**3. Results**

A total of 192,460 individuals were included in the analysis, with 6995 participants identifying as lesbian/gay women and gay men. **Table 1** displays sociodemographics of lesbian, gay, and heterosexual individuals before and after the CSCD. There is an overall increase in non-white populations regardless of sexual orientation and a notable increase in reports of legal married/partnered lesbian women and gay men. Before 2008, only 11 percent of lesbian/gay female and gay male Californians reported being legally married/partnered. That percentage rose to 26.5% after the state Supreme Court decision. Among heterosexuals, marriage slightly declined, from 57.2% before the ruling versus 51.8% after the decision. **Table 1** also reports the mean distress score for sexual identity group pre versus post CSCD and shows that lesbian women and gay men reported higher scores of moderate distress than their heterosexual counterparts.

**Table 2** provides descriptive results expressly for lesbian women and gay men by marital/partnered status pre versus post-CSCD. Employment was stable among married/partnered respondents, but unemployment increased among others. Household income increased among married/partnered respondents but decreased among others. Notably, the percentage of respondents who had a child in the home decreased from 51 to 36% among married/partnered lesbian and gay respondents. Mean scores of moderate mental distress decreased for married or legally partnered but increased for other following the CSCD.

**Total**

**79**

**Pre-CSCD**

**n**

Sample size

RACEETHN:

Latino Asian/PI/AI/AN

African American

White Other MARITDPN:

 Marital or domestic partnered status

Married/Legally

Other Gender

Women

Men KIDCNTD:

Yes No DEGREE00:

<High School Education

High School Diploma or Some College

 Educational

 attainment

 Have child aged 0–17 in household

 Partnered

Race/Ethnicity

pPercentage)

76,979

15,730

7974

3574

47,385

2316

42,382

34,597

45,131

31,848

30,992

45,987

7294

38,141

 51.1

 55,929

 49.0

 1062

 48.0

 1973

 48.6

 37,079

 51.2

 53,956

 49.0

 15.8

 12,372

 15.5

 118

 7.6

 252

 10.2

 7176

 16.0

 12,120

 15.7

 51.2

 75,915

 56.3

 2109

 78.0

 3583

 75.2

 43,878

 50.4

 72,332

 55.5

 48.8

 39,566

 43.7

 466

 22.0

 837

 24.8

 30,526

 49.6

 38,729

 44.5

 41.4

 49,069

 42.5

 1300

 50.5

 2169

 49.1

 30,548

 41.1

 46,900

 42.2

 58.6

 66,412

 57.5

 1275

 49.5

 2251

 50.9

 43,856

 58.9

 64,161

 57.8

 44.3

 54,095

 49.3

 2300

 88.9

 3140

 73.5

 32,297

 42.8

 50,955

 48.2

 55.7

 61,386

 50.7

 275

 11.1

 1280

 26.5

 42,107

 57.2

 60,106

 51.8

 1.6

 3063

 2.4

 116

 3.3

 185

 3.6

 2200

 1.6

 2878

 2.3

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples*

 46.2

 67,116

 41.1

 1832

 56.8

 2842

 47.3

 45,553

 45.9

 64,274

 40.8

 5.7

 5378

 5.7

 112

 6.2

 205

 5.2

 3462

 5.7

 5173

 5.7

 13.6

 12,654

 14.7

 150

 9.1

 279

 10.5

 7824

 13.7

 12,375

 14.9

 32.8

 27,270

 36.1

 365

 24.6

 909

 33.3

 15,365

 33.1

 26,361

 36.3

 24.1

 115,481

 75.9

 2575

 19.3

 4420

 80.7

 74,404

 24.3

 111,061

 75.7

*DOI: http://dx.doi.org/10.5772/intechopen.90249*

 **wgt %**

 **n**

 **wgt %**

 **N**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

**Lesbian women and gay men**

**Heterosexual**

We explored the relationship the 2008 CSCD on self-reported moderate psychological distress among legally married or partnered and other respondents by sexual identity. A higher percentage of Lesbian women and gay men reported rates of distress than heterosexual counterparts. There was no change in the proportion of lesbian women and gay men who experienced moderate mental psychological distress before and after the CSCD. However, this result changes when we compare those who are legally partnered or married compared to other relationship status Legally married or partnered lesbian women and gay men were half as likely to report moderate psychosocial distress after the CSCD [OR, 0.52] as compared to prior to the CSCD. In contrast, moderate psychological distress remained relatively unchanged among other lesbian women and gay men [1.04], married heterosexuals [0.94] and other heterosexuals [0.94]. These results and their 95% confidence intervals (CIs) for statistically significant relationships appear in **Table 3**.

