research paper about same sex marriage

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Research Article

Perceived psychosocial impacts of legalized same-sex marriage: A scoping review of sexual minority adults’ experiences

Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation College of Health and Human Sciences, San José State University, San José, California, United States of America

Roles Data curation, Formal analysis, Methodology, Validation, Writing – original draft, Writing – review & editing

Affiliation School of Social Welfare, University of California, Berkeley, California, United States of America

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation School of Nursing, Columbia University, New York, New York, United States of America

Roles Formal analysis, Writing – original draft, Writing – review & editing

Affiliation Department of Political Science and Gender and Women’s Studies, University of Kentucky, Lexington, Kentucky, United States of America

Affiliation Educational, Counseling and School Psychology, University of Kentucky, Lexington, Kentucky, United States of America

Affiliation Center for Human Sexuality Studies, Widener University, Chester, Pennsylvania, United States of America

Affiliation Department of Psychology, Palo Alto University, Palo Alto, California, United States of America

Roles Conceptualization, Writing – original draft, Writing – review & editing

Affiliation School of Nursing & Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America

• Laurie A. Drabble, 
• Angie R. Wootton, 
• Cindy B. Veldhuis, 
• Ellen D. B. Riggle, 
• Sharon S. Rostosky, 
• Pamela J. Lannutti, 
• Kimberly F. Balsam, 
• Tonda L. Hughes

• Published: May 6, 2021
• https://doi.org/10.1371/journal.pone.0249125
• Reader Comments

A growing body of literature provides important insights into the meaning and impact of the right to marry a same-sex partner among sexual minority people. We conducted a scoping review to 1) identify and describe the psychosocial impacts of equal marriage rights among sexual minority adults, and 2) explore sexual minority women (SMW) perceptions of equal marriage rights and whether psychosocial impacts differ by sex. Using Arksey and O’Malley’s framework we reviewed peer-reviewed English-language publications from 2000 through 2019. We searched six databases (PubMed, PsycINFO, CINAHL, Web of Science, JSTOR, and Sociological Abstracts) to identify English language, peer-reviewed journal articles reporting findings from empirical studies with an explicit focus on the experiences and perceived impact of equal marriage rights among sexual minority adults. We found 59 studies that met our inclusion criteria. Studies identified positive psychosocial impacts of same-sex marriage (e.g., increased social acceptance, reduced stigma) across individual, interpersonal (dyad, family), community (sexual minority), and broader societal levels. Studies also found that, despite equal marriage rights, sexual minority stigma persists across these levels. Only a few studies examined differences by sex, and findings were mixed. Research to date has several limitations; for example, it disproportionately represents samples from the U.S. and White populations, and rarely examines differences by sexual or gender identity or other demographic characteristics. There is a need for additional research on the impact of equal marriage rights and same-sex marriage on the health and well-being of diverse sexual minorities across the globe.

Citation: Drabble LA, Wootton AR, Veldhuis CB, Riggle EDB, Rostosky SS, Lannutti PJ, et al. (2021) Perceived psychosocial impacts of legalized same-sex marriage: A scoping review of sexual minority adults’ experiences. PLoS ONE 16(5): e0249125. https://doi.org/10.1371/journal.pone.0249125

Editor: Peter A. Newman, University of Toronto, CANADA

Received: September 9, 2020; Accepted: March 11, 2021; Published: May 6, 2021

Copyright: © 2021 Drabble et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: Dr. Drabble and Dr. Trocki are supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R03MD011481 ( https://www.nimhd.nih.gov/ ). Dr. Veldhuis’ participation in this research was made possible through an NIH/NIAAA Ruth Kirschstein Postdoctoral Research Fellowship (F32AA025816; PI C. Veldhuis). Dr. Hughes is funded by the National Institute on Alcohol Abuse and Alcoholism (R01 AA0013328, https://www.niaaa.nih.gov/ ). The content is solely the responsibility of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Legalization of same-sex marriage represents one important step toward advancing equal rights for sexual and gender minorities. Over the past two decades same-sex marriage has become legally recognized in multiple countries around the world. Between 2003 and mid-2015, same-sex couples in the United States (U.S.) gained the right to marry in 37 of 50 states. This right was extended to all 50 states in June 2015, when the U.S. Supreme Court ruled in Obergefell v. Hodges that same-sex couples in all U.S. states had equal marriage rights. As of October 2019, same-sex couples had the right to marry in 30 countries and territories around the world [ 1 ].

National laws or policies that extend equal marriage rights to same-sex couples signal a reduction in structural stigma and have the potential to positively impact the health and well-being of sexual minorities. Structural stigma refers to norms and policies on societal, institutional and cultural levels that negatively impact the opportunities, access, and well-being of a particular group [ 2 ]. Forms of structural stigma that affect sexual minorities—such as restrictions on same-sex marriage—reflect and reinforce the social stigma against non-heterosexual people that occurs at individual, interpersonal, and community levels [ 3 ]. According to Hatzenbuehler and colleagues, structural stigma is an under-recognized contributor to health disparities among stigmatized populations [ 4 – 6 ], and reductions in structural stigma can improve health outcomes among sexual minorities [ 7 , 8 ].

Marriage is a fundamental institution across societies and access to the right to marry can reduce sexual-minority stigma by integrating sexual minority people more fully into society [ 9 ]. Same-sex marriage also provides access to a wide range of tangible benefits and social opportunities associated with marriage [ 9 , 10 ]. Despite the benefits of marriage rights, sexual minorities continue to experience stigma-related stressors, such as rejection from family or community, and discrimination in employment and other life spheres [ 11 ]. In addition, reactions to same-sex marriage appear to differ among sexual minorities and range from positive to ambivalent [ 11 – 13 ]. Extending marriage rights to same-sex couples remedies only one form of structural stigma. Although legalization of same-sex marriage represents a positive shift in the social and political landscape, the negative impact of social stigma may persist over time. For example, a recent Dutch study found that despite 20 years of equal marriage rights, sexual minority adolescents continue to show higher rates of substance use and lower levels of well-being than their heterosexual peers [ 14 ]. This study underscores the importance of understanding the complex impact of stigma at the structural, community, interpersonal, and individual levels.

Impact on sexual minority health

A growing body of literature, using different methods from diverse countries where same-sex marriage has been debated or adopted, provides important insights into the impact of equal marriage rights on the health and well-being of sexual minority individuals. Research to date has consistently found that legal recognition of same-sex marriage has a positive impact on health outcomes among sexual and gender minority populations [ 15 – 20 ]. Studies in the U.S. have found evidence of reduced psychological distress and improved self-reported health among sexual minorities living in states with equal marriage rights compared to those living in states without such rights [ 5 , 21 – 23 ]. One state-specific study also found improved health outcomes for sexual minority men after legalization of same-sex marriage [ 24 ]. Furthermore, sexual minorities living in states that adopted, or were voting on, legislation restricting marriage recognition to different-sex couples reported higher rates of alcohol use disorders and psychological distress compared to those living in states without such restrictions [ 5 , 25 – 31 ]. Consistent with research in the U.S., findings from research in Australia on marriage restriction voting, found that sexual minorities living in jurisdictions where a majority of residents voted in support of same-sex marriage reported better overall health, mental health, and life satisfaction than sexual minorities in locales that did not support same-sex marriage rights [ 32 ].

Although existing literature reviews have documented positive impacts of equal marriage rights on physical and mental health outcomes among sexual minority individuals [ 15 – 20 ], to our knowledge no reviews have conducted a nuanced exploration of the individual, interpersonal, and community impacts of legalized same-sex marriage. An emerging body of quantitative and qualitative literature affords a timely opportunity to examine a wide range of psychosocial impacts of equal marriage rights. Understanding these impacts is important to guide and interpret future research about the potential protective health effects of same-sex marriage.

Potential differences between SMW and SMM

Given the dearth of research focusing on the health and well-being of sexual minority women (SMW), especially compared to the sizable body of research on sexual minority men (SMM) [ 33 , 34 ], there is a need to explore whether the emerging literature on same-sex marriage provides insights about potential differences in psychosocial impacts between SMW and SMM. Recent research underscores the importance of considering SMW’s perspectives and experiences related to same-sex marriage. For example, gendered social norms play out differently for women and men in same-sex and different-sex marriages, and interpersonal dynamics and behaviors, including those related to coping with stress, are influenced by gender socialization [ 35 ]. However, there is little research about how societal-level gender norms and gendered social constructions of marriage may be reflected in SMW’s perceptions of same-sex marriage. Structural sexism (e.g., gendered power and resource inequality at societal and institutional levels) differentially impacts women’s and men’s health [ 36 ], and may also contribute to sex differences in experiences and impacts of same-sex marriage. For example, research from the U.S. suggests that same-sex marriage rights may improve health outcomes and access to healthcare for SMM, but evidence is less robust for SMW [ 37 – 39 ]. Differences in health outcomes appear to be at least partially explained by lower socioeconomic status (income, employment status, perceived financial strain) among SMW compared to SMM [ 40 ]. Further, other psychosocial factors may contribute to differential experiences of legalized same-sex marriage. For example, a study of older sexual minority adults in states with equal marriage rights found that married SMW experienced more LGBTQ (lesbian, gay, bisexual, transgender, queer) microaggressions than single SMW, but no differences by relationship status were noted among SMM [ 41 ]. Mean number of microaggressions experienced by SMW in partnered unmarried relationships fell between, but were not significantly different from, that of married and single SMW.

Theoretical framework

Social-ecological and stigma theoretical perspectives were used as the framework for organizing literature in this review (See Fig 1 ). Stigma occurs and is experienced by sexual minorities at individual, interpersonal, and structural levels, which mirror the levels of focus within the social-ecological framework [ 6 , 42 ]. Consequently, changes such as extending equal marriage rights to same-sex couples may influence sexual minorities’ experiences of stigma across all of these levels [ 43 ]. Gaining access to the institution of marriage is distinct from marital status (or being married) and likely impacts sexual minority adults across individual, interpersonal, and community contexts [ 44 ], regardless of relationship status.

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From a social-ecological perspective, individual and interpersonal processes can amplify or weaken the impact of structural level policies, such as equal marriage rights, on sexual minority individuals’ health and well-being [ 43 , 45 , 46 ]. For example, on an individual level, experiences and perceptions of equal marriage rights may influence stigma-related processes such as internalized heterosexism, comfort with disclosure, and centrality of sexual identity [ 47 ]. Interpersonal and community level interactions may trigger stigma-related processes such as prejudice concerns, vigilance, or mistrust. Such processes may in turn, influence the impact of social policy change on sexual minority stress and well-being [ 48 – 50 ].

