Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts
Open accessAbstract
Importance: Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts. Objective: To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. Design, Setting, and Participants: This study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies. Interventions: Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection. Main Outcomes and Measures: Self-report of 1 or more suicide attempts within the past 12 months. Results: Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6% of all high school students and 28.5% of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6-percentage point (95% CI, -1.2 to -0.01 percentage points) reduction in suicide attempts, representing a 7% relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities. Conclusions and Relevance: State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes.
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Past studies found higher suicide rates in cities with the highest levels of disadvantage among Black males as measured by unemployment rate, education level, family income, and residential racial segregation.
“and in cities with the highest levels of disadvantage among Black males as measured by unemployment rate, education level, family income, and residential racial segregation (101).”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [101]
Existing research, albeit scant, demonstrates that structural racism, as represented by economic inequity and residential segregation, is linked to suicide.
“The existing research, albeit scant, demonstrates that structural racism, as represented by economic inequity and residential segregation, is linked to suicide.”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [101]
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- Authors
- Raifman, J., Moscoe, E., Austin, S. B., & McConnell, M.
- Affiliations
- Johns Hopkins University (US)
- Harvard University (US)
- Boston Children's Hospital (US)
- Corresponding author
- Raifman, Julia
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-04-01
- Volume
- 171
- Issue
- 4
- Pages
- 350
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5848493
- OpenAlex
- W2590462955
- Cited by
- 426
- References
- 35
- Citations by year
- 2026: 17 · 2025: 35 · 2024: 33 · 2023: 28 · 2022: 43 · 2021: 42 · 2020: 72 · 2019: 102 · 2018: 28 · 2017: 24
- FWCI
- 88.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R25MH083620)
- National Institute of Allergy and Infectious Diseases (T32AI102623)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Health › Gun Ownership and Violence Research
- Keywords
- adolescent suicide attempts, sexual minority youth, LGBTQ youth mental health, high school students, Youth Risk Behavior Surveillance System, suicide prevention
- MeSH terms
- Adolescent, Adolescent Behavior, Female, Humans, Male, Marriage, Risk-Taking, Sexual Behavior, Students, Suicide, Suicide, Attempted, United States
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