Legalization of Same-Sex Marriage and Drop in Adolescent Suicide Rates: Association but Not Causation To the Editor Raifman et al1 use robust statistical tools to demonstrate an association between the legalization of same-sex marriage (SSM) in the United States and a decrease in adolescent suicide rates, the absolute reduction being 0.6 percentage points for all students and 4 percentage points in sexual minorities. Nevertheless, we are concerned about the representativeness of their sample. Indeed, 30.2% of all students included in their sample belong to the “sexual minorities” group (Table 21). Consequently, the proportion of suicide attempts from this group (34.1% in 2015) and the net benefit potentially attributable to the legalization of SSM might be artificially inflated. Moreover, by concluding that “implementation of same-sex marriage policies reduced adolescent suicide attempts,”1 they jump over a few steps in the journey from association to causation. First, they did not report the motives of the suicide attempts, making it impossible to know whether these were attributable to the perspective of not having access to marriage or to the lack of social attention. Second, the contribution of other general policies aimed at promoting equality and preventing suicide is not clearly individualized. Such policies are likely to produce a more significant effect in sexual minorities because they bear the greatest risk.2 The association reported might just reflect a global improvement over time in states’ commitment to create supportive environments for minorities. Indeed, when placed in supportive school environments, sexual minority students experience lower rates of depression and suicidal ideation and have fewer plans and attempts of suicide than recorded in less supportive conditions.3 Finally, in future studies, the authors might want to analyze the differences in adult suicide rates across states depending on whether the state adopted SSM policies and also within the same state before and after the implementation of these policies. Higher suicide rates in sexual minority adults would mean that the problem has just been transferred to a later stage of life. Focusing on SSM is setting marriage as the ultimate goal of sexual minorities and considering it as a magic potion when the individuals might not necessarily have the same view. We should focus on the reduction of stigma that is known to have a more immediate effect on adolescent mental health, independent of the benefits of marriage,4 rather than nurturing a far-off dream of SSM that might not give a satisfactory answer to their existential questions.

中文翻译：

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同性婚姻合法化和青少年自杀率下降：关联而非因果关系

同性婚姻合法化与青少年自杀率下降：相关而非因果关系编辑 Raifman 等人1 使用强大的统计工具来证明美国同性婚姻 (SSM) 合法化与青少年自杀率下降之间存在关联。青少年自杀率，所有学生的绝对下降为 0.6 个百分点，性少数群体为 4 个百分点。然而，我们担心他们样本的代表性。事实上，样本中包括的所有学生中有 30.2% 属于“性少数群体”（表 21）。因此，该群体的自杀未遂比例（2015 年为 34.1%）和可能归因于 SSM 合法化的净收益可能被人为夸大。而且，通过得出结论“同性婚姻政策的实施减少了青少年的自杀企图”1，他们在从关联到因果关系的旅程中跳过了几步。首先，他们没有报告自杀未遂的动机，因此无法知道这些是由于无法结婚的观点还是缺乏社会关注所致。其次，其他旨在促进平等和预防自杀的总体政策的贡献并没有明显地个体化。此类政策可能会对性少数群体产生更显着的影响，因为他们承担的风险最大。2 所报告的协会可能只是反映了随着时间的推移，各国致力于为少数群体创造支持性环境的全球改善。事实上，当被置于支持性的学校环境中时，性少数学生的抑郁和自杀意念发生率较低，自杀计划和自杀企图比支持性较差的条件下记录的要少。 3 最后，在未来的研究中，作者可能想分析各州成人自杀率的差异，具体取决于该州采取了 SSM 政策，并且在这些政策实施前后也在同一州内。性少数成年人较高的自杀率意味着这个问题刚刚转移到生活的后期。关注 SSM 是将婚姻作为性少数群体的最终目标，并在个人可能不一定有相同观点时将其视为一种神奇的药水。我们应该专注于减少众所周知对青少年心理健康有更直接影响的耻辱感，