Deborah Hasin

Same-sex marriage bans may be harmful to the mental health of gay people in those states. That is the conclusion of a new study published in the March issue of the American Journal of Public Health.

Deborah Hasin, professor of clinical epidemiology at Columbia University’s Mailman School of Public Health, and colleagues conducted their research by analyzing data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a project of the National Institutes of Health.

NESARC is a nationally representative study that interviewed the same group of non-institutionalized U.S. adults in both 2001–2002 and 2004-2005. Hasin and her team used the NESARC data to determine whether lesbian, gay, and bisexual individuals living in the 14 states that instituted same-sex marriage bans in or just after the 2004-2005 elections had increased rates of psychiatric disorders as a result of the discriminatory policies. The researchers controlled for age, gender, race, ethnicity, income, educational attainment, marital status, and region.

Few previous studies had looked at the mental health effect of laws that deprive LGB people of rights. One prior study on the subject came to similar conclusions, but the current study stands out for using a large, nationally representative sample and for looking at the participants over a period of time. Additionally, the NESARC data allowed the researchers to measure mental health against very specific definitions in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

They found that among the LGB population, the prevalence of mood disorders, generalized anxiety disorder, and alcohol use disorders increased significantly between the two waves of the study. Generalized anxiety disorder (GAD) showed the greatest increase, over 200 percent. GAD, as defined by the DSM-IV, is a state of long-term, excessive worry that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

The prevalence of any psychiatric disorder also increased slightly among heterosexual subjects in states that instituted same-sex marriage bans, but to a much lesser extent than among the LGB sample.

The researchers attribute the decline in mental health among the LGB population not only to the deprivation of rights, but also to the “extended and heated public discourse focusing on the legitimacy of such deprivation.”

Hasin, in an interview, said the costs go beyond individual harm.

“There’s a health care cost,” she said, “and any time people have psychiatric disorders with impairment in functioning, there are potentially costs in terms of their work productivity.”

Hasin and her co-authors at the New York State Psychiatric Institute, Harvard University, and Yale University, outline some remedies.

“Implementing social policy changes to abolish institutional forms of discrimination may ultimately reduce mental health disparities in LGB populations, an important public health priority,” they write. They cite the 2009 Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act and the legalization of same-sex marriage in Iowa as examples of such changes. Conversely, they say, California’s Proposition 8 “may have pernicious consequences for the health and well-being of the LGB community.”

Hasin said their study could be useful in legal cases that seek to overturn anti-gay laws.

“It is probably among the best types of evidence that you’re going to get,” she asserted, “because it is national and it does allow you to look closely at this.”

Jennifer Pizer, senior counsel and Marriage Project Director for Lambda Legal Defense and Education Fund, agreed that studies like this “are exceedingly useful and often critical for the work we do and for public health purposes.”

“It is immensely helpful to have top academic researchers quantifying and confirming these serious deleterious effects,” she said. Lawyers, she said, “don’t have the skills to be describing and measuring these effects as experts.” She and her colleagues, however, often give policy recommendations to legislatures and, in doing so, “We have to establish the need. We have to show the nature of the harm we have to stop.”

Pizer explained that experts in psychology and other social sciences, who have strong personal records from respected institutions, “can draw conclusions and offer opinions that can make an enormous difference in a trial.”

For example, she noted, Gregory Herek, professor of psychology at the University of California-Davis, assisted the APA with a brief in the 1993 Romer v. Evans trial that struck down an anti-gay amendment in Colorado and testified at this year’s trial on the legality of Proposition 8. One of Hasin’s colleagues at the Mailman School, Ilan Meyer, associate professor of clinical socio-medical sciences, also testified in the Proposition 8 case.

As for Hasin’s study, Pizer said, “Their finding is not a new scientific conclusion, but they have employed a methodology that will give it greater weight and context…. The focus on the harmful health effect of anti-gay ballot measures is timely and will have a positive impact.”