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Denial of Service Laws, Mental Distress Linked

JAMA Psychiatry; ePub 2018 May 23; Raifman, et al

Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress, according to a recent study. Researchers analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). They found:

  • Of 109,089 participants, 4,656 (4.8%; all percentages incorporate survey weights) identified as sexual minorities, 86,141 (72.1%) were non-Hispanic white, and ages were uniformly distributed between 18 and 64 years.
  • In 2014, 2,038 of 16,637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the 3 same-sex denial states reported mental distress.
  • The proportion of sexual minority adults reporting mental distress increased by 10.1 percentage points between 2014 and 2016 in states that passed laws permitting denial of services to same-sex couples compared with control states, a 46% relative increase.


Raifman J, Moscoe E, Austin B, Hatzenbuehler ML, Galea S. Association of state laws permitting denial of services to same-sex couples with mental distress in sexual minority adults. A difference-in-difference-in-differences analysis. [Published online ahead of print May 23, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0757.

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