The impact of equal marriage rights among sexual minority individuals may also be influenced by other social and political factors such as state- or regional-level social climate [ 50 – 52 ], or inconsistency among other policy protections against discrimination (e.g., in housing or public accommodations) [ 11 , 50 ]. Sociopolitical uncertainty may continue long after the right to marry is extended to same-sex couples [ 53 , 54 ]. Monk and Ogolsky [ 44 ] define political uncertainty as a state of “having doubts about legal recognition bestowed on individuals and families by outside systems; being unsure about social acceptance of marginalized relationships; being unsure about how ‘traditional’ social norms and roles pertain to marginalized relationships or how alternative scripts might unfold” (p. 2).

Current study

The overall aim of this scoping review was to identify and summarize existing literature on psychosocial impacts of equal marriage rights among sexual minority adults. Specific objectives were to: 1) identify and describe the psychosocial impacts of equal marriage rights on sexual minority adults; and 2) explore SMW-specific perceptions of equal marriage rights and whether psychosocial impacts differ for SMM and SMW.

Study design

We used a scoping review approach, as it is well-suited for aims designed to provide a descriptive overview of a large and diverse body of literature [ 55 ]. Scoping reviews have become a widely used approach for synthesizing research evidence, particularly in health-related fields [ 55 ]. Scoping reviews summarize the range of research, identify key characteristics or factors related to concepts, and identify knowledge gaps in particular areas of study [ 56 , 57 ]. By contrast, systematic reviews are more narrowly focused on creating a critically appraised synthesized answer to a particular question pertinent to clinical practice or policy making [ 57 ]. We aimed to characterize and summarize research related to psychosocial impacts of equal marriage rights and same-sex marriage, including potential gaps in research specific to SMW. Following Arksey and O’Malley [ 56 ], the review was conducted using the following steps: 1) identifying the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarizing and reporting results. Because this is a scoping review, it was not registered with PROSPERO, an international registry for systematic reviews.

Selection method

The authors used standard procedures for conducting scoping reviews, including following PRISMA guidelines [ 58 ]. Articles that report findings from empirical studies with an explicit focus on the psychosocial impacts of equal marriage rights and same-sex marriage on sexual minority adults are included in this review. All database searches were limited to studies in English language journals published from 2000 through 2019 (our most recent search was executed in June 2020). This time frame reflects the two decades since laws regarding same-sex marriage began to change in various countries or jurisdictions within countries. Literature review articles and commentaries were excluded. To ensure that sources had been vetted for scientific quality by experts, only articles in peer-reviewed journals were included; books and research in the grey literature (e.g., theses, dissertations, and reports) were excluded. There was no restriction on study location. A librarian searched PubMed, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, JSTOR, and Sociological Abstracts databases using combinations of key search terms. Following is an example of the search terms used in CINAHL database searches: ((TI "marriage recognition" OR AB "marriage recognition") OR (TI marriage OR AB marriage) OR (TI same-sex OR AB same-sex) OR (TI "same sex" OR AB "same sex")) AND ((TI LGBT OR AB LGBT) OR (TI gay OR AB gay) OR (TI lesbian OR AB lesbian) OR (TI bisexual OR AB bisexual) OR (TI transgender OR AB transgender) OR (TI Obergefell OR AB Obergefell) OR (TI "sexual minorities" OR AB "sexual minorities))

Articles were selected in two stages of review. In stage one, the first author and librarian independently screened titles and abstracts for inclusion or exclusion using eligibility criteria. We excluded articles focused solely on the impact of relationship status on health outcomes, satisfaction or dynamics within marriage relationships, or the process of getting married (e.g., choices of who to invite, type of ceremony), or other topics that did not pertain directly to the research aims. For example, a study about the impact of getting married that also included themes pertaining to the impact or meaning of equal marriage rights was included in the full review. The first author and a librarian met to review and resolve differences and, in cases where relevance was ambiguous, articles underwent a full-text review (in stage 2). Table 1 summarizes exclusion categories used in the title and abstract reviews.

https://doi.org/10.1371/journal.pone.0249125.t001

In stage two, articles not excluded in stage one were retrieved for full-text review. Each article was independently reviewed by two authors to assess study relevance. Discrepancies related to inclusion were few (less than 10%) and resolved through discussion and consensus-building among the first four authors. This process resulted in an analytic sample of 59 articles (see Fig 2 ).

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Table 2 provides an overview of characteristics of the studies included in this scoping review. Most were qualitative and most aggregated SMW and SMM in analyses. Only 14 studies explored differences in impact for SMW and SMM, or separately examined the specific perceptions and experiences of SMW. Although search terms were inclusive of transgender individuals, samples in the studies we reviewed rarely included or focused explicitly on experiences of transgender or gender nonbinary identified individuals. In studies that explicitly included transgender and nonbinary individuals, sample sizes were rarely large enough to permit examination of differences based on gender identity (e.g., survey samples with 2–3% representation of nonbinary or transgender individuals) [ 44 , 59 – 63 ]. Other studies recruiting sexual minorities may have included transgender and nonbinary individuals (who also identified as sexual minorities), but did not assess gender identity. Among studies in which participant race/ethnicity was reported, most included samples that were majority White.

https://doi.org/10.1371/journal.pone.0249125.t002

Studies of the impact of legalized marriage on physical health were not excluded in the original search parameters; however, physical health has been addressed in prior reviews [ 15 – 20 ]. Further, because our research questions focused on psychosocial factors, we excluded studies on physical health unless they also addressed individual, interpersonal, or community psychosocial impacts of same-sex marriage legalization. Studies that focused on physical health impacts or access to health insurance were used only in the introduction.

Civil union was not explicitly included as a search parameter, but articles focusing on civil unions were captured in our search. Although civil unions are not equivalent to marriage, they often confer similar substantive legal rights. We included articles about civil union that explicitly pertained to our research question, such as a study that examined perceived stigma and discrimination before and after implementation of civil union legislation in one U.S. state [ 64 ], and excluded articles that did not (e.g., a study of relationship quality or longevity among same-sex couples in civil unions) [ 65 ].

A majority of the studies were conducted in the U.S. Of the 43 U.S. studies, 20 sampled from a single state, 10 included participants from multiple states, 12 used a national sample, and one had no human subjects (secondary analysis of legal cases). Of those sampling a single state, all focused on the impact of changes (or proposed changes) in same-sex marriage policy: 10 focused on Massachusetts (the first state in the U.S. to legalize same-sex marriage), two focused on Iowa, two on Vermont, and two on California. One article each included study participants from Nebraska, Oregon, Illinois, and a small (unnamed) non-metropolitan town in the Midwest.

Analysis method

We created a data extraction form to ensure consistency across team members in extracting key study information and characteristics including study design (e.g., quantitative, qualitative, or mixed method), location (e.g., country and/or region), sample (e.g., whether the study included or excluded SMW or SMM, assessed and reported race/ethnicity), and key results. Articles were also classified based on findings related to level of impact (e.g., individual, couple, family, community, or broader social attitudes toward LGBTQ+ individuals; see S1 Table ). A final category on significance/implications allowed reviewers to further identify and comment on major themes and relevance to the current review. Themes were then identified and organized using stigma and social-ecological frameworks.

Aim 1: Psychosocial impacts of same-sex marriage rights

Individual level impacts..

Although most studies about the impact of equal marriage rights have been conducted with couples or individuals in committed or married relationships, 15 studies in this review included sexual minority adults across relationship statuses. In general, studies examining the impact of equal marriage rights among sexual minorities suggest that equal access to marriage has a positive impact on perceptions of social acceptance and social inclusion regardless of relationship status [ 47 , 63 , 66 , 67 ]. For example, Riggle and colleagues [ 47 ] examined perceptions of sexual minority individuals in the U.S. during the period in which same-sex couples had equal marriage rights in some, but not all, U.S. states. Sexual minorities who resided in states with equal marriage rights reported less identity concealment, vigilance, and isolation than their peers in states without equal marriage rights. Similarly, using data from the longitudinal Nurses’ Health Study in the U.S., Charlton and colleagues [ 68 ] examined potential positive impacts of equal marriage rights on sexual identity disclosure. They found that participants living in states with any form of legal recognition of same-sex relationships (inclusive of marriage, civil unions, or domestic partnerships) were 30% more likely than those is states without legal recognition to consistently disclose a sexual minority identity across survey waves [ 68 ].

Researchers have documented ambivalence among sexual minority adults regarding the institution of marriage and whether same-sex marriage would impact other forms of structural or interpersonal stigma. Sexual minority participants in several studies expressed concern about continued interpersonal stigma based on sexual or gender identity, the limitations of marriage as a vehicle for providing benefits and protections for economically marginalized LGBTQ+ individuals, and the possibility that an increased focus on marriage would contribute to devaluing unmarried same-sex relationships [ 12 , 13 , 62 , 69 , 70 ]. Studies also documented concerns about marriage being inherently linked to heteronormative expectations and about assimilation to heterosexist cultural norms [ 60 , 69 , 71 ]. These concerns were summarized by Hull [ 69 ]: “The fact that LGBTQ respondents favor marriage more in principle (as a right) than in practice (as an actual social institution) suggests that marriage holds multiple meanings for them” (p. 1360).

Five studies explicitly examined racial/ethnic minority identities as a factor in individuals’ perceptions of same-sex marriage; one qualitative study focused exclusively on Black individuals in the U.S. [ 72 ] and the other four examined differences by race/ethnicity [ 64 , 66 , 67 , 73 ]. McGuffy [ 72 ] conducted in-depth interviews with 102 Black LGBT individuals about their perceptions of marriage as a civil rights issue before and after same-sex marriage was recognized nationally in the U.S. The study found that intersecting identities and experiences of discrimination related to racism, homophobia, and transphobia influenced personal views of marriage. For example, although most participants were supportive of equal marriage rights as a public good, many felt that the emphasis on marriage in social movement efforts overlooked other important issues, such as racism, economic injustice, and transgender marginalization.

