The legalization of same-sex marriage in Minnesota and other states before June 2015, when a ruling by the U.S. Supreme Court made such marriages legal nationwide, was associated with a significant drop in the rate of suicide attempts among high school students, according to a study published Monday in JAMA Pediatrics.

Not surprisingly, most of that decline in suicides was found to be concentrated among lesbian, gay and bisexual (LGB) adolescents.

The findings underscore the important role that government policies aimed at reducing structural stigma can have on improving health, including mental health.

“These are high school students so they aren’t getting married any time soon, for the most part,” says Julia Raifman, the study’s lead author and a post-doctoral researcher at Johns Hopkins University, in a released statement. “Still, permitting same-sex marriage reduces structural stigma associated with sexual orientation. There may be something about having equal rights — even if they have no immediate plans to take advantage of them — that makes students feel less stigmatized and more hopeful for the future.”

As background information in the study points out, suicide is the second leading cause of death (behind accidents) among young people aged 15 to 24 years in the United States. The rate is considerably higher for teens who identify as sexual minorities. Federal research published last year found that more than 29 percent of LGB high school students (grades 9 through 12) reported attempting suicide within the previous 12 months. That compared to 6 percent of heterosexual students.

Study details

For their study, the Hopkins University researchers used data collected between 1999 and 2015 by the Centers for Disease Control and Prevention as part of its Youth Risk Behavior Surveillance System — a survey conducted every two years. The data included survey responses from more than 760,000 students in 47 states, including 32 of the 35 states that had passed laws to legalize same-sex marriage by Jan. 1, 2017. (Minnesota passed such a law in August 2013.)

First, the researchers established attempted-suicide rates within each state that passed a same-sex marriage law — both for the five years leading up to the law’s implementation and for at least two years afterward. They then compared those rates with those for the states that did not enact same-sex marriage laws.

The analysis found that states that passed a law legalizing same-sex marriage experienced, on average, a 7 percent decline in suicide attempts among their high school students after the law was implemented. Most of that association was concentrated among young people who identified as LGB. Their suicide attempts declined 14 percent, on average, in states that implemented same-sex marriage laws.

States that did not enact such laws saw no drop in suicide attempts among their high school youth.

Raifman and her colleagues estimate that more than 134,000 fewer teens attempted suicide every year that their state permitted same-sex marriages. 

“These results reflect an important reduction in adolescent emotional distress and risk of mortality from suicide,” they write.

Implications for future policies

The study is an observational one, so it can show only a correlation, not a direct causation, between passage of the same-sex marriage laws and a reduction in teen suicide attempts. Still, the study’s findings support prior research that has found that legalizing same-sex marriage is positively associated with improvements in both the physical and mental health of adults within the LGB and other sexual minority communities.

As Raifman explained to Guardian reporter Nicola Davis, the current study didn’t examine why same-sex marriage laws had such an impact on LGB youth, but several factors are likely involved.

“Those include whether the policies themselves reduce perceived stigma among adolescents — and that may drive reductions in suicide attempts — but it is also possible that same-sex marriage policies drive social change among parents, teachers and peers of sexual minority adolescents,” she said. “It is also possible that the campaigns around same-sex marriage policies are responsible for changing the experiences of LGB adolescents.” 

Raifman warns that while legalizing same-sex marriage may have helped to reduce teen suicide attempts, other policies — ones that take away rights or add to stigma — could have the opposite effect.

“We can all agree that reducing adolescent suicide attempts is a good thing, regardless of our political views,” she says in the released statement. “Policymakers need to be aware that policies on sexual minority rights can have a real effect on the mental health of adolescents. The policies at the top can dictate in ways both positive and negative what happens further down.”

FMI: The study can be read on the JAMA Pediatrics website.