Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts.
Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts.
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DOI：
10.1001/jamapediatrics.2016.4529
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发表时间：
2017-04-01
期刊：
影响因子：
26.1
通讯作者：
McConnell M
中科院分区：
文献类型：
--
作者：
Raifman J;Moscoe E;Austin SB;McConnell M
自杀是15至24岁青少年死亡的第二大原因。性少数群体的青少年自杀未遂率较高。评估各州同性婚姻政策与青少年自杀企图之间的关联。这项研究使用了从1999年1月1日到2015年12月31日的州级青年风险行为监测系统（YRBSS）数据，这些数据被加权以代表参与调查的每个州超过60%。一项差异中的差异分析比较了32个州允许同性婚姻的州政策实施前后所有公立高中学生自杀企图的变化，以及15个州不允许同性婚姻的州高中生自杀企图的逐年变化。线性回归用于控制州、年龄、性别、种族/民族和年份，泰勒级数线性化标准误按州和教室聚类。在对性少数群体学生的二次分析中，我们纳入了性少数群体身份与生活在实施同性婚姻政策的州之间的相互作用。在YRBSS数据收集的整个期间执行允许同性婚姻的国家政策。在过去的12个月内有1次或多次自杀企图的自我报告。在1999年至2015年期间参加YRBSS的762678名学生（平均[SD]年龄，16.0 [1.2]岁; 366063名男性和396615名女性）中，所有高中生的加权8.6%和28.5%的被确定为性少数的学生在实施同性婚姻政策之前报告了自杀企图。同性婚姻政策与自杀企图减少0.6个百分点（95% CI，-1.2至0.01个百分点）相关，这意味着由于同性婚姻的实施，高中生自杀企图的比例相对减少7%。该协会集中在性少数群体的学生中。州同性婚姻政策与报告自杀企图的高中生比例下降有关，为同性婚姻政策与心理健康结果之间的关联提供了经验证据。
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. To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. 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. Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection. Self-report of 1 or more suicide attempts within the past 12 months. 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. 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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