The four other studies examining racial/ethnic differences in perceptions about whether equal marriage rights facilitated inclusion or reduced interpersonal stigma yielded mixed results. One found that residing in states with equal marriage rights was associated with greater feelings of acceptance among sexual minorities; however, White sexual minorities reported greater feelings of inclusion than participants of color [ 66 ]. By contrast, in a quasi-experiment in which SMW in a midwestern state were interviewed pre- or post- passage of civil union legislation, those interviewed after the legislation reported lower levels of stigma consciousness and perceived discrimination than those interviewed before the legislation; however, effects were stronger among SMW of color than among White SMW [ 64 ]. In a study of unmarried men in same-sex male couples, Hispanic/Latino men were more likely than non-Latino White participants to report perceived gains in social inclusion after equal marriage rights were extended to all U.S. states [ 67 ]. However, men who reported higher levels of minority stress (enacted and anticipated stigma as well as internalized homophobia) were less likely to show improvement in perceptions of social inclusion. Lee [ 73 ], using data from a national Social Justice Sexuality Project survey, found no statistical differences in Black, White and Latinx sexual minorities’ perceptions that equal marriage rights for same-sex couples had a moderate to major impact on their lives. In analyses restricted to Black participants, individuals with higher level of sexual minority identity salience reported significantly higher importance of equal marriage rights. Lee suggests that same-sex marriage was perceived by many study participants as a tool to gain greater acceptance in the Black community because being married is a valued social status.

Couple level impacts.

We identified 15 studies that focused on couples as the unit of analysis. Findings from studies of the extension of equal marriage rights in U.S. states suggest positive impacts among same-sex couples, including access to financial and legal benefits as well as interpersonal validation, such as perceptions of being viewed as a “real” couple and increased social inclusion [ 12 , 59 , 63 , 74 , 75 ]. Furthermore, couples in several studies described the potential positive impacts of legal recognition of their relationship on their ability to make joint decisions about life issues, such as having children and medical care [ 75 ]. Couples also described having a greater sense of security associated with financial (e.g., taxes, healthcare) and legal (e.g., hospital visitation) benefits and reduced stress in areas such as travel and immigration [ 75 ]. Collectively, these findings suggest that marriage rights were perceived to imbue individuals in same-sex relationships with a sense of greater security, stability, and safety due to the legal recognition and social legitimization of same-sex couples. Although equal marriage rights were perceived as an important milestone in obtaining civil rights and reducing institutional discrimination, concerns about and experiences of interpersonal stigma persisted [ 76 – 78 ]. The social context of legal same-sex marriage may create stress for couples who elect to not marry. For example, in a study of 27 committed, unmarried same-sex couples interviewed after the U.S. Supreme Court decision on Obergefell, couples who chose not to marry described feeling that their relationships were less supported and perceived as less committed [ 79 ].

Reports from the CUPPLES study, a national longitudinal study of same-sex couples in the U.S. from 2001 to 2014, provided a unique opportunity to examine the impact of different forms of legal recognition of same-sex relationships. In wave three of the study during 2013–2014, open-ended qualitative questions were added to explore how individuals in long-term committed partnerships perceived the extension of equal marriage rights in many U.S. states. Themes included awe about the historic achievement of a long-awaited civil rights goal, celebration and elation, and affirmation of minority sexual identity and relationships, but also fears of backlash against sexual minority rights [ 80 ]. Some individuals who divorced after institutionalization of the right to same-sex marriage reported shame, guilt, and disappointment—given that they and others had fought so hard for equal marriage rights [ 81 ].

Studies outside the U.S. have also found evidence of positive impacts of legal recognition of same-sex couple relationships (e.g., increased social recognition and social support), as well as potential concerns [ 82 – 86 ]. For example, in a study of couples from the first cohort of same-sex couples to legally marry in Canada, participants described marriage as providing them with language to describe their partner that was more socially understood and helping to decrease homophobic attitudes among the people around them [ 83 ]. Some couples said they could fully participate in society and that marriage normalized their lives and allowed them to “live more publicly.” Couples also discussed the safety, security, and increased commitment that came from marriage, and some felt that marriage opened up previously unavailable or unimagined opportunities, such as becoming parents. However, some participants noted that their marriage caused disjuncture in relationships with their family of origin, as marriage made the relationship feel too real to family members and made their sexual identities more publicly visible.

Family level impacts.

Seventeen studies examined the impact of equal marriage rights on sexual minority individuals’ or couples’ relationships with their families of origin. Although these studies predominately used cross-sectional survey designs, one longitudinal study included individuals in both different-sex and same-sex relationships before and after the U.S. Supreme Court decision that extended marriage rights to all states [ 44 ]. This study found that support from family members increased following national legalization of same-sex marriage [ 44 ]. A cross-sectional online survey of 556 individuals with same-sex partners in Massachusetts (the first U.S. state to extend equal marriage rights to same-sex couples), found that greater family support and acceptance of same-sex couples who married was associated with a stronger overall sense of social acceptance [ 66 ].

Other cross-sectional surveys found mixed perceptions of family support and feelings of social acceptance. For example, a study of 357 participants in long-term same-sex relationships found that perceived social support from family did not vary by state-level marriage rights or marital status [ 47 ]. However, living in a state with same-sex marriage rights was associated with feeling less isolated. The finding of no differences in perceived support might be partly explained by the fact that the sample included only couples in long-term relationships; older, long-term couples may rely less on support from their family of origin than younger couples [ 12 ].

In studies (n = 6) that included dyadic interviews with same-sex married couples [ 74 , 79 , 85 , 87 – 89 ], participants described a wide range of family members’ reactions to their marriage. These reactions, which emerged after same-sex marriage legalization, were typically described by couples as profoundly impactful. Couples who perceived increased family support and acceptance described these changes as triumphant [ 85 ], transformative [ 88 ], and validating [ 74 , 87 ]. Conversely, some same-sex couples reported feeling hurt and betrayed when familial reactions were negative or when reactions among family members were divided [ 85 , 87 , 89 ]. Findings from these and other studies suggest that if certain family members were accepting or rejecting prior to marriage, they tended to remain so after equal marriage rights and/or the couple’s marriage [ 61 , 74 , 90 , 91 ]. In some cases, family members were perceived as tolerating the same-sex relationship but disapproving of same-sex marriage [ 85 , 90 ].

Findings from studies of married sexual minority people suggest that family (especially parental) disapproval was a challenge in the decision to get married [ 92 ], possibly because disclosure of marriage plans by same-sex couples frequently disrupted family “privacy rules” and long-time patterns of sexual identity concealment within families or social networks [ 87 ]. In a few studies, same-sex partners perceived that their marriage gave their relationship more legitimacy in the eyes of some family members, leading to increased support and inclusion [ 61 , 66 , 89 – 91 ]. Further, findings from two studies suggested that participating in same-sex weddings gave family members the opportunity to demonstrate support and solidarity [ 87 , 93 ].

Two qualitative studies collected data from family members of same-sex couples. In one, heterosexual siblings (all of whom were in different-sex marriages) described a range of reactions to marriage equality—from support for equal marriage rights to disapproval [ 80 ]. The other study interviewed sexual minority migrants to sexual minority friendly countries in Europe who were married and/or raising children with a same-sex partner, and these migrant’s parents who lived in Central and Eastern European countries that prohibited same-sex marriage. Parents found it difficult to accept their adult child’s same-sex marriage, but the presence of grandchildren helped to facilitate acceptance [ 94 ].

Community level impacts.

Twelve studies in this review examined the community-level impacts of same-sex marriage. These studies focused on community level impacts from two perspectives: impacts of equal marriage rights on LGBTQ+ communities, and the impacts of equal marriage rights on LGBTQ+ individuals’ interactions with their local communities or extended social networks.

LGBTQ+ communities . A prominent theme among these studies was that marriage is beneficial to LGBTQ+ communities because it provides greater protection, recognition, and acceptance of sexual minorities, their families, and their relationships—even beyond the immediate impact on any individual and their relationship or marriage [ 12 , 62 , 89 , 95 ]. Despite these perceived benefits, studies have found that some sexual minority adults view marriage as potentially harmful to LGBTQ+ communities because of concerns about increased assimilation and mainstreaming of LGBTQ+ identities [ 12 , 50 , 62 ], stigmatizing unmarried relationships [ 62 ], and weakening of unique and valued strengths of LGBTQ+ culture [ 12 ]. For example, Bernstein, Harvey, and Naples [ 96 ] interviewed 52 Australian LGBTQ+ activists and legislators who worked alongside activists for equal marriage rights. These authors described the “assimilationist dilemma” faced by activists: a concern that gaining acceptance into the mainstream societal institution of marriage would lessen the salience of LGBTQ+ identity and ultimately diminish the richness and strength of LGBTQ+ communities. Another downside of the focus on marriage as a social movement goal was the concern about reinforcing negative heteronormative aspects of marriage rather than challenging them [ 95 ].

Four studies explicitly examined possible community level impacts of same-sex marriage. In a mixed-methods study with 115 LGBTQ+ individuals in Massachusetts, participants reported believing that increased acceptance and social inclusion as a result of equal marriage rights might lessen reliance on LGBTQ+-specific activism, events, activities, and venues for social support [ 13 ]. However, a majority of study participants (60%) reported participating in LGBTQ+-specific events, activities, or venues “regularly.” A few studies found evidence of concerns that the right to marry could result in marriage being more valued than other relationship configurations [ 12 , 62 , 79 ].

Local community contexts and extended social networks . Studies examining the impact of same-sex marriage on sexual minority individuals’ interactions with their extended social networks and in local community contexts yielded mixed results. In an interview study with 19 same-sex couples living in the Netherlands, Badgett [ 66 ] found that LGBTQ+ people experienced both direct and indirect increases in social inclusion in their communities and extended social networks as a result of equal marriage rights. For example, direct increases in social inclusion included people making supportive comments to the couple and attending their marriage ceremonies; examples of indirect increases included same-sex spouses being incorporated into family networks [ 66 ]. Other studies found mixed or no change in support for LGBTQ+ people and their relationships. Kennedy, Dalla, and Dreesman [ 61 ] collected survey data from 210 married LGBTQ+ individuals in midwestern U.S. states, half of whom were living in states with equal marriage rights at the time of data collection. Most participants did not perceive any change in support from their community/social network following legalization of same-sex marriage; other participants reported an increase or mixed support from friends and co-workers. Similarly, Wootton and colleagues interviewed 20 SMW from 15 U.S. states and found positive, neutral, and negative impacts of same-sex marriage on their interactions in work and community contexts [ 50 ]. Participants perceived increased positivity about LGBTQ+ issues and more accepting attitudes within their extended social networks and local communities, but also reported hearing negative comments about sexual minority people more frequently and experiencing continued sexual orientation-based discrimination and stigma [ 50 ]. Many SMW reported feeling safer and having more positive conversations after Obergefell, but also continued to have concerns about being out at work as a sexual minority person [ 50 ].

