prior to same-sex marriage. We found that suicide attempts were stable over time prior to the implementation of state same-sex marriage policies, suggesting that improvements in outcomes that might be associated with increasingly supportive environments for sexual minorities did not predate changes in legal status of same sex marriage. We also agree that there is a need for further high-quality evidence to better understand the nature of the association between same-sex marriage and suicide attempts among both adolescent and adult populations. While KamtchumTatuene et al suggest that reduced teen suicide attempts may indicate delayed suicide attempts until adulthood, the available evidence indicates a positive association between suicide attempts in adolescence and adulthood2 and that the implementation of state same-sex marriage policies in Massachusetts was associated with improvements in adult mental health.3 Rather than hypothesizing that marriage is the ultimate goal of sexual minority populations, we suggest there are a number of potential mechanisms by which state samesex marriage policies may be associated with reduced adolescent suicide attempts, including reduced stigma. We agree that further research is critical to understand the mechanisms by which state same-sex marriage policies were associated with adolescent suicide attempts and to assess the association between policies affecting sexual and gender minority rights and health outcomes more broadly.

中文翻译：

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儿童早期预防性牙科护理的好处

在同性婚姻之前。我们发现，在州同性婚姻政策实施之前，自杀企图随着时间的推移是稳定的，这表明可能与对性少数群体越来越支持的环境相关的结果改善并未早于同性婚姻法律地位的变化。我们也同意需要进一步的高质量证据来更好地了解青少年和成年人群中同性婚姻与自杀未遂之间关联的性质。虽然 KamtchumTatuene 等人认为青少年自杀企图的减少可能表明自杀企图推迟到成年，现有证据表明，青春期和成年期的自杀企图之间存在正相关关系 2，并且马萨诸塞州实施州同性婚姻政策与成人心理健康的改善有关。 3 而不是假设婚姻是性少数群体的最终目标，我们建议有许多潜在的机制，通过这些机制，州同性婚姻政策可能与减少青少年自杀企图有关，包括减少耻辱感。我们同意，进一步的研究对于了解州同性婚姻政策与青少年自杀企图相关的机制以及更广泛地评估影响性和性别少数群体权利与健康结果的政策之间的关联至关重要。