Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts

Abstract

IMPORTANCE Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts.OBJECTIVE To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. DESIGN, SETTING, AND PARTICIPANTSThis study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies.INTERVENTIONS Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection.MAIN OUTCOMES AND MEASURES Self-report of 1 or more suicide attempts within the past 12 months. RESULTS Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6% of all high school students and 28.5% of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6-percentage point (95% CI, -1.2 to -0.01 percentage points) reduction in suicide attempts, representing a 7% relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities.CONCLUSIONS AND RELEVANCE State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes.

Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment

“…Similarly, Raifman et al. () recently demonstrated that same‐sex marriage legislation at the state‐level related to decreased rates of suicide among LGBQ youth in that respective state. The higher risk status of both sexual and gender minority youth (LGBT) may also be attributed to the consistently higher rates of victimization they experience both at home and school, relative to sexual nonminority youth (D'Augelli, Grossman, & Starks, ; Friedman et al., ; McGuire, Anderson, Toomey, & Russell, ).…”

Designing Difference in Difference Studies: Best Practices for Public Health Policy Research

“…S. Decisions about how many leads to examine are somewhat arbitrary and mainly have to do with the total number of periods available for analysis and the timing of the policy changes. Examples of studies that include lead tests are those by Bachhuber et al (11) (on the relationship between medical cannabis laws and opioid overdose mortality) and Raifman et al (88) (on the relationship between same-sex marriage laws and adolescent suicide attempts).…”

The kids are OK: it is discrimination not same‐sex parents that harms children

“…Recent research indicates that legalising same‐sex marriage has a positive impact on the mental health and wellbeing of LGBTIQ+ young people. Analysis of data from the Youth Risk Behavior Surveillance System, a nationally representative survey of school students in the US, revealed a 7% relative reduction in suicide attempts among sexual minority students living in states where same‐sex marriage laws had been enacted 28 …”