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.
Kamtchum-Tatuene J, Noubiap JJ, Fogang YF. Legalization of Same-Sex Marriage and Drop in Adolescent Suicide Rates: Association but Not Causation. JAMA Pediatr. 2017;171(9):915. doi:10.1001/jamapediatrics.2017.1955
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