Marriage Equality = Fewer Adolescents Killing Themselves. Some Implications:

JAMA, The Journal of the American Medical Association, recently published a study: “Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts”.

Findings …same-sex marriage policies were associated with a 7% reduction in the proportion of all high school students reporting a suicide attempt within the past year.

Meaning Same-sex marriage policies are associated with reduced adolescent suicide attempts.

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 [the Youth Risk Behavior Surveillance System] between 1999 and 2015, a weighted 8.6% of all high school students and 28.5% of 231 413 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. [emphasis added]

A 0.6–percentage point decline in suicide rates for all students would be equivalent to an estimated 134 446… fewer adolescents attempting suicide each year, based on the 2015 US population estimates of adolescents aged 15 to 19 years.

In other words, in each year following the establishment of nationwide marriage equality, about 130,000 American adolescents didn’t attempt suicide, who otherwise would have. Between 2.5% and 10% of suicide attempts result in death, so that’s roughly 3,000 to 13,000 kids alive each year who would have been dead otherwise.

Note that it was true of all adolescents, not just LGBT kids. The effect was more pronounced in LGBT kids, but it was present in all kids. LGBT equality is a tide which lifts straight boats, too.

That’s just considering death. There’s also the human suffering to consider, both of those who remain alive and of those who ultimately killed themselves. People don’t kill themselves on a whim. They do it because they can’t bear the agony that they’re going through, and they run out of whatever hope or determination was getting them through that day, or that hour, or that minute. They do it because the fear of death and the risk of surviving maimed are less painful than the pressure they are under, whatever that pressure is.

We know that chronic pain increases suicide risk. So does traumatic brain injury, and kidney failure requiring hemodialysis. A cancer diagnosis roughly doubles the risk of suicide. Being a veteran of war roughly doubles or triples the risk of suicide, depending on the study.

The rate of suicide attempt in the general population is about 4.6%. If attempt were perfectly correlated with completion, then the attempt rate in the population of war veterans would be about 10-12%, but studies show that veterans are more likely to complete a suicide attempt, which would mean that combat veterans have a suicide attempt rate lower than 12%.

The rate of suicide attempt among trans adults (those who were still alive to respond to surveys) is about 41%.

Ever since the Williams Institute published the study which contained that 41% figure, anti-trans people have used it as “evidence” to argue that trans people are mentally ill — because only mentally ill people would kill themselves, right?

But we don’t make that argument of combat veterans, do we? Somehow, most people understand effortlessly that human beings who survive the toxic, corrosive stew that is combat are often wounded because of it.

We don’t make that argument about victims of bullying, either. It’s well-known that being bullied increases the risk of suicide, but when someone suggests that children who kill themselves after being bullied are ill, or weak, and just needed to be tougher… most people understand effortlessly that if a person says that about a bullied child, that person is acting like an asshole.

Trans people deal with daily, hourly corrosion, and the result is that for some of us, the fear of another day of it, or another hour of it, comes to outweigh the fear of death or maiming.

I’m not going to try to explain what that corrosion is like. Getting into that headspace thoroughly enough to describe it to someone who has never been there… that is difficult and corrosive in itself. (Especially when the person you’re explaining it to still doesn’t get it. People who don’t get it are not necessarily bad people, it’s just that they have no life experience sufficiently parallel to enable them to grasp it. It’s a level of unrelenting pressure qualitatively beyond their experience. The chasm is too wide to leap.)

Instead, consider it from the other side. If trans people are not fundamentally mentally ill, if we are “just folks”, and most of our troubles, like other folks’ troubles, arise from having to grapple with how people in our society treat us…

…then the treatment our society metes out to us must be truly hellish, to produce an average level of suicidal despair more than four times higher than that of combat veterans.

And indeed, our society’s treatment is hellish. And also, like all folks encountering extreme difficulty, when the difficulty moderates somewhat, we do better. A 2015 study in Canada, focused specifically on trans people, found that

High levels of social support (90th percentile) versus low levels (10th percentile) were significantly associated with a 49 % reduction in suicide ideation… and with a further 82 % reduction in attempt risk among those with ideation… This would be associated with potential prevention of 100 cases of ideation per 1,000 trans persons… and a further prevention of 220 attempts per 1,000 trans persons considering suicide…

This is not a shocking finding, but one of the basic tasks of scientific research is to discover whether what we believe is supported by the evidence. So, there we go: there is some evidence that lower levels of social support result in more dead people.

