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Comment & Response
September 2017

Legalization of Same-Sex Marriage and Drop in Adolescent Suicide Rates: Association but Not Causation

Author Affiliations
  • 1Liverpool Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, England
  • 2Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  • 3Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
  • 4Neurology Department, Bafoussam Regional Hospital, Bafoussam, Cameroon
JAMA Pediatr. 2017;171(9):915. doi:10.1001/jamapediatrics.2017.1955

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.