Two studies examined the experiences of LGBTQ+ people in U.S. states in which same-sex marriage restrictions were decided by voters through ballot measures. These studies documented mixed impacts on participants’ interactions with extended social networks and community. Maisel and Fingerhut [ 28 ] surveyed 354 sexual minority adults in California immediately before the vote to restrict recognition of marriage to one man and one woman in the state (Proposition 8) and found that about one-third experienced interactions with social network members that were positive, whereas just under one-third were negative, and the rest were either mixed or neutral. Overall, sexual minority people reported more support than conflict with extended social network members and heterosexual community members over the ballot measure, with friends providing the most support [ 28 ]. Social support and solidarity from extended social network members in the face of ballot measures to restrict marriage recognition were also reported in an interview study of 57 same-sex couples residing in one of seven U.S. states that had passed marriage restriction amendments in 2006 [ 97 ]. However, some LGBTQ+ people also experienced condemnation and avoidance in their extended social networks [ 97 ].

Societal level impacts.

Sixteen studies examined ways that same-sex marriage influenced societal attitudes about sexual minority individuals or contributed to additional shifts in policies protecting the rights of sexual minority individuals. Findings suggested that the right of same-sex couples to marry had a positive influence on the political and socio-cultural context of sexual minorities’ lives. For example, changes in laws may influence social attitudes or result in LGBTQ positive policy diffusion across states (jurisdictions). There is debate over whether legal changes, such as equal marriage rights, create or are simply reflective of changes in social attitudes toward a group or a social issue [ 98 ]. Flores and Barclay [ 98 ] theorize four different socio-political responses to changes in marriage laws: backlash, legitimacy, polarization, and consensus. Some scholars argue that changes in law are unlikely to impact social attitudes (consensus), while others argue that legal changes influence the political and social environment that shapes social attitudes. Possible effects range from decreased support for sexual minorities and attempts to rescind rights (backlash) to greater support for the rights of sexual minorities and possible future expansion of rights and protections (legitimacy).

Findings from research generally suggest a positive relationship between same-sex marriage and public support for the overall rights of sexual minorities (legitimacy), and mixed results related to changes in mass attitudes (consensus) [ 98 – 106 ]. For example, in a panel study in Iowa before and after a state Supreme Court ruling in favor of equal marriage rights, Kreitzer and colleagues found that the change in law modified registered voters’ views of the legitimacy of same-sex marriage and that some respondents felt “pressure” to modify or increase their expressed support [ 102 ]. Similarly, Flores and Barclay [ 98 ] found that people in a state with equal marriage rights showed a greater reduction in anti-gay attitudes than people in a state without equal marriage rights. Studies based on data from European countries also found that more positive attitudes toward sexual minorities were associated with equal marriage rights; improvements in attitudes were not evident in countries without equal marriage rights [ 9 , 105 , 106 ].

There is some evidence to support the third possible socio-political response to changes in marriage laws in Flores and Barclay’s model: increased polarization of the general public’s attitudes toward sexual minorities. Perrin, Smith, and colleagues [ 107 ], using successive-independent samples study of conservatives, moderates, and progressives across the U.S. found no overall changes in opinions attitudes about sexual minorities immediately after the Supreme Court decision extending equal marriage rights to all same-sex couples in the U.S. However, analyses by subgroup found that those who were conservative expressed more prejudice toward gay men and lesbians, less support for same-sex marriage, and less support for LGB civil rights immediately after the decision. Similarly, drawing on data from approximately one million respondents in the U.S. who completed implicit and explicit measures of bias against gay men and lesbian women (Project Implicit), Ofosu and colleagues [ 100 ] found that implicit bias decreased sharply following Obergefell. However, changes in attitudes were moderated by state laws; respondents in states that already had equal marriage rights for same-sex couples demonstrated decreased bias whereas respondents in states that did not yet have equal marriage rights evidenced increased bias [ 100 ]. Using data from the World Values Survey (1989–2014) in European countries, Redman [ 103 ] found that equal marriage rights were associated with increases in positive opinions about sexual minorities, but that the increase was driven largely by those who already held positive views.

Little support has been found for the hypothesis that the extension of equal marriage rights would be followed by a backlash of sharp negative shifts in mass attitudes and public policy [ 98 , 108 , 109 ]. For example, a general population survey in one relatively conservative U.S. state (Nebraska) found public support for same-sex marriage was higher after the Supreme Court ruling than before, suggesting no backlash in public opinion [ 108 ]. Similarly, Bishin and colleagues [ 109 ], using both an online survey experiment and analysis of data from a U.S. public opinion poll (National Annenberg Election Studies) before and after three relevant policy events, found little change in public opinion in response to simulated or actual policy changes.

Although equal marriage rights confer parental recognition rights, there are still legal challenges and disparate rulings and interpretations about some family law issues [ 77 , 110 , 111 ]. For example, some states in the U.S. have treated the parental rights of same-sex couples differently than those of different-sex (presumed heterosexual) couples. Both members of a same-sex couple have traditionally not been automatically recognized as parents of a child born or adopted within the relationship. However, the presumptions of parenthood after same-sex marriage was legalized have forced states to treat both members of same-sex couples as parents irrespective of method of conception or adoption status [ 112 ]. Still, results from a cross-national study of laws, policies, and legal recognition of same-sex relationships suggests that parental rights are recognized in some jurisdictions but not others [ 111 ].

Aim 2: SMW-specific findings and differences by gender

A total of 13 studies included in this review conducted SMW-specific analyses or compared SMW and SMM’s perceptions and experiences of same-sex marriage and equal marriage rights. In studies that included only SMW [ 50 , 64 , 68 , 77 , 81 , 86 , 89 , 91 ], findings emphasized the importance of relational and interpersonal impacts of same-sex marriage. Examples include creating safety for sexual identity disclosure and visibility [ 68 , 81 ], providing legal protections in relation to partners and/or children [ 77 , 81 ], offering social validation [ 86 , 89 ], and reducing stigma in larger community contexts [ 50 , 64 ]. Relational themes centered on concerns and distress when experiencing rejection or absence of support from family members or extended social networks [ 50 , 81 , 86 , 89 , 91 ].

Two of the studies of SMW documented sexual identity and gender identity differences in interpersonal experiences associated with same-sex marriage [ 86 , 89 ]. Lannutti’s interview study of the experiences of 26 married or engaged SMW couples with different sexual identities (bisexual-lesbian couples) revealed how the right to marry made them feel more connected to LGBTQ+ communities through activism and being “counted” as a same-sex married couple. However, same-sex marriage made some bisexual women feel more invisible within LGBTQ+ communities [ 89 ]. Scott and Theron [ 86 ] found that married lesbian women and cisgender women partners of transmasculine individuals (i.e., masculine-identifying transgender individuals) faced different challenges as they navigated through gendered social expectations and made choices about conforming or rejecting heteronormativity.

Only five of the studies focusing on psychosocial impacts of equal marriage rights explicitly examined potential differences by sex [ 28 , 66 , 73 , 76 , 95 ]. Some studies found perceptions of greater social inclusion [ 66 ], or feelings of ambivalence (simultaneously holding positive, negative, and critical perspectives about marriage as an institution) [ 95 ] that were similar among SMW and SMM. Maisel and Fingerhut’s study of consequences of a state-level campaign to restrict marriage rights [ 28 ] showed that SMW and SMM experienced similar negative impacts on personal well-being and interactions with extended social networks. However, Lee found that, compared with Black SMM, Black SMW perceived same-sex marriage to have a larger impact on their lives [ 73 ]. Other studies found that SMW were more likely than SMM to report positive perceptions of same-sex marriage, possibly because they are more likely than SMM to have children and to be concerned about parental protections [ 73 , 95 ]. SMW and SMM may be differentially impacted by interpersonal stigma despite equal marriage rights. For example, one study found that SMW experienced higher levels of distress than SMM when their relationships were not treated as equal to heterosexuals’ [ 76 ].

Overall, findings from this scoping review suggest that psychosocial impacts of equal marriage rights among sexual minorities are apparent at all levels of our social-ecological and stigma framework. Sexual minority-specific stigma occurs on multiple levels (e.g., individual, interpersonal, and structural simultaneously and changes in social policies have cascading effects on sexual minority individuals’ experiences at each level. Generally, equal marriage rights had a positive impact on perceptions of social acceptance and social inclusion for sexual minority individuals, couples, and the LGBTQ+ community as a whole. However, many studies described mixed, ambivalent, or complicated perceptions of same-sex marriage, as well as stigmatizing interactions that were unaffected or exacerbated by equal marriage rights.

Although research does not unequivocally suggest the presence of a backlash in public opinion after equal marriage rights, there has been an increase in laws and policies at the U.S. state and federal levels that explicitly allow for religious-belief-based denial of services to sexual minority individuals and same-sex couples. For example, by 2017, 12 states in the U.S. enacted laws permitting the denial of services (e.g., allowing government officials to refuse to issue same-sex marriage licenses, allowing magistrates to refuse to perform same-sex marriages, and permitting adoption and child welfare agencies to refuse same-sex couples’ adoption or fostering children) based on religious beliefs [ 113 ]. Research has documented negative health and psychological outcomes among sexual minorities living in U.S. states with policies that permit denial of services to sexual or gender minorities [ 114 , 115 ] and in states that do not have legal protections against discrimination [ 38 , 116 , 117 ]. Additional research is needed to examine how changes in local or national laws impact the health and well-being of sexual and gender minorities—particularly over the long term.

Gaps & future research needs

Research is limited in terms of examining how same-sex marriage may differentially impact sexual minority individuals based on sex, gender identity, or race/ethnicity. Only 14 studies included in this review addressed the psychosocial impacts of same-sex marriage among SMW. More research is needed to understand the unique experiences and psychosocial impact of same-sex marriage for SMW and SMM. Further, many study samples were largely homogenous and included an overwhelming majority of White participants. The few studies with substantial sample sizes of people of color, and that compared people of color to White people, found differences by race in perceived impact of same-sex marriage [ 64 , 67 , 73 ], demonstrating the need for additional work in this area.

There were also very few studies in this review that explored differences by sexual identity (e.g., monosexual vs. plurisexual), gender identity (e.g., transgender vs. cisgender), gender expression (e.g., masculine vs. feminine presentation), or differences based on sex/gender of participants’ partners. Although transgender and nonbinary individuals were included in eight studies, five provided only descriptive information and only three described any unique findings from transgender study participants. For example, McGuffey [ 72 ] found that transgender individuals who identified as heterosexual described same-sex marriage rights as less relevant than issues of gender identity and expression and Hull found that cisgender sexual minority men generally expressed more enthusiasm about marriage than both cisgender women and transgender individuals [ 69 ]. Transgender and nonbinary individuals who perceive positive impacts of equal marriage rights may still experience challenges in navigating heteronormative and cisnormative expectations [ 72 , 86 ]. Other qualitative studies documented concerns that LGBTQ+ advocacy efforts, once marriage rights were secured, might fail to address rights and protections for transgender and nonbinary individuals [ 62 , 69 ]. Future studies that include the voices of transgender and nonbinary individuals are needed to better understand perceptions across both sexual and gender identities [ 118 ].

