Data Highlight Complex Interaction Between Politics, Mental Health

Bans on same-sex marriages imposed by 16 states during 2004 or 2005 appear to have negatively impacted the mental health of gay, lesbian, and bisexual individuals in those states, according to a study in the March American Journal of Public Health.

The authors concluded that the findings “lend scientific support to ... efforts to overturn these policies.”

The lead investigator was Mark Hatzenbuehler, M.S., a doctoral student in clinical psychology at Yale University.

The researchers used data from wave one (2001-2002) and wave two (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. The cohort included 34,076 heterosexual subjects, 9,963 of whom lived in states that had imposed same-sex marriage bans and 24,113 of whom lived in states that had not imposed such bans. The cohort also included 577 subjects who identified themselves as gay, lesbian, or bisexual. Of these 577 subjects, 135 lived in states that had imposed same-sex marriage bans, and 442 lived in states that had not.

The researchers compared the 2001-2002 mental health status of the 135 gay-lesbian-bisexual subjects living in states with same-sex marriage bans with their 2004-2005 status. The researchers took possibly confounding factors such as gender, age, race/ethnicity, income, education, and marital status (either legally married or living with someone as if married) into consideration. The incidence of mood disorders, alcohol use disorder, and generalized anxiety disorder was found to have increased significantly in the group between the two time periods, especially anxiety disorder.

The researchers then conducted the same analysis for the 9,963 heterosexual subjects living in the 16 states that had imposed bans on same-sex marriage in 2004 or 2005. The incidence of mood disorders, alcohol use disorder, and generalized anxiety disorder was found to have increased slightly, but not significantly, between the two time periods.

Finally, the researchers repeated the analysis for the 442 gay, lesbian, or bisexual subjects living in states that had not imposed same-sex marriage bans in 2004 or 2005. The incidence of alcohol use disorder and generalized anxiety disorder was found to have increased a little, but not significantly, between the two time periods. The incidence of mood disorders was found to have decreased between that time span.

“The study puts numbers on what psychiatrists have long known: that institutionalized societal prejudice harms the mental health of those who are targeted by the prejudice,” David Scasta M.D., told Psychiatric News. “The study is a compelling indictment of the animus that so clearly compromises the mental health of lesbian-gay-bisexual people and makes it imperative that psychiatrists be proactive in opposing prejudicial laws such as those that preclude gay marriage.” Scasta, a Princeton, N.J., forensic psychiatrist, represents the Association of Gay and Lesbian Psychiatrists in the APA Assembly.

“This study supports the proposal ... that social stress may contribute to higher rates of some psychiatric disorders in lesbian-gay-bisexual people,” Benjamin McCommon, M.D., a clinical professor of psychiatry at Columbia University with a special interest in the subject, noted. “Also, it follows a prior study by the same team that showed higher rates of psychiatric problems in lesbian-gay-bisexual people living in states without legal protections in areas such as employment.”

The study was funded by the National Institutes of Health and the New York State Psychiatric Institute.

An abstract of “The Impact of Institutional Discrimination on Psychiatric Disorders in Lesbian, Gay, and Bisexual Populations: A Prospective Study” is posted at <http://ajph.aphapublications.org/cgi/content/abstract/100/3/452>.