MedicalResearch.com Interview with:
Julia Raifman, ScD SM
Health Law, Policy, and Management
Boston University School of Public Health
Boston, MA 02118
MedicalResearch.com: What is the background for this study? What methods did you use? What are the main findings?
Response: The study was motivated by evidence that lesbian, gay, and bisexual (LGB) people in the United States have elevated levels of depression, anxiety, suicide, and mental distress. LGB mental health disparities have been linked to experiences of stigma based on sexual orientation, but most of this evidence comes from studies of association. We were interested in investigating how state policies permitting the denial of services to same-sex couples affected the mental health of LGB individuals.
We used data that are representative of all adults in each of the nine states included in the study, from the 2014 to 2016 waves of the Behavioral Risk Factor Surveillance System (BRFSS). The main outcome was mental distress, which can include stress, depression, and problems with emotions. We evaluated changes in mental distress among LGB adults in three states that passed policies permitting the denial of services to same-sex couples compared to changes in mental distress among heterosexual adults in the same states and among LGB adults in six control states. We controlled for all state characteristics that did not change over time, as well as individual age group, race, ethnicity, sex, educational attainment, employment, income, and marital status.
MedicalResearch.com: What should readers take away from your report?
Response: Policies permitting the denial of services to same-sex couples were associated with a 10 percentage point and 46% relative increase in the proportion of LGB adults experiencing mental distress when we adjusted for all control variables. Mental distress was already elevated among LGB adults prior to the policy changes, with 22% reporting mental distress relative to 13% of heterosexual adults in 2014 in the three states with policy changes. In states that passed policies permitting the denial of services to same-sex couples, the proportion of LGB adults reporting mental distress increased by an additional 11 percentage points, relative to a 1 percentage point increase in mental distress among heterosexual adults in the same states and among LGB adults in the six control states.
MedicalResearch.com: What recommendations do you have for future research as a result of this work
Response: Policies permitting the denial of services to same-sex couples are associated with a 46% increase in the proportion of LGB adults reporting mental distress.
MedicalResearch.com: What are the implications of this study?
Response: We hope that our study will inform judges and policymakers about how policies that permit the denial of services to LGB and transgender (LGBT) populations harm health. Policymakers who want to prevent mental health harm from denying services to LGBT populations could implement policies to prohibit the denial of services to LGBT populations.
No conflicts of interest
Raifman J, Moscoe E, Austin SB, Hatzenbuehler ML, Galea S. Association of State Laws Permitting Denial of Services to Same-Sex Couples With Mental Distress in Sexual Minority AdultsA Difference-in-Difference-in-Differences Analysis. JAMA Psychiatry. Published online May 23, 2018. doi:10.1001/jamapsychiatry.2018.0757
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