4, 18– 22 This research has provided important insights, but histories and types of discrimination confronted by racial/ethnic and sexual minorities differ. Recent research with racial/ethnic minorities has shown that institutional discrimination, typically in the form of housing and neighborhood effects, is associated with various adverse health outcomes, including physical and mental health status, violence, and mortality. 17ĭespite the high prevalence of institutional discrimination against lesbian, gay, and bisexual individuals, few empirical studies have examined the extent to which this form of discrimination affects the mental health of the lesbian, gay, and bisexual community. Collectively, these policies represent examples of institutional discrimination, which refers to societal-level conditions that constrain individuals' opportunities, resources, and well-being. The failure to prohibit employer discrimination on the basis of sexual orientation and the exclusion of sexual orientation as a protected category in federal hate crimes legislation 15, 16 are additional examples of policies that do not extend protection to lesbian, gay, and bisexual individuals. This is but one of several current social policies targeting lesbian, gay, and bisexual individuals. 14ĭebates on social policies affecting lesbian, gay, and bisexual individuals have been common in recent years, including the November 2008 California election, in which voters reversed a state Supreme Court decision allowing gays and lesbians to marry. In the area of obesity, researchers have also pointed to social policy changes that may reduce the prevalence of obesity and associated morbidities, 13 such as altering the school food environment. For example, legislation restricting access, availability, and opportunities to use tobacco 6– 9 and alcohol 10– 12 has been shown to greatly affect the rates of use of these substances. 1– 5 In particular, social policies have received attention because they represent clear targets for intervention that can lead to significant improvement in public health at a population level.
Policies that reduce discrimination against gays and lesbians are urgently needed to protect the health and well-being of this population.Ī longstanding area of importance in public health research is the determination of how social factors influence the distribution of adverse health outcomes. State-level protective policies modify the effect of lesbian, gay, or bisexual status on psychiatric disorders.
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 =. 02), post-traumatic stress disorder ( F = 3.42 df = 2 P =. 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 =. States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation. 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). We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders.