Mental health among lesbian, gay and bisexual people worsened in US states that banned gay marriage in 2004. Photograph: Susana Bates/Reuters
In the past few years, psychologists and doctors have discovered that policy changes for or against same-sex marriage can influence patterns of healthcare for lesbian and gay people. Although the research was conducted primarily on gay men in the US, the implications for other sexual minority groups in nations considering same-sex marriage legislation are far-reaching.
In the US, gay marriage has sparked a heated debate. Studying the health effects of policy changes is tricky, and never perfect, but some situations allow us to follow people's health as policy changes are enacted.
In the 2004 US elections, 14 states voted to limit the definition of marriage to being between a man and a woman.
One study followed the mental health of lesbian, gay and bisexual (LGB) individuals living in states who voted for constitutional amendments to ban gay marriage in 2004. They found that LGB individuals living in states that enacted the amendments showed higher rates of psychiatric disorders than LGB people living in states without such amendments.
The researchers also took "snapshots" of a sample of LGB individuals' mental health before and after the amendment to ban gay marriage. The magnitude of the effect was impressive: mood disorders increased by 38%, generalised anxiety disorder by a staggering 248% and alcohol use disorder by 42%.
The rates of psychiatric disorders didn't increase significantly among LGB individuals living in states without constitutional amendments, or among heterosexual people living in states with constitutional amendments.
The samples aren't perfect, but they are largely representative, so it is unlikely that random social differences between gay and lesbian people in pro-marriage states and those in anti-marriage states can explain these vast differences in mental health. What this research says to me is that living in a state with a discriminatory policy can have serious consequences for the mental health of gay and lesbian people.
But is the converse true? Could legislation enabling gay marriage have a protective effect on the mental health of gay and lesbian people?
A study in Arizona, a state which failed to pass an anti-gay marriage ballot, showed that lesbian, gay and bisexual people living there had fewer mood disorders than those living in states that passed anti-gay marriage ballots.
Now, such research is not without limitations ? the effects of changes to legislation will take years to occur so stronger scientific tests of these so-called "state interventions" are needed. For example, we often don't have good comparison groups and we need to know what the patterns of health were like before the policy was implemented.
One groundbreaking study in Massachusetts published last year addressed this problem. The study looked at 1,211 gay and bisexual men attending a community health centre. They were followed up during the 12 months before and the 12 months after the 2003 ballot to legalise gay marriage, therefore allowing researchers to directly test for changes to healthcare and its costs before and after the change in law.
The scientists discovered that in the 12 months following the change in marriage law, medical visits about physical problems among gay and bisexual men decreased by 13% and healthcare costs decreased by 10% compared with the 12 months before the change in law. Medical visits about mental health issues among gay and bisexual men decreased by 13% and associated costs decreased by 14%. These patterns were independent of whether the men had partners or not.
The outcomes of these studies might not be generalisable to all LGB people and, at an individual level, there are many other factors that may influence gay people's mental health. However, as a body of evidence, it does suggest a negative effect of state-level discrimination on the mental health of the gay community. It is an important part of the debate.
Tuesday's Commons vote in favour of same-sex marriage in the UK is good news for gay rights, and as we may see in the coming years, good news for the mental health of the UK gay, lesbian and bisexual community.
Dr Qazi Rahman is an academic at the Institute of Psychiatry, King's College London. He studies the biology of sexual orientation and the implications for mental health
Source: http://www.guardian.co.uk/science/blog/2013/feb/07/legalising-gay-marriage-health-healthcare-costs
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