There is limited research on immediate and extended family members’ perceptions of equal marriage rights. There is also a need for prospective studies that examine whether familial acceptance increases over time. Many studies did not account for differences in LGBTQ+ identity salience and connection to LGBTQ+ and other communities, which may influence differences in perceptions and reactions to same-sex marriage.

The majority of studies (43 of 59) we reviewed were conducted in the U.S. Eleven of these collected data after Obergefell (June 25, 2015). Only two used longitudinal research designs that included data collection before and after national same-sex marriage legalization [ 44 , 107 ]. The legal and social landscapes have changed since this time and there is a need for re-assessment of the impact of same-sex marriage over multiple future timepoints.

Limitations

Although this scoping review used a systematic approach and, to our knowledge, is novel in its focus on impact of equal marriage rights on sexual minorities’ personal lives, interpersonal relationships, and social/community contexts, we acknowledge several limitations. We did not conduct a search of grey literature (e.g., reports, policy literature, working papers) or books and, consequently, likely excluded some scholarly work aligned with our focus. Our inclusion criteria of only peer-reviewed studies may have led us to exclude dissertations that focus on emerging areas of research, such as differences by gender identity, sexual identity, or race and ethnicity. As with all scoping reviews, studies may have been missed because of the search strategy. For example, it is possible that relevant studies were indexed in databases not used in our review. We also restricted our review to English language literature, excluding potentially relevant studies published in other languages. Studies in other languages may provide useful insights from other countries where English is not widely used. Although we focused exclusively on empirical studies, we did not assess the quality of the studies. Findings of the review are also limited by the collective body of research questions, designs, and analyses that have been pursued. For example, as noted above, few studies explored psychosocial impacts of same-sex marriage among SMW or explored differences by sex; consequently we were limited in our ability to address our second research aim.

This scoping review identified and described psychosocial impacts of equal marriage rights among sexual minority adults and explored potential SMW-specific experiences and differences by sex. Our results highlight four points. First, equal marriage rights are associated with a wide range of positive impacts on the psychological and social well-being of sexual minority adults. Second, the potential positive impacts of equal marriage rights are amplified or weakened by the presence or absence of stigma in interpersonal interactions and in the larger political and social environment. Third, although there is a growing body of global research on the impact of same-sex marriage, most studies have been conducted in the U.S. Cross-cultural studies can improve understanding of individual, interpersonal, and community level impacts of same-sex marriage in different cultural contexts. Fourth, given indications of differences between SMW and SMM in perceived impact of same-sex marriage, there is a need for research that examines the specific perspectives of SMW and that explores possible differences in perspectives and experiences by sex. Research is also needed to understand differences based on race/ethnicity, gender identity, and age. The right of same-sex couples to marry does not merely address the concerns of sexual minorities, it aims to right a far bigger wrong: the exclusion of some individuals from one of the most important institutions in social life.

Supporting information

S1 table. articles included in scoping review on the psychosocial impact of equal marriage rights among sexual minority adults..

https://doi.org/10.1371/journal.pone.0249125.s001

S1 Checklist. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist.

https://doi.org/10.1371/journal.pone.0249125.s002

S1 Text. Definitions.

https://doi.org/10.1371/journal.pone.0249125.s003

Acknowledgments

The authors thank Karen F. Trocki for providing input during the initial conceptualization of this project. Our thanks to Carol A. Pearce, MLIS, who helped with finding records, removing duplicates, title and abstract review, and data management.

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Expert Commentary

Same-sex marriage: Research roundup

Selection of academic scholarship on the dynamics of the same-sex marriage debate in the public square and within lesbian, gay, bisexual and transgender (LGBT) communities.

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by John Wihbey, The Journalist's Resource June 26, 2013

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On June 26, 2013, the Supreme Court ruled that the Defense of Marriage Act (DOMA) is unconstitutional and violates the principle of equal protection under the law. The decision opens the door for same-sex couples to receive federal benefits. As the Pew Research Center has documented through various surveys, societal opinion on the issue has begun to swing dramatically in favor of accepting gay couples over the past decade. Indeed, Pew found in a report released June 2013 that “nearly three-quarters of Americans — 72% — say that legal recognition of same-sex marriage is ‘inevitable.’ This includes 85% of gay marriage supporters, as well as 59% of its opponents.”

In the majority opinion in the case, United States v. Windsor , Justice Kennedy wrote:

DOMA singles out a class of persons deemed by a State entitled to recognition and protection to enhance their own liberty. It imposes a disability on the class by refusing to acknowledge a status the State finds to be dignified and proper. DOMA instructs all federal officials, and indeed all persons with whom same-sex couples interact, including their own children, that their marriage is less worthy than the marriages of others. The federal statute is invalid, for no legitimate purpose overcomes the purpose and effect to disparage and to injure those whom the State, by its marriage laws, sought to protect in personhood and dignity. By seeking to displace this protection and treating those persons as living in marriages less respected than others, the federal statute is in violation of the Fifth Amendment.

Since the 1996 Defense of Marriage Act defined marriage as a legal union between a man and a woman, the states of Washington, Massachusetts, Maine, Maryland, Connecticut, Vermont, New Hampshire, New York and Iowa, as well as the District of Columbia, have legalized same-sex marriage; many other states are poised to allow it or the less controversial “civil union” designation in the near future. California’s Proposition 8, a ballot question that banned same-sex marriage, passed in 2008 but was subsequently overturned by a U.S. District Court judge and is on hold until the Supreme Court issues its ruling.

Supporters of legalizing same-sex marriage argue that the institution is a civil institution that comes with a host of legal privileges, including shared assets, benefits and citizenship. To deny these rights to American citizens on the basis of their sexual preferences, they assert, is a violation of rights automatically granted to heterosexual couples. Opponents of same-sex marriage view it as sacrilegious, debasing religious beliefs and the laws of nature, and at odds with the primary marriage function of raising children.

Academic scholarship and research have much to say on the dynamics of the same-sex marriage debate in the public square and within lesbian, gay, bisexual and transgender (LGBT) communities. The following are recent scholarly research papers and studies published from 2010 to April 2013.

“The Future Impact of Same-Sex Marriage: More Questions than Answers” Hunter, Nan D. Georgetown Law Journal , 2012, Vol. 100, 1855-1879.

Abstract: “The author identifies three questions likely to arise in the relatively near future that will flow, directly or indirectly, from same-sex marriage: First, we may see an increasing uptake by different-sex couples of marriage equivalent and marriage alternative statuses (e.g., domestic partnerships) that have grown out of LGBT rights efforts. If present demographic trends continue, the group of different-sex couples most likely to seek access to these new statuses will be persons middle-aged or older. Second, federal recognition of same-sex marriage, which will occur if the Defense of Marriage Act is invalidated or repealed, could significantly increase the number of same-sex couples who marry. The end of DOMA is also likely to further complicate the law of interstate recognition, as more gay couples have their marriages recognized for federal law purposes, such as tax, but not under state laws that regulate divorce, custody and property division… Lastly, the author questions whether the issue of ‘accidental procreation’ that has become a theme in court decisions related to same-sex marriage may migrate to marriage law more generally.”

“Contact with Gays and Lesbians and Same-Sex Marriage Support: The Moderating Role of Social Context” Merino, Stephen M. Social Science Research , March 2013. doi: 10.1016/j.ssresearch.2013.02.004.

Abstract: “Empirical research on the contact hypothesis has paid inadequate attention to the broader social and normative context in which contact occurs. Using data from the nationally representative Portraits of American Life Study, I test whether individuals’ core networks moderate the effect of personal contact with gays and lesbians on same-sex marriage attitudes. OLS regression results demonstrate that, though contact is strongly associated with greater support for same-sex marriage, the effect is attenuated for individuals with a higher proportion of religious conservatives in their core network. This moderating effect holds even after controlling for respondents’ religiosity and when the sample is limited to self-identified religious liberals and moderates. Future research on intergroup contact should be attentive to other influences within individuals’ social contexts and examine how the outcomes of contact across a variety of social boundaries are moderated by these social influences.”

“Changing Same-Sex Marriage Attitudes in America from 1988 Through 2010” Baunach, Dawn Michelle . Public Opinion Quarterly , summer 2012, Vol. 76, 364-378. doi: 10.1093/poq/nfs022.

Abstract: “Many of the characteristics commonly thought to increase opposition to same-sex marriage (including being African American, living in the southern United States, being an evangelical Protestant, and being Republican) are associated with attitudes only in the later years. In 1988, opposition was generally much higher for everyone; most respondents expressed at least some to strong disapproval of same-sex marriage in 1988, which was then reduced for the highly educated, urban residents, and those with less conservative or no religious affiliations… But, by 2010, support for same-sex marriage was much more broad-based, and opposition to same-sex marriage became more localized to specific subgroups — older Americans, southerners, African Americans, evangelical Protestants, and Republicans. The decomposition analysis finds that changing same-sex marriage attitudes are not due to demographic changes in the American population. Rather, the liberalization in same-sex marriage attitudes from 1988 to 2010 is due primarily to a general societal change in attitudes, as is evidenced by the large change in the constant. Taken together, the results suggest that changing attitudes toward same-sex marriage reflect a cultural shift.”

“Legislating Unequal Treatment: An Exploration of Public Policy on Same-Sex Marriage” Chonody, Jill M.; Smith, Kenneth Scott; Litle; Melanie A. GLBT Family Studies , 2012, Vol. 8, Issue 3, 270-286. doi: 10.1080/1550428X.2012.677238.

Abstract: “Social policy surrounding same-sex marriage has resulted in subsequent changes to public policy. Over the past 15 years, increased discussion surrounding the issue has emerged, inciting the Defense of Marriage Act (DOMA) and the proposed Federal Marriage Amendment (FMA). It is particularly salient for social workers to keep abreast of legislation that is impacting vulnerable and disenfranchised populations. Since the social work profession espouses social justice values for those who are oppressed, inclusion of gays and lesbians in this mission must take a higher priority, especially in light of the social capriciousness that has recently emerged. This article provides a history of the policies that have framed the current national debate about same-sex marriage as well as recent judicial and legislative changes. A summary of the social and economic consequences to same-sex marriage bans will be provided along with social work implications.”

