The Relationship between State-Level Policy and Mental Health among Sexual Minority Youth in the United States

Abstract

This study sought to investigate the effect of state-level policies, pertaining to hate crimes and mental health care, on the association between sexual orientation and the prevalence of depression, suicidal ideation, suicide attempt, and bullying amongst adolescents. State-level policies included whether hate crime laws included sexual orientation as a protected category, and rates of follow-up care after hospital discharge amongst acutely mentally ill youth covered by public health insurance (Medicaid or the Children's Health Insurance Program; CHIP). Data were from the 2019 State-Level Youth Risk Behavior Survey (YRBS), completed by a representative sample (N = 153,215) of U.S. students in grades 9-12 across 44 states. The YRBS is one of the few population-based studies to gather sexual orientation data in a youth sample. Compared with living in states with hate crime laws extending protections to lesbian, gay, and bisexual (LGB) people, living in states without inclusive hate crime laws did not predict a significantly stronger association between LGB status and mental health. However, the association between LGB status and electronic (i.e., cyber) bullying was significantly greater in states with hate crime laws that excluded sexual orientation as a protected category than in states with inclusive hate crime laws. The association between LGB status and suicide attempt was significantly greater in states with lower rates of follow-up mental health care for acutely ill youth than in states with higher rates of follow-up care. This is the first known study to find an association between residing in a state with higher quality government-funded mental health care for acutely ill youth and reduced suicide attempt among LGB youth. These findings underscore the urgent need for state-level policies that increase legal protections and improve access to mental health care for sexual minority youth.