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Denial of services linked with mental distress among same-sex couples

Laws in the United States that permit same-sex couples to be denied services were associated with a 46% increase in adult sexual minorities experiencing mental distress, according to data published in JAMA Psychiatry. Researchers noted that such laws currently exist in 12 states and are under review by the Supreme Court.

“The United States is at a turning point with regard to institutional stigma in the form of federal and state laws permitting the denial of services to sexual minorities,” Julia Raifman, ScD, department of health law, policy and management, Boston University School of Public Health, and colleagues wrote. “Evidence indicates changes in state-level institutional stigma, such as through same-sex marriage laws, are associated with changes in mental health outcomes among sexual minorities.”

Researchers examined whether state laws permitting the refusal of services to sexual minorities impacted the proportion of adults who identified as gay, lesbian, bisexual or unsure of their sexual orientation reporting mental distress.

Using 2014 to 2016 Behavioral Risk Factor Surveillance System data, Raifman and colleagues performed a difference-in-difference-in-differences linear regression analysis with state fixed effects to determine mental distress among sexual minority adults living in three states that implemented these laws — Utah, Michigan and North Carolina — and six control states — Idaho, Nevada, Ohio, Indiana, Virginia and Delaware). They controlled for year and individual-level sex, race, ethnicity, age group, education level, income, employment and marital status.

Of 109,089 participants included in the analysis, 4,656 identified as sexual minorities. Overall, 2,038 of 16,637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the three states that denied services to same-sex couples reported mental distress in 2014.

Between 2014 and 2016, the proportion of sexual minority adults reporting mental distress increased by 10.13 percentage points (95% CI, 1.8-18.5) in same-sex denial states compared with control states, which indicated a 46% relative increase in mental distress among sexual minority adults. Sensitivity analyses showed same-sex denial laws were linked to 2.47 additional unhealthy days in the past month among sexual minority adults (95% CI, 0.49-4.46). However, laws that allowed denial of services were not related to changes in heterosexual adults reporting mental distress (0.36 percentage points; 95% CI, 1.73 to 1.01).

“The magnitude of the 10.13 percentage point increase (a 46% relative increase) in mental distress associated with laws permitting denial of services to same-sex couples is on the larger end of the spectrum compared with other laws and policies that affect population mental health,” Raifman and colleagues wrote. “Lawmakers and courts considering laws permitting denial of services to sexual minorities should consider the association between these laws and increases in the proportion of sexual minority adults experiencing mental distress.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.