“Will Marriage Matter? Effects of Marriage Anticipated by Same-Sex Couples” Shulman, Julie L.; Gotta, Gabrielle; Green, Robert-Jay. Journal of Family Issues , 2011, Vol. 33, No. 2, 158-181. doi: 10.1177/0192513X11406228.

Abstract: “The current study used an online survey to explore the anticipated impact of legalized marriage on partners in same-sex couples living in California. These data were gathered prior to the California Supreme Court decision in May 2008 legalizing same-sex marriage, which held sway for 5 months before California Proposition 8 eliminating same-sex marriage was passed by a voter referendum. In addition to administering three quantitative measures (Gay and Lesbian Acceptance and Social Support Index, Anticipated Impact of Marriage Scale, and The Couple Satisfaction Index), a qualitative approach to inquiry was used to derive themes in the reported experiences of the study participants. The principal theme emerging from participants’ responses involved a ubiquitous sense of security in all areas of their life, including increased permanence in their couple relationship as well as feeling protected as a unit by the larger society.”

“The Impact of Institutional Discrimination on Psychiatric Disorders in Lesbian, Gay, and Bisexual Populations: A Prospective Study” Hatzenbuehler, Mark L.; et al. American Journal of Public Health , March 2010, Vol. 100, Issue 3. doi: 10.2105/AJPH.2009.168815.

Findings: “Living in states with discriminatory policies may have pernicious consequences for the mental health of LGB populations.”

“Morality or Equality? Ideological Framing in News Coverage of Gay Marriage Legitimization” Pan, Po-Lin; Meng, Juan; Zhou, Shuhua. Social Science Journal , September 2010, Vol. 47, Issue 3. doi: 10.1016/j.soscij.2010.02.002.

Findings: “The study used the Massachusetts legitimization of gay marriage as a dividing point to look at what kinds of specific political or social topics related to gay marriage were highlighted in the news media…The results indicated that The New York Times was inclined to emphasize the topic of human equality related to the legitimization of gay marriage. After the legitimization, The New York Times became an activist for gay marriage. Alternatively, the Chicago Tribune highlighted the importance of human morality associated with the gay marriage debate. The perspective of the Chicago Tribune was not dramatically influenced by the legitimization.”

“California’s Ban on Same-Sex Marriage: The Campaign and its Effects on Gay, Lesbian and Bisexual Individuals” Maisel, Natalya; Fingerhut, Adam W. Journal of Social Issues , June 2011, Vol. 67, Issue 2, 242-263. doi: 10.1111/j.1540-4560.2011.01696.x.

Findings: “Participants reported experiencing both negative and positive emotions (e.g., anger, pride) and were particularly ambivalent regarding the effect of Proposition 8 on relationships with friends, family, coworkers, and their intimate partner. The campaign created opportunities for support but also opportunities for stigmatization and conflict.”

“Impact of Marriage Restriction Amendments on Family Members of Lesbian, Gay and Bisexual Individuals” Horne , Sharon G.; Rostosky, Sharon Scales; Riggle, Ellen D.B. Journal of Social Issues , June 2011, Vol. 67, Issue 2, 358-375. doi: 10.1111/j.1540-4560.2011.01702.x.

Findings: “Analysis of responses to an open-ended question about feelings about marriage amendments revealed six themes, including concern for the safety and well-being of LGB family members and negative impact on family. Overall, findings suggest that family members may experience increased concern for LGB family members during policy initiatives aimed at LGB individuals.”

“Psychological Distress, Well-being, and Legal Recognition in Same-sex Couple Relationships” Riggle, Ellen D.B.; Rostosky, Sharon S.; Horne, Sharon G. Journal of Family Psychology , February 2010, Vol. 24, 82-86. doi: 10.1037/a0017942.

Findings: “Participants in a legally recognized relationship reported less internalized homophobia, fewer depressive symptoms, lower levels of stress, and more meaning in their lives than those in committed relationships, even after controlling for other factors.”

Tags: research roundup, gay issues, law

About The Author

John Wihbey

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• v.103(2); Feb 2013

Same-Sex Legal Marriage and Psychological Well-Being: Findings From the California Health Interview Survey

R. G. Wight designed the study, designed the analytic strategy, conducted the data analysis, and wrote the article. A. J. LeBlanc assisted with the study design, writing of the article, and article preparation. M. V. L. Badgett assisted with the study design, the analytic strategy, and article preparation.

Objectives. We examined whether same-sex marriage was associated with nonspecific psychological distress among self-identified lesbian, gay, and bisexual adults, and whether it had the potential to offset mental health disparities between lesbian, gay, and bisexual persons and heterosexuals.

Methods. Population-based data (weighted) were from the 2009 adult (aged 18–70 years) California Health Interview Survey. Within-group analysis of lesbian, gay, and bisexual persons included 1166 individuals (weighted proportion = 3.15%); within-group heterosexual analysis included 35 608 individuals (weighted proportion = 96.58%); and pooled analysis of lesbian, gay, and bisexual persons and heterosexuals included 36 774 individuals.

Results. Same-sex married lesbian, gay, and bisexual persons were significantly less distressed than lesbian, gay, and bisexual persons not in a legally recognized relationship; married heterosexuals were significantly less distressed than nonmarried heterosexuals. In adjusted pairwise comparisons, married heterosexuals had the lowest psychological distress, and lesbian, gay, and bisexual persons who were not in legalized relationships had the highest psychological distress ( P  < .001). Psychological distress was not significantly distinguishable among same-sex married lesbian, gay, and bisexual persons, lesbian, gay, and bisexual persons in registered domestic partnerships, and heterosexuals.

Conclusions. Being in a legally recognized same-sex relationship, marriage in particular, appeared to diminish mental health differentials between heterosexuals and lesbian, gay, and bisexual persons. Researchers must continue to examine potential health benefits of same-sex marriage, which is at least in part a public health issue.

Well-established research demonstrates that lesbian, gay, and bisexual persons have worse mental health outcomes than their heterosexual counterparts, highlighting important but poorly understood mental health disparities associated with sexual orientation. 1 For example, a meta-analysis of 4 decades of research concluded that lesbian, gay, and bisexual persons had higher rates of mental disorder, substance misuse, suicidal ideation, and self-harm than did heterosexuals. 2 Research that examines both population- and individual-level outcomes supports the theory that sexual minority stressors (e.g., stigma or expectations of rejection, experiences of discrimination, internalized homophobia, the need for concealment of sexual identity) might be at the root of this disparity because they strain lesbian, gay, and bisexual persons’ abilities to adapt to and function in their everyday environments, increasing risks for poor mental health. 3–8

Extensive research also provides broad evidence that individuals in heterosexual marriages, on average, experience better mental health outcomes than their unmarried counterparts. 9–11 This differential might stem from tangible economic benefits (e.g., access to health insurance) or a heightened sense of relationship stability associated with legal recognition of the marital commitment, the positive effects of intimacy and closeness, as well as from greater emotional support and self-worth conferred to the married. 1

Taken together, these 2 large bodies of work suggest that lesbian, gay, and bisexual persons might be uniquely disadvantaged because they endure sexual minority-related stressors and challenges not experienced by heterosexuals, and in most parts of the United States, they are denied access to legal marriage, which potentially could enhance their mental health in the same ways it does for heterosexuals. In 2009, the American Medical Association officially recognized that exclusion from legal marriage among sexual minorities contributes to health care disparities in same-sex households, 12 yet very little research has examined the potential mental health benefits of permitting lesbian, gay, and bisexual persons to legally marry someone of the same sex. To date, the best evidence has come from small-scale nonrepresentative studies, which suggest that, like their heterosexual counterparts, sexual minority persons realize psychological benefits from same-sex legal marriage and other types of legally recognized same-sex relationships (e.g., civil unions, registered domestic partnerships [RDPs]). 13,14

Beginning in June 2008, same-sex couples were allowed to legally marry in California. A statewide referendum (Proposition 8) overturned this legal right in November 2008, putting a halt to all new same-sex marriages. In 2010, Proposition 8 was overturned by a US District Court, a decision recently twice affirmed by the US Court of Appeals. As of this writing, the issue is with the US Supreme Court and the status of same-sex marriage in California is in flux: existing same-sex marriages stand, but no new same-sex marriages are legally permitted. Also, since 2000, lesbian, gay, and bisexual persons may enter a RDP with a same-sex partner in California. A 2005 law enhanced the status of RDP to include almost all of the state-provided rights and responsibilities of marriage.

This study analyzed population-based data from the 2009 California Health Interview Survey (CHIS) to investigate the association between legal marriage and mental health among heterosexual and lesbian, gay, and bisexual adults aged 18 to 70 years, as well as the potential relationship between same-sex marriage and mental health disparities based on sexual orientation. Given the apparent mental health benefits of marriage found in previous research, we hypothesized that lesbian, gay, and bisexual persons in legal same-sex marriages and partnerships would experience better mental health than lesbian, gay, and bisexual persons not in same-sex legal relationships. Consistent with the previously described findings, we also hypothesized that married heterosexuals would report lower psychological distress than unmarried heterosexuals. Further, we hypothesized that mental health disparities between lesbian, gay, and bisexual persons and heterosexuals would be diminished when same-sex relationship status was taken into account, given the tangible and emotional benefits that accrue with legal marriage.

Data were from the 2009 adult CHIS. 15 Conducted by telephone every 2 years, the CHIS is the nation’s largest population-based state health survey. The CHIS has been a leader in telephone survey methodology and employs a multistage sample design with random-digit-dial (RDD) sampling that includes both landline and cellular telephone numbers to enhance coverage. For the landline RDD sample, the state was divided into 56 geographic sampling strata, including 2 counties with subcounty strata, 41 single-county strata, and 3 multicounty strata. Within each stratum, residential telephones were selected, and within each household, 1 adult (aged ≥ 18 years) was randomly selected. A separate RDD sample was drawn of telephone numbers assigned to cellular service. The cell RDD sample was stratified by area code, and 1 adult household member was randomly selected from cell-only households.

The sample size was 47 614 adults. The overall household response rate (a product of the screener response rate, 36.1%, and the extended adult response rate, 49.0%, landline and cellular numbers combined) was 17.7% and was roughly comparable to other large telephone surveys specific to California at around the same time, such as the 2009 California Behavioral Risk Factor Surveillance System Survey. 16 RDD response rates have declined in recent years, a trend at least partly caused by the proliferation of telemarketing and telephone screening devices. 17 However, emerging studies show that RDD response rates should not be the sole criteria in rating data quality or survey representativeness because there might be little correlation between response rates and nonresponse bias. 18 CHIS researchers conducted extensive data quality studies to assess methodological issues related to nonresponse and noncoverage biases with CHIS data and consistently found that the data accurately represented California’s household population. 19 Detailed information about CHIS methodology can be found at the CHIS data quality Web site ( http://www.chis.ucla.edu/dataquality.html ).

