**4. Discussion**

Before same-sex marriage became legal throughout the United States in 2015, clinical researchers promoted marriage equality as a health promotion strategy for lesbian/gay women and gay men [8, 12, 28]. Others ventured that marriage equality not only would improve lesbian/gay health, but also would benefit society at large [29]. Though our project was more circumscribed, we found some confirmation of our exploratory aim: Many adult Californians in legal same-sex partnerships and marriages reported lower levels of psychological distress than their single counterparts following the CSCD.

The inelegant results in this quasi-natural experiment may be no surprise, as this time period was fraught with instability regarding the state legality of same-sex marriage/partnerships and the stay of issuing same-sex marriage licenses between November 2008 and June 2014. Though Californians in same-sex unions maintained their legal status at the ends of the disputes, during this tumultuous legal period some undoubtedly worried whether their marital status would continue. Engaged same-sex couples were precluded from marriage licenses. Those with same-sex orientations may have experienced stressors related to passage of the state referendum Proposition 8 and the court cases appealing that referendum that abolished marriage for same-sex couples. In sum, this period was uncertain on the

### *Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples DOI: http://dx.doi.org/10.5772/intechopen.90249*

status of same-sex marriage and mental health self-reports fluctuated during periods when the issue's status also changed (**Figure 1**, **Table 3**). Reports of distress declined over time for legally-married or -partnered lesbian women and gay men while distress increased for their single counterparts. However, the changes in slope were not significant and no single year showed as the changing point when using Joinpoint analyses. In contrast, distress reports among heterosexual women and men remained relatively stable between 2009 and 2015. Our results suggest that marriage may have had a positive influence on mental health for legally-married and -partnered gay and lesbian people even during this turbulent period.

Recent studies posit that people in legal same-sex relationships have higher relationship stability, more financial resources, and better health outcomes than couples who cohabit without legal recognition [19, 30] and that marriage may mitigate minority stress effects among same-sex and other marginalized couples [21]. Our project found lower psychological distress levels among many lesbian/gay women and gay male Californians, though this health benefit was not uniform over time across same-sex marriages or legal partnerships—perhaps a reflection of the time period during which the continued legality of same-sex marriage in California was uncertain. The support we found for our hypothesis, even when the data were collected during a period in which the legality of same-sex marriage was questioned, reinforces a finding of a National Academies report that encourages research to understand the qualities of resilience unique to sexual minorities and how that relates to their overall health [3].

We also found evidence that gay and lesbian CHIS respondents who were legally-married and -partnered were substantively more likely to be employed and to have college educations than those unmarried or not legally partnered. That said, marriage equality in California can find its roots in 2005 legislation that required private employers to extend health insurance benefits to employees'same-sex partners just as the benefits were extended to opposite-sex spouses—a time when samesex marriage was unlawful. An earlier study found this policy had no influence on gay men but was of great benefit to lesbian women [17]. Our work, in light of previous studies, suggests more research is needed to explore whether and how same- and opposite-sex marriage is associated with benefits to health, well-being, and prosperity across communities.

Minority stress theory posits that prejudicial experiences over the lifecourse have a negative impact on the actual and perceived mental and physical health of lesbian/gay people [18, 21, 31]. Full legal protections for sexual- and genderminorities are incomplete; however, an exploration of the influence of national marriage equality on health issues of the multifaceted, non-exclusively-heterosexual, cis- and transgender people who comprise sexual minorities may be worthwhile.

Studies using future iterations of CHIS can determine whether the mental health benefits we found continue over time and whether other self-reported health benefits emerge. For example, extant research suggests that marriage equality has, at minimum, mental health benefits for non-heterosexual youth for whom suicide is the second most frequent cause of death [32–34].

Additional research projects might explore these questions across U.S. populations beyond California. To explore the implications of minority stress theory more thoroughly, future projects might consider biopsychosocial measures typically associated with stress responses—for example, to explore changes or differences in telomere lengths [35] and/or cortisol levels [36] in addition to self-reported data from single and married lesbian/gay women, gay men, and additional sexual and gender minorities over time. Longitudinal studies in this regard would enhance both understanding and health promotion among sexual minorities.

separately (married/partnered gays, married partnered lesbians). Distress increased

increased from their 2013 levels among married/partnered lesbians and gays in 2014 and decreased only among gay men in 2015, the year of the U.S. Supreme Court decision that legalized same-sex marriage. However, none of these trends were significant as determined by the p-values for each slope in Joinpoint analyses. In addition, there was no significant changing point in terms of year for any of the

Before same-sex marriage became legal throughout the United States in 2015, clinical researchers promoted marriage equality as a health promotion strategy for lesbian/gay women and gay men [8, 12, 28]. Others ventured that marriage equality not only would improve lesbian/gay health, but also would benefit society at large [29]. Though our project was more circumscribed, we found some confirmation of our exploratory aim: Many adult Californians in legal same-sex partnerships and marriages reported lower levels of psychological distress than their single counter-

The inelegant results in this quasi-natural experiment may be no surprise, as this time period was fraught with instability regarding the state legality of same-sex marriage/partnerships and the stay of issuing same-sex marriage licenses between

November 2008 and June 2014. Though Californians in same-sex unions maintained their legal status at the ends of the disputes, during this tumultuous legal period some undoubtedly worried whether their marital status would continue. Engaged same-sex couples were precluded from marriage licenses. Those with same-sex orientations may have experienced stressors related to passage of the state referendum Proposition 8 and the court cases appealing that referendum that abolished marriage for same-sex couples. In sum, this period was uncertain on the

in this same year among other gay men and lesbian women. Distress scores

*Trend of moderate phycological distress by marital status and sexual identity.*

*Psycho-Social Aspects of Human Sexuality and Ethics*

slopes for moderate psychological distress for any of the sub-groups.

**4. Discussion**

**84**

**Figure 1.**

parts following the CSCD.