It’s especially important not to be rejected by your family. According to The Trevor Project,

LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGB peers who reported no or low levels of family rejection.

Administrative support matters, too. Back to the Canadian study:

Having one or more identity documents concordant with lived gender was significantly associated with reductions in past-year ideation… with the potential to prevent 90 cases of ideation per 1,000 trans persons… and 230 attempts per 1,000 with ideation.

In other words, being able to legally assert your identity is positively correlated with survival.

Nothing succeeds like success. Success begets hope. Hope begets resilience.

Harvey Milk knew this from his own lived experience, way back in 1978, almost forty years ago:


Somewhere in Des Moines, or San Antonio, there is a young gay person, who all of a sudden realizes that she or he is gay, knows that if the parents find out, they will be tossed out of the house, their classmates will taunt the child, and the Anita Bryants and John Briggs are doing their bit on TV, and that child has several options: staying in the closet, suicide. And then one day that child might open a paper that says, “Homosexual elected in San Francisco” and there are two new options. One option is to go to California, [and the other option] is to stay in San Antonio and fight.

Two days after I was elected, I got a phone call, and the voice was quite young. It was from Altoona, Pennsylvania. And the person said, “Thanks.”

And you’ve got to elect gay people, so that that young child, and the thousands upon thousands like that child know that there’s hope for a better world, there’s hope for a better tomorrow. Without hope, not only gays, but the blacks, the asians, the disabled, the seniors, the usses, the usses. Without hope, the usses give up. I know that you cannot live on hope alone. But without it, life is not worth living.

And you, and you, and you: you’ve got to give them hope.

Probably most of those adolescents who didn’t kill themselves weren’t planning on getting married, specifically. But the movement of our nation toward equality gave them hope, so that when the next moment of suicidal ideation came, they were able to push past it, and survive.

When Attorney General Loretta Lynch gave her powerful speech in support of trans people

… it gave us hope. I’ve talked about that speech before. I felt that sense of hope.

Conversely, in 2012, when the government of New Hampshire last considered the rights of trans people to equal access in public accommodation and it never got out of committee, and was unanimously voted “inexpedient to legislate”… I felt that sense of despair.

If our society stopped treating trans and gender nonconforming people like pariahs, we would kill ourselves no more often than other folks.

And some evidence for the truth of that proposition is in the reduction in adolescent suicide which followed nationwide marriage equality.

Last summer I attended a meeting at the Unitarian Church of Montpelier. One of the things they do to support their community’s LGBT youth is to regularly open their doors to them, I think every other week, and throw a social, where those kids can have pizza and do their thing in a safe environment. That program has saved lives. They know this, because the survivors tell them. A kid arrives, planning to commit suicide later, and mentions it, and people rally around, and protect them, and they make it through to another day, with more hope.

This issue is not merely a matter of principle, of fair treatment. This is a matter of survival. It is as lethal as a heart attack.

…lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection.

Let’s give kids hope, here in New Hampshire. All the kids, including your kids. Especially LGBT kids… some of whom might turn out to be yours, too, since we LGBT folks are born to every kind of parent.

Let’s pass HB478, the New Hampshire gender identity nondiscrimination bill. In 2012, it died in committee. Here in 2017, it made it out of committee and into the whole House.

This week, I’m meeting with one of my reps. She’s in favor, but she has questions about details and wants to be able to understand trans people better, which will enable her to advocate better.

Here’s my offer: I will make time to meet with any rep who wants to meet with me. I’ve called all of mine. If you have one who would like to meet a trans person who is thoughtful, knowledgeable, and pleasant, please have them contact me at this e-mail, minus the chaff (to defeat robots):

Let’s pass this thing.

How to contact your NH legislators.



3 thoughts on “Marriage Equality = Fewer Adolescents Killing Themselves. Some Implications:

  1. Pingback: Thoughts While Driving Home as a Second-Class Citizen: Look After the Children | And Taking It Personally

  2. Pingback: Open Thread and Link Farm, Pie In A Mirror Edition | Alas, a Blog

  3. Pingback: AG Jeff Sessions: We affirm the dignity of trans people… but we won’t protect them from those who don’t. | And Taking It Personally

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