Adults aged 70 years and younger were asked, “Do you think of yourself as straight or heterosexual, as {gay/gay,lesbian} or homosexual, or bisexual?” The analytic sample for within-group lesbian, gay, and bisexual analysis included those who responded that they were gay, lesbian, homosexual, or bisexual (n = 1166). After the application of sample weights, this number represented 3.15% of the 70-years-and-younger adult California population (weighted n = 777 508). The analytic sample for within-group heterosexual analysis included those who reported they were straight or heterosexual (n = 35 608). After the application of sample weights, this number represented 96.85% of the 70-years-and-younger adult California population. For a small number of cases, respondents reported exclusively engaging in sexual behavior that did not “match” their marital status (i.e., being in a same-sex marriage but having only different-sex partners, n = 12; being in a different-sex marriage but having only same-sex partners, n = 28); these cases were omitted from the analysis. These omissions did not affect the findings presented. Heterosexual RDPs were not assessed in the CHIS. The pooled lesbian, gay, bisexual, and heterosexual analysis included 36 774 individuals. Nonheterosexuals who reported being “not sexual,” celibate, or “other” were excluded from the analysis. Transgender identity was not assessed in the CHIS.

Psychological distress.

The dependent variable was nonspecific psychological distress, as measured with a continuous form of the widely used Kessler 6 (K6) screening scale, 20 which asks how often in the past 30 days (responses scored from 0 [none of the time] to 4 [all of the time]) respondents felt nervous, hopeless, restless, fidgety, so depressed that nothing could cheer them up, everything was an effort, and worthless. Responses were summed (possible range = 0–24). The continuous form of the K6 was used rather than the dichotomous form (cutoff score of “13+” = possible serious mental illness) to capture the full range of psychological distress, including subsyndromal symptomatology.

Legal relationship status.

Nonheterosexual respondents were asked, “Are you legally registered as a domestic partner or legally married in California with someone of the same sex?” RDP and same-sex legal marriage responses were mutually exclusive. We referred to a lesbian, gay, or bisexual person who was legally married as “same-sex married” to clearly distinguish individuals with same-sex and different-sex spouses. Heterosexual marriage was assessed with the question, “Are you now married, living with a partner in a marriage-like relationship, widowed, divorced, separated, or never married?” (responses were mutually exclusive).

Sociodemographic controls.

Multiple sociodemographic variables that might influence observed findings were controlled in the analysis:

• gender (male or female)
• ethnicity (Asian or Asian Pacific Islander, African American, Hispanic, Non-Hispanic White, and other),
• age (categorized because of its known nonlinear association with psychological distress, such that, on average, distress is high in young adulthood, then decreases, and then increases in old age, 21 18–29, 30–39, 40–49, 50–59, 60–70 years),
• education (< high school, high school, some college, ≥ college degree),
• whether English was the primary language spoken in the home (yes or no),
• employment status (works now vs not),
• health insurance status (has insurance vs not),
• whether the respondent lives in an urban area (yes or no),
• whether household income was below the 2008 California median household income level of $61 000 (yes or no), 22
• self-rated fair or poor health (yes or no).

Analyses were conducted with the Stata SVY procedure (StataCorp, College Station, TX), which accounts for sample weights and the complex survey sampling design. Associations between relationship status and psychological distress, adjusted for sociodemographic controls, were first assessed with ordinary least-squares SVY regression models (within-group lesbian, gay, and bisexual association, within-group heterosexual association, pooled lesbian, gay, and bisexual–heterosexual association). Adjusted means for psychological distress by relationship status were then assessed with the Stata ANOVALATOR procedure, which provides adjusted pairwise comparisons. Because of multiple comparisons, a P value of .05 was divided by the number of paired comparisons made to determine the significance level.

Sample characteristics of lesbian, gay, and bisexual persons (weighted) are shown in Table 1 . Most lesbian, gay, and bisexual adults in California were not in a legally recognized same-sex marriage or domestic partnership. The proportion in same-sex marriages (7.13%) was nearly identical to recent US Census Bureau Reports, 23 and the proportion in RDPs was also comparable to recent estimates (12.35%). 24 Slightly more than half of heterosexual adults in California were currently married, similar to recent national estimates. 25

TABLE 1—

Weighted Characteristics of California Lesbian, Gay, and Bisexual Persons and Heterosexuals Aged 18–70 Years in 2009 by Legal Relationship Status

Note . Neither = neither same-sex married nor RDP; RDP = registered domestic partnership. The unweighted sample sizes were n = 1166 for lesbian, gay, and bisexual persons and 35 608 for heterosexuals.

In the CHIS lesbian, gay, and bisexual subsample, men outnumbered women, ethnicity and age were roughly comparable to the California population, 26 nearly half had a college degree or more, most spoke English in their homes, were currently employed, had health insurance, and had household incomes below the 2008 California median level. A majority (94.72%) lived in urban areas. About one fifth rated their health as fair or poor. Heterosexuals were roughly similar to lesbian, gay, and bisexual persons, with the exception of education (lesbian, gay, and bisexual persons were more educated) and English being the primary language spoken at home (lesbian, gay, and bisexual persons were more likely to live in homes where English was the primary language).

Comparisons among lesbian, gay, and bisexual persons who reported being in legal same-sex marriages, RDPs, and neither of these legal arrangements revealed wide variation for some characteristics ( Table 1 ). For example, lesbian or bisexual women were more likely to be in same-sex marriages than gay or bisexual men, whereas gay or bisexual men were more likely to be in RDPs. Among lesbian, gay, and bisexual persons, non-Hispanic Whites were disproportionately more likely than other ethnicities to be in either type of legally recognized union, as were late middle-aged persons and those with more socioeconomic resources (education, employment, health insurance, income). Such relationship-related disparities were less evident among heterosexuals, although married heterosexuals had more socioeconomic resources than nonmarried heterosexuals.

Association Between Psychological Distress and Relationship Status

Lesbian, gay, and bisexual persons..

As shown in Table 2 , model 1, same-sex married lesbian, gay, and bisexual persons were significantly less distressed than lesbian, gay, and bisexual persons not in a same-sex legal relationship. The level of distress among lesbian, gay, and bisexual persons in RDPs was not significantly different than that of lesbian, gay, and bisexual persons not in a legal relationship. Model 1 also showed that among lesbian, gay, and bisexual persons, psychological distress was negatively associated with being male, older, and currently employed, whereas it was positively associated with living in a home in which English was the primary language spoken. Model 1 accounted for 16% of the variance in psychological distress.

TABLE 2—

Parameter Estimates (weighted) for Psychological Distress Among Californians Aged 18–70 Years in 2009

Heterosexuals.

Model 2 in Table 2 shows that married heterosexuals were significantly less distressed than nonmarried heterosexuals. Model 2 also indicated that among heterosexuals, psychological distress was negatively associated with being Asian or Asian Pacific Islander or Hispanic (compared with being non-Hispanic White), being older, having a high school education or more, and being currently employed. Distress was positively associated with living in an urban area, having a household income lower than the median California household income, and reporting fair or poor health. Model 2 accounted for 12% of the variance in psychological distress.

Lesbian, gay, and bisexual persons and heterosexuals pooled.

Model 3 in Table 2 shows that psychological distress was lower among married heterosexuals, unmarried heterosexuals, and same-sex married lesbian, gay, and bisexual persons than among lesbian, gay, and bisexual persons not in a legally recognized relationship (the omitted reference group). The estimate for same-sex RDP was not significant. The association between the control variables and psychological distress was nearly identical to model 2 (the heterosexual model).

Adjusted Mean Psychological Distress Scores

As shown in Table 3 , adjusted pairwise comparisons (controlling for sociodemographics, statistical significance set at P  < .017 to adjust for 3 comparisons) indicated that psychological distress was significantly higher among persons who were not in any type of same-sex legal union than in those in a same-sex marriage, but not compared with those in an RDP. Differences in mean psychological distress scores between persons in same-sex marriages and RDPs were nonsignificant ( P  > .05).

TABLE 3—

Psychological Distress Scores (Kessler 6) by Legal Relationship Status among Californians Aged 18–70 Years in 2009, Weighted and Adjusted for Sociodemographic Characteristics

Note. RDP = registered domestic partnership.

Adjusted pairwise comparisons (controlling for sociodemographics, statistical significance set at P  < .05 to adjust for 1 comparison) indicated that psychological distress was significantly higher ( P  < .001) among unmarried heterosexuals than among those who were married ( Table 3 ).

The overall mean psychological distress score (adjusted and weighted) for heterosexuals (4.01; SE = 0.10) was significantly ( P  < .001) lower than that for lesbian, gay, and bisexual persons (5.25; SE = 0.26), consistent with previous research. 2 As shown in Table 3 , adjusted pairwise comparisons (controlling for sociodemographics, statistical significance set at P  < .005 to adjust for 10 comparisons) indicated that married heterosexuals had the lowest psychological distress, and lesbian, gay, and bisexual persons who were not in any legalized relationship had the highest psychological distress, a significant difference ( P  < .001). Psychological distress was not significantly distinguishable among same-sex married lesbian, gay, and bisexual persons, lesbian, gay, and bisexual persons in RDPs, and heterosexuals of any marital status. Same-sex married lesbian, gay, and bisexual persons were significantly less distressed than were lesbian, gay, and bisexual persons who were not in legal relationships ( P  < .001).

Supplemental Analysis

Because there did not appear to be significant differences in psychological distress between lesbian, gay, and bisexual persons in same-sex marriages and RDPs, supplemental analyses of the lesbian, gay, and bisexual analytical sample were conducted to test associations between each relationship type and psychological distress when added individually to the adjusted model. Postestimation Wald tests indicated that the association between same-sex marriage and psychological distress was significantly different from 0 ( F [1,79] = 6.98; P  = .01), but this was not the case for the association between same-sex RDP and psychological distress ( F [1,79] = 0.01; P  = .92). Thus, although direct mental health differences between same-sex marriage and RDP were not detected among lesbian, gay, and bisexual persons, it appears there might be a unique positive mental health association specifically conferred by legal marriage, particularly compared with not being in any type of legally recognized relationship at all.

Findings presented here add to the very small body of work aimed at exploring associations between being in a same-sex legal marriage and mental health among sexual minorities. With data from a population-based sample representative of Californians aged 18 to 70 years, we found results similar to those found in small-scale studies. These data suggested that psychological distress might be lower among lesbian, gay, and bisexual persons in same-sex marriages compared with those not in any type of legally recognized same-sex union. This association was statistically significant even when controlling for myriad sociodemographic characteristics related to mental health.

