States.Among other things, the YRBSS asks about number of suicide attempts in the past 12 months.

They looked at data from 1999-2015. 2015 is before country-wide marriage equality. So instead of looking at national data, they looked state by state. They compared suicide attempts before and after legalization in that state. They also compared suicide attempts in states that legalized and in states that did not legalize in the same year.

In addition they compared straight suicide attempts to LGB suicide attempts. Only 25 states were actually asking about sexual orientation by 2015, so this part of the study was limited.

In total there were data from roughly 760 thousand adolescents. 12.7% of students in states that asked about sexual orientation identified as LGB. 2.3% were gay/lesbian, 6.4% were bisexual, and 4% were uncertain.

8.6% of all students had attempted suicide in the past year before marriage equality. That dropped by 0.6% to 8.0% after same-sex marriage was legalized. If we extrapolate out, that’s roughly 134 thousand adolescents who did not attempt suicide after marriage equality.

For LGB students the difference was even more impressive. Out of 231 thousand adolescents, 28.5% had attempted suicide in the past year prior to legalization. After marriage equality it dropped by 4.0% to 24.5%. That’s a relative reduction of 14%.

And for the statistically nerdy folks among us, those results were statistically significant at the p = 0.05 level.

Nice data, but what does it mean?

Here’s the bottom line. There were fewer suicide attempts in all high school students after marriage equality. This was especially true among LGB youth, but the effect was seen in all youth.

There’s a very important lesson in these results. Legal policies and the message those policies convey have very real effects on health. And it’s not just as simple as policies like mandatory vaccination and the resulting drop in infectious diseases. Denying same sex couples the right to marry and all the legal protections associated with marriage sends the message that LGB people are inferior. And our youth hear that. It has very real effects on their health. It’s behooves us as a society to examine other policies like employment and school protections to see if they send the same message.

From a personal perspective, these results are not surprising. While the Defense of Marriage Act was still law, even as a teenager I was very aware of what that meant for my legal rights. I knew about, and was distressed by, the lack of hospital visitation rights and insurance coverage. As an adult the knowledge that I have the legal right to make medical decisions for my wife without question is immensely comforting. We have a long way to go on other matters, but this one small step makes a difference.

Lastly, never underestimate suicidality. If you or someone you love is in crisis, the Trevor Project is an LGBT friendly suicide hotline for youth. Adults who need assistance can find the right hotline for them here.

Want to read the study for yourself? The abstract is publicly available.

Jun 292015

Two_golden_wedding_ringsAs I’m sure you know by now, the United State Supreme Court has declared that same-sex marriage is legal in all of the United States. Why was marriage so important, anyway? And what’s next?

Marriage is a legal institution in the United States. There are legal rights and responsibilities for spouses. Marriage proponents were not arguing for the religious right to have a marriage ceremony. Anyone who wants to can have a ceremony. What mattered, and why they found so hard for so long, were the legal rights. Many of these rights have to do with taxes, estates, the right to adopt, and so on — areas that are somewhat outside the realm of this blog. There are some important medical-related rights that are covered by marriage, including…

  • The right to hospital visitation. If one spouse is in a restricted area of a hospital (such as an intensive care unit), the other spouse has the legal right to visit. While President Obama did issue an executive order ordering hospitals to allow visitation for same-sex couples, it only applies to hospitals that accept Medicare/Medicaid. Most hospitals do, but it isn’t all.
  • The right to make medical decisions
  • Giving consent for autopsies and burial arrangements
  • Medical insurance coverage for spouses
  • Family leave to take care of a sick or injured spouse

Individual institutions can and have granted some or all of these rights before. For example, Google is well-known for its equitable treatment of employees in same-sex relationships. And some hospitals have accepted medical power of attorney documents with no question for same-sex partners. But it wasn’t universal.

For a long time now people in same-sex relationships have been in a legal gray zone. They may be legally married in one state. But cross a state line and suddenly that state may not consider them to be married anymore. This was because of the Defense of Marriage act, which is now null thanks to the US Supreme Court.

The US Supreme Court not only ensured that all same-sex marriages be considered legal marriages at the Federal level, it ordered all states to issue same-sex marriage licenses and honor the same-sex marriages performed in other states.

This should ensure equal marriage rights for both same-sex and opposite sex couples.

As the Onion and Boing Boing jointly pointed out, there are many many more rights that LGBT people lack that they need. It’s not just marriage. Many states still do not allow same-sex couples to adopt. Others allow discrimination based on sexual orientation or gender identity in employment, schools, or housing. Men who have sex with men are still barred from giving blood at the federal level. In some states, transgender people lack access to legal name changes, protection from violence, health care coverage, and equal access to employment. There’s still a lot of legal work to be done.

And everybody needs access to knowledgeable, compassionate health care. No matter who they are, what they do, or who they do it with.

If you’re interested in medical organizations seeking to advance health care for all people, check these groups out:

  • GLMA: Gay and Lesbian Medical Association. Despite the name, covers all of “LGBT”. They are the premier medical advocacy group, and maintain a list of LGBT and LGBT-friendly providers.
  • WPATH: World Professional Association for Transgender Health. Creators of the Standard of Care, which give providers guidelines on best medical practices for transgender people around the world. Also has a list of providers.
  • TASHRA: The Alternative Sexualities Health Research Alliance​. A newer, smaller group “working to create a world where all kinksters have equal access to culturally competent, non-judgmental, and knowledgeable healthcare”.

And have a lovely rest of Pride month. We truly do have something to celebrate this year.