The Supreme Court decision that same-sex couples anywhere in the United States have a right to marry could improve the health of gay, lesbian and bisexual people, experts say.
A large body of evidence shows that heterosexual people who are married have better physical and mental health than people who are not married. Although there have not been as many studies done on people in same-sex marriages, the research done so far suggests marriage may provide the same benefits for same-sex couples.
"We know that marriage does enhance people's health," said Richard Wight, a community health researcher at the University of California, Los Angeles School of Public Health. "Now, there's the potential for marriage to enhance the health of sexual minorities" in the same way it does for heterosexual people, Wight said.
A recent study that Wight and colleagues conducted found that sexual minorities who were in same-sex marriages were no different than married heterosexuals in terms of their general level of psychological stress. In contrast, people who were gay, lesbian or bisexual and who were in relationships that were not legally recognized had the highest levels of psychological distress.
In this way, the right to marriage may have the potential to offset differences in mental health between sexual minorities and heterosexuals, Wight said. [10 Milestones in Gay Rights History]
Another study, which surveyed more than 2,600 people who were gay, lesbian or bisexual, found that those who were in legally recognized relationships — marriages, civil unions or registered domestic partnerships — reported lower levels of stress, fewer depressive symptoms and more meaning in their lives than those who were in committed relationships that did not have a legal status.
"Cohabiting doesn't seem to give you the same improvements in health, or protections for health," that marriage does, said Dr. Georges Benjamin, executive director of the American Public Health Association. "Thanks to this ruling, same-sex couples can now enjoy health benefits of marriage equal to those of opposite-sex couples," he said.
The exact reasons why marriage improves people's health are not known, but it may be due to a number of factors, including being in a supportive relationship and having an improved financial status.
It's also possible that people who married engage in healthier behaviors than their unmarried counterparts. For example, another study by Wight and colleagues found that same-sex couples who are married have lower rates of tobacco use than those who are not married, a finding that's true of married heterosexuals as well.
Studies also suggest that laws banning same-sex marriage are linked with poorer mental health among lesbian, gay and bisexual (LGB) people, possibility because such forms of discrimination increase stress levels. A 2010 study found that in states that passed same-sex marriage bans, rates of mood disorders increased 36 percent among LGB people after the bans went into effect, and rates of anxiety disorders more than doubled. In contrast, LGB people living in states that did not pass same-sex marriage bans did not see an increase in the rates of either of these conditions.
The benefits of legalizing same-sex marriage may even extend to LGB people who are not married. A 2012 study found that after same-sex marriage was legalized in Massachusetts in 2003, there was a decrease in health care visits, including visits for mental health, and health care costs among gay and bisexual men, regardless of whether they were married or not. The researchers said that although the reason for these decreases is not clear, it could be that levels of stress among sexual minorities are reduced when same-sex marriages are legally recognized.
"In places where this institutionalized discrimination exists, then the population as a whole suffers," Wight said. "By lifting the institutionalized discrimination, it stands to improve the health" of sexual minorities, he said.
Marriage also brings legal health benefits, such as gaining more affordable health insurance by being included on a spouse's policy, or the right to visit a spouse in the hospital.
It's important to note that, because same-sex marriage has been legally recognized only recently, more studies are needed that follow people over time to see whether it is marriage itself that leads to better health for these couples, or if healthier people tend to be the ones to get married, Wight said. Such questions have been looked at in terms of heterosexual marriage, but not same-sex marriage.
Same-sex marriage "seems to demonstrate health benefits, but I think more research needs to be done before we can definitively state that marriage equality, in and of itself, improves health," said Jeffrey Crowley, program director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law in Washington, D.C.
Now that same-sex marriage is legal in the United States, Wight said he expects more studies will be done across the country that look at such questions.