There was no significant difference in psychological distress between persons in same-sex marriages and RDPs. However, consistent with previous work, 14 supplemental analyses suggested that same-sex marriage might be the more beneficial legal arrangement for lesbian, gay, and bisexual persons in terms of their mental health. Future studies that explore the mechanisms by which this benefit might arise are needed.

Perhaps most importantly, findings additionally indicated that there were no statistically significant differences in psychological distress between heterosexual individuals and same-sex married lesbian, gay, and bisexual persons and lesbian, gay, and bisexual persons in RDPs, and that persons in each of these relationship categories had significantly lower distress scores than did lesbian, gay, and bisexual persons not in any type of legally recognized relationship, net of a range of sociodemographic control variables. Legal recognition of same-sex relationships, legal marriage in particular, thus appeared to have potential to offset mental health disparities between heterosexuals and lesbian, gay, and bisexual persons.

Previous research has suggested that the positive association between psychiatric disorders and being lesbian, gay, or bisexual was stronger in states that did not specifically protect sexual minorities from hate crimes or employment discrimination. 27 In addition, it has been shown that rates of psychiatric disorders actually increased among lesbian, gay, and bisexual persons in states that enacted constitutional amendments to ban same-sex marriage. 28 These associations were hypothesized to stem from social stress derived from institutionalized discrimination, one aspect of sexual minority stress. 8 Our findings were consistent with this work, in that sexual minority stressors, such as stigma, prejudice, internalized homophobia, and identity concealment, 8 might play a role in how same-sex marriage manifests in psychological well-being. Being legally married might negate or “buffer” 29 the mental health impact of these stressors at the individual level and might offset the larger macro-level effects of sanctioned discrimination. Much more research is needed that identifies pathways by which same-sex marriage might affect mental health.

As previously described, we operationalized psychological distress with a continuous version of the K6 to capture the full range of the severity of distress experiences, including subsyndromal symptomatology. The K6 was originally designed to screen for Diagnostic and Statistical Manual of Mental Disorders-4th Edition ( DSM-IV ) serious mental illness, defined as any DSM-IV mental disorder within a particular time frame, with a cutoff score of 13+ signifying possible serious mental illness. 20 Continuous operationalization of the K6 allowed us to examine associations between legal relationship status and a unit change (i.e., frequency of experiencing symptoms) in nonspecific psychological distress rather than comparing persons at the extreme end of the symptom spectrum from the majority of persons who either were asymptomatic or were symptomatic but did not meet diagnostic screening criteria, an approach that discards information about the full distress continuum. When we reran the adjusted within-group lesbian, gay, and bisexual analysis with the K6 dichotomized and made subsequent pairwise comparisons, the proportion of lesbian, gay, and bisexual persons who were screened as potentially seriously mentally ill did not differ across relationship status. In the pooled analyses, the proportion of persons who met diagnostic criteria did not significantly differ between heterosexuals, lesbian, gay, and bisexual persons in same-sex marriages, and lesbian, gay, and bisexual persons in RDPs, however it did differ between heterosexuals and lesbian, gay, and bisexual persons not in a legally recognized relationship. Thus, even when analyses separated individuals who were most likely to experience a diagnosable disorder from those who were not, legal recognition of same-sex relationships still appeared to diminish known mental health differentials between heterosexuals and lesbian, gay, and bisexual persons.

Study Limitations

Limitations to this investigation included the cross-sectional nature of the analysis, which precluded definitively establishing the causal directions of the observed associations. Longitudinal studies on the health benefits (or lack thereof) of same-sex marriage are needed to clarify the directionality of findings, in particular, reverse causation and selection effects. Although most longitudinal research suggests that entering into marriage is associated with increases in psychological well-being and decreases in psychological distress among heterosexuals (i.e., no selection effect), the magnitude of this protective effect appears to be smaller than that found in cross-sectional studies, 11 and caution should be used in ascribing a marriage effect to the marital relationship per se. Because the time period during which same-sex couples could marry in California was brief, lesbian, gay, and bisexual persons in relatively good health might have been most likely and able to take advantage of this narrow window of opportunity, enhancing the possibility of a selection of healthier individuals into same-sex marriage.

There was also the possibility that multiple unobserved confounding variables were responsible for the significant same-sex marriage finding. For example, it could be that unmeasured environmental or personality factors attenuated the association between same-sex marriage and psychological distress. In addition, self-reporting of same-sex marriage is subject to bias, and it was possible that some of the legal same-sex marriages actually reported were not legal marriages, but were “marriage-like” relationships, leading to false-positive reports of legal marriages. Such a bias would suggest that the relationship itself matters more to mental health than the legal status of the relationship. Furthermore, marriage dissolution data (widowhood, separation, divorce) were available for heterosexuals but not for lesbian, gay, and bisexual persons, precluding us from systematically comparing mental health differentials among subgroups of nonmarried heterosexuals and lesbian, gay, and bisexual persons. Future studies are needed to examine how marriage dissolution and many other confounding variables might be associated with sexual minority mental health. Marriage tenure was not assessed for either heterosexuals or lesbian, gay, and bisexual persons. It was also likely that some of the “neither same-sex married nor RDP” individuals were in long-term relationships that had no legal recognition: the CHIS did not differentiate these individuals from other lesbian, gay, and bisexual persons, preventing us from partitioning out specific associations for this group.

Conclusions

The findings presented here offer empirical evidence that same-sex marriage might be positively associated with psychological well-being in lesbian, gay, and bisexual persons, and that same-sex marriage might also be associated with the mental health disparity between heterosexuals and lesbian, gay, and bisexual persons. This finding emerged despite the fact that lesbian, gay, and bisexual persons in same-sex marriages, in California and any US state, do not enjoy the same level of social support or government recognition and benefits that those in different-sex marriages do. Given that same-sex marriage was the better predictor of psychological well-being than same-sex RDP, these findings suggest that potential mental health benefits might incrementally accrue with access to relationships that offer greater degrees of social and legal recognition. Mental health benefits of same-sex marriage might in part be derived from a heightened sense of social inclusion concomitant with the social institution of marriage. 30 Given these results, researchers should continue to examine the potential health benefits of legalizing same-sex marriage nationwide and re-legalizing same-sex marriage in California. In short, this research showed that same-sex marriage among lesbian, gay, and bisexual persons in the United States is at least in part a public health concern.

Acknowledgments

This research was supported by a grant from the Williams Institute, University of California, Los Angeles School of Law (R. G. W., Principal Investigator). We thank David Grant and Steven P. Wallace for data assistance.

Human Participant Protection

This research was approved by the University of California, Los Angeles, Office for the Protection of Research Subjects.

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In places where same-sex marriages are legal, how many married same-sex couples are there?

Same-sex marriage is now legal in more than 30 countries and territories around the world, according to a new Pew Research Center analysis . In 24 of these places where detailed statistics are available, same-sex marriages in recent years have ranged from less than 1% to 3.4% of all marriages.

Pew Research Center conducted this analysis to find out how common same-sex marriage is in countries and territories where it is legal. This analysis is based on official marriage statistics from the jurisdictions where same-sex marriage is permitted. In the United States, which does not collect marriage data nationally, we used data from the Census Bureau’s American Community Survey and Current Population Survey to estimate the share of all married-couple households with same-sex married couples. Figures for all other countries and territories represent marriages recorded in the given year.

The analysis used the most recent year for which marriage statistics were available in each country – 2020, 2021 or 2022, depending on the country. For the United Kingdom, that was 2020 because, even though the statistical agencies for Scotland and Northern Ireland had data for 2021, the office for England and Wales did not. (Bear in mind that the number of marriages that occurred in these places may have been impacted by COVID-19 restrictions on gatherings.)

Other jurisdictions were excluded from the analysis because data on same-sex marriages was not readily available. Argentina, for instance, has no single nationwide repository for vital statistics on such topics as marriage. In Canada, some provinces and territories don’t record the gender of marriage partners on their registration forms, so Statistics Canada doesn’t release separate nationwide statistics for same- and opposite-sex marriages.

In South Africa, same-sex marriages are called “civil unions,” but they carry the same rights and obligations as civil and traditional marriages and are considered legally equivalent. Data for New Zealand and Portugal includes marriages between overseas residents or foreigners who got married in those countries.

In Spain, where same-sex marriage has been legal since 2005, 3.4% of the 148,588 marriages registered in 2021 were same-sex – the highest share among the countries and territories for which data is available. (The latest year available is 2020, 2021 or 2022, depending on the jurisdiction.)

The lowest rate of same-sex marriage was in Ecuador, where the Constitutional Court legalized it in a 2019 ruling. In 2021, only 250 out of 56,921 marriages registered in the country , or 0.4%, were between same-sex couples.

Related: How people in 24 countries view same-sex marriage

The United Kingdom had the second-highest share of same-sex marriages among the countries with data available, at 3.3%. However, in the UK, data is reported for three subnational jurisdictions – England and Wales together, Scotland and Northern Ireland – rather than for the country as a whole.

In 2020, the most recent year figures are available for all three units, same-sex marriages accounted for 3.3% of all marriages in England and Wales, 3.5% in Scotland, and 4.2% in Northern Ireland – making the same-sex marriage share 3.3% for the entire UK. Scotland and Northern Ireland have since published marriage data for 2021, with same-sex marriage rates that year of 3.4% and 5.0%, respectively, but the Office for National Statistics for England and Wales has yet to do so.

Twenty of the jurisdictions that had data on same-sex marriages distinguished marriages between women from those between men. In 16 of these places, a majority of same-sex marriages were between two women. The biggest disparity was in Taiwan, where 1,794 of the 2,493 same-sex marriages recorded in 2022, or 72.0%, were between two women. The highest share of marriages between men was in Costa Rica, where they comprised 370 of the 677 same-sex marriages (54.7%) recorded in 2022.

Directly comparable figures for the United States aren’t available because marriage registrations are kept at the state and local levels rather than nationally, and not all jurisdictions keep separate counts of same-sex and opposite-sex marriages. However, the Census Bureau estimates that as of 2021, 711,129 of the nation’s 61.3 million married-couple households, or 1.2%, involved same-sex married couples. As in many other countries, households with two married women were more prevalent than households with two married men in the U.S., accounting for 52.6% of all same-sex married-couple households.

Overall, Gallup estimates that as of 2022, 7.2% of American adults identify as “lesbian, gay, bisexual, transgender or something other than straight or heterosexual.”

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Drew DeSilver is a senior writer at Pew Research Center

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