A nationwide analysis suggests same-sex marriage policies were associated with a reduction in suicide attempts by adolescents, according to a new study published online by JAMA Pediatrics.

Suicide is the second leading cause of death in young people between the ages of 15 and 24, and adolescents who are sexual minorities are at increased risk of suicide attempts. It is unclear what causes adolescents who are sexual minorities to have greater rates of suicide attempts, but potential mechanisms may include stigma. Policies preventing same-sex marriage are a form of structural stigma because they label sexual minorities as different and deny them benefits associated with marriage, according to the article.

Julia Raifman, Sc.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and coauthors estimated the association between same-sex marriage policies and the proportion of adolescents attempting suicide based on analysis using state-level Youth Risk Behavior Surveillance System data from 1999 through 2015.

The authors compared changes in suicide attempts among all public high school students before and after implementation of policies permitting same-sex marriage in 32 states with changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. The authors analyzed data from almost 763,000 adolescents.

Authors report 8.6 percent of all high school students and 28.5 percent of 231,413 students who identified as sexual minorities reported suicide attempts before same-sex marriage policies were implemented.

Same-sex marriage policies were associated with a 0.6 percentage point reduction in suicide attempts, which represents a 7 percent reduction in the proportion of all high school students reporting a suicide attempt within the past year, according to the results. The effect of that reduction was concentrated among adolescents who were sexual minorities. The authors estimate same-sex marriage policies would be associated each year with more than 134, 000 fewer adolescents attempting suicide, according to the article.

The study has limitations, including that it does not tell authors the ways by which implementing same-sex marriage policies reduces adolescent suicide attempts.

"We provide evidence that implementation of same-sex marriage policies reduced adolescent suicide attempts. As countries around the world consider enabling or restricting same-sex marriage, we provide evidence that implementing same-sex marriage policies was associated with improved population health. Policymakers should consider the mental health consequences of same-sex marriage policies," the study concludes.

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(JAMA Pediatr. Published online February 20, 2017. doi:10.1001/jamapediatrics.2016.4529; available pre-embargo at the For The Media website.)

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