State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations

Am J Public Health. 2009 Dec;99(12):2275-81. doi: 10.2105/AJPH.2008.153510. Epub 2009 Oct 15.


Objectives: We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders.

Methods: Data were from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study of noninstitutionalized US adults (N=34,653). States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation.

Results: Compared with living in states with policies extending protections, living in states without these policies predicted a significantly stronger association between lesbian, gay, or bisexual status and psychiatric disorders in the past 12 months, including generalized anxiety disorder (F=3.87; df=2; P=.02), post-traumatic stress disorder (F=3.42; df=2; P=.04), and dysthymia (F=5.20; df=2; P=.02). Living in states with policies that did not extend protections also predicted a stronger relation between lesbian, gay, or bisexual status and psychiatric comorbidity (F=2.47; df=2; P=.04).

Conclusions: State-level protective policies modify the effect of lesbian, gay, or bisexual status on psychiatric disorders. Policies that reduce discrimination against gays and lesbians are urgently needed to protect the health and well-being of this population.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety Disorders / epidemiology
  • Bisexuality / psychology*
  • Crime
  • Female
  • Homosexuality, Female / psychology*
  • Homosexuality, Male / psychology*
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Mood Disorders / epidemiology
  • Odds Ratio
  • Prejudice*
  • Public Policy* / legislation & jurisprudence
  • Substance-Related Disorders / epidemiology