Teen suicide attempts are a persistent challenge. But policy changes may present an answer – albeit a controversial one.

In a study published Monday in the journal JAMA Pediatrics, researchers from Harvard and Johns Hopkins looked at the correlation between student-reported suicide attempts and state policies in the 16 years before June 2015, when the US Supreme Court ruled in favor of marriage equality nationwide. Drawing on a health survey database of almost 763,000 students, they observed a 7 percent decline in teenagers’ efforts to take their own lives in the year after their states legalized marriage equality, a figure that increased to 14 percent among teens who identified as gay, lesbian, or bisexual. All in all, that amounts to 134,000 fewer attempted suicides annually over the period.

"It's not easy to be an adolescent, and for adolescents who are just realizing they are sexual minorities, it can be even harder,” said lead study author Julia Raifman, a post-doctoral fellow at Johns Hopkins University, in a news release.

Legalizing same-sex marriage may have helped reduce suicide attempts by dismantling much of the social stigma LGB teens feel over their “sexual minority” status, the study’s authors suggested. Legalization reflects changing attitudes and may improve teenagers’ sense of being included in their communities, an idea that appears to be further supported by the fact that suicide rates remained flat in states that did not legalize same-sex marriage.

“The study tells us that even though young people are not necessarily thinking about getting married, the fact that the path is clear and the opportunity is real has a very positive impact on their level of optimism for the future,” writes Ellen Kahn, director of the Children, Youth, and Families Program at Human Rights Campaign, an advocacy organization, in an email to the Monitor.

Some groups are reluctant to say that the correlation proves that policy changes had any causative effect on the decline in suicide attempts.

“It’s always good news to hear that there is a report of decreased suicide attempts for whatever reason – it’s certainly worth celebrating,” Joseph L. Grabowski, director of communications for the National Organization for Marriage (NOM), an organization founded to oppose same-sex marriage, tells The Christian Science Monitor. But, he says, “I don’t think they’ve demonstrated that the policies as such had a direct impact on this question.”

In 2014, the last year for which such data are available, suicide ranked as the second leading cause of death among young people aged 10 to 24, according to the Centers for Disease Control and Prevention. And teens who identify as lesbian, gay, or bisexual are four times as likely to attempt to take their lives, according to the Trevor Project, a national suicide prevention organization.

For advocacy organizations that support marriage equality, the study offers encouragement as they continue their policy work.

“We have to continue our progress in creating a legal landscape that opens doors for LGBTQ youth … on many levels,” Ms. Kahn writes, noting that supportive schools, corporations, and laws “send a powerful message to LGBTQ youth that their hopes and dreams can come to fruition.”

For social conservatives, the drop in suicides is just as encouraging. Equally, however, it may present a conundrum: Which value – the sanctity of life or traditional marriage – takes precedence?

That may depend on how strongly they oppose same-sex marriage. Attitudes have undergone a dramatic shift over the past 15 years, from 60 percent opposition in 2000 to 60 percent support today, says Brian Powell, a sociology professor at Indiana University-Bloomington. If accurate, the study could encourage a group of current opponents to reconsider, he suggests.

“People change their mind, and a finding like this could have an impact on those people who are opposed but not adamantly opposed,” Professor Powell tells the Monitor.

But that shift in thought relies on having clear evidence of the pattern, he cautions.

“For research to have an impact, it has to be … so visible that people are talking about it,” Powell explains. He offers the example of climate change, where publicly presented, consistent data about climate change has, he says, helped spur a dramatic change in public attitudes.

Currently, the study demonstrates correlation, rather than proving causation, its authors acknowledge. To some, that suggests the policy shift, and its associated decline in stigma, may not be responsible.

“Stigma does not seem to account totally for why this happens,” says Mr. Grabowski of NOM. Instead, he proposes, the drop could be a sign that caregivers have become increasingly alert to the possibility of suicide among sexual minorities.

“Over the time of the study, the LGBT community was increasingly recognized as an at-risk population for suicide,” Grabowski says. That meant caregivers – from school guidance counselors to parents – were paying closer attention to these teenagers, directing them toward mental health services and counseling that “may have had more of an impact” than legislative changes, he says.

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The next step, he says, is further research to look for a causative link between marriage equality and suicide prevention, making a more substantive debate possible.

“We hope that future studies do get to the root cause of that decrease, so we can take better care of all our children,” Grabowski concludes.