We conducted Joinpoint analyses to determine if moderate psychological distress decreased at specific years. **Figure 1** displays percent of respondents


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

Bi-variate and logistic regression analyses compared psychological distress using the K6 scale between the periods before and after the CSCD. Bi-variate analyses were replicated only for lesbian/gay women and gay men and compared stress levels between those legally married or partnered as compared with those not. Independent variables of the logistic regression included the main effects of sexual identity, marriage/legal partnership and the timing of CSCD (before or after) and all the two-way interaction effects (i.e., sexual identity x marriage/legal partnership, sexual identity x timing of CSCD, marriage/legal partnership x timing of CSCD) and the three-way interaction effect of the three variables (i.e., sexual identity x marriage/legal partnership x timing of CSCD) while adjusting for the following sociodemographics: Race, marital/partnered status, children in home, education, work status, income, geography, age. The conditional adjusted odds ratios compare the odds of reporting moderate mental health distress for that specific group pre- versus after-CSCD while holding all other variables constant.

*Psycho-Social Aspects of Human Sexuality and Ethics*

A total of 192,460 individuals were included in the analysis, with 6995 partici-

**Table 2** provides descriptive results expressly for lesbian women and gay men by marital/partnered status pre versus post-CSCD. Employment was stable among married/partnered respondents, but unemployment increased among others. Household income increased among married/partnered respondents but decreased among others. Notably, the percentage of respondents who had a child in the home decreased from 51 to 36% among married/partnered lesbian and gay respondents. Mean scores of moderate mental distress decreased for married or legally partnered

We explored the relationship the 2008 CSCD on self-reported moderate psychological distress among legally married or partnered and other respondents by sexual identity. A higher percentage of Lesbian women and gay men reported rates of distress than heterosexual counterparts. There was no change in the proportion of lesbian women and gay men who experienced moderate mental psychological distress before and after the CSCD. However, this result changes when we compare those who are legally partnered or married compared to other relationship status Legally married or partnered lesbian women and gay men were half as likely to report moderate psychosocial distress after the CSCD [OR, 0.52] as compared to prior to the CSCD. In contrast, moderate psychological distress remained relatively unchanged among other lesbian women and gay men [1.04], married heterosexuals [0.94] and other heterosexuals [0.94]. These results and their 95% confidence intervals (CIs) for statistically significant relationships appear in **Table 3**.

We conducted Joinpoint analyses to determine if moderate psychological dis-

tress decreased at specific years. **Figure 1** displays percent of respondents

pants identifying as lesbian/gay women and gay men. **Table 1** displays sociodemographics of lesbian, gay, and heterosexual individuals before and after the CSCD. There is an overall increase in non-white populations regardless of sexual orientation and a notable increase in reports of legal married/partnered lesbian women and gay men. Before 2008, only 11 percent of lesbian/gay female and gay male Californians reported being legally married/partnered. That percentage rose to 26.5% after the state Supreme Court decision. Among heterosexuals, marriage slightly declined, from 57.2% before the ruling versus 51.8% after the decision. **Table 1** also reports the mean distress score for sexual identity group pre versus post CSCD and shows that lesbian women and gay men reported higher scores of

moderate distress than their heterosexual counterparts.

but increased for other following the CSCD.

**3. Results**

**78**


**Total**

**Pre-CSCD**

**n**

3.61

0.30

0.17

 0.00

 0.19

 0.00

 0.18

 0.01

 0.21

 0.01

 0.17

 0.00

 0.19

 0.00

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples*

 0.00

 0.30

 0.00

 0.43

 0.02

 0.44

 0.02

 0.29

 0.00

 0.29

 0.00

 0.02

 3.66

 0.03

 4.84

 0.13

 5.06

 0.13

 3.57

 0.02

 3.60

 0.03

*DOI: http://dx.doi.org/10.5772/intechopen.90249*

K6SUM: K6Sum

**81**

Mean (Standard Error)

PSY\_INDICATOR:

Mean (Standard Error) POORFAIR\_HEALTH:

Poor/Fair

**Table 1.** *Psychological*

 *health influences and the 2008 California*

 *supreme court decision: Descriptive*

 *statistics for California*

 *adults 18–70, by sexual identity.*

 Poor/Fair Health

Psychological

 distress indicator

 **wgt %**

 **n**

 **wgt %**

 **N**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

**Lesbian women and gay men**

**Heterosexual**

#### *Psycho-Social Aspects of Human Sexuality and Ethics*



#### **Table 1.**

*Psychological health influences and the 2008 California supreme court decision: Descriptive statistics for California adults 18–70, by sexual identity.*

**Total**

**Pre-CSCD**

**n**

31,544

54,253

2050

20,676

32,480

 44,499 71,430

5549

3335

9647

21,385

25,423

17,189

Mean

41.07

 0.02

 41.83

 0.03

 38.66

 0.40

 37.83

 0.40

 41.14

 0.03

 42.01

 0.03

 SE

 Mean

 SE

 Mean

 SE

 Mean

 SE

 Mean

 SE

 Mean

 SE

 21.1

 22,458

 19.4

 560

 21.8

 732

 17.6

 16,629

 21.1

 21,726

 19.4

 31.5

 36,987

 31.6

 833

 31.9

 1425

 31.2

 24,590

 31.4

 35,562

 31.7

 30.0

 33,532

 30.3

 698

 28.0

 1312

 29.8

 20,687

 30.1

 32,220

 30.3

 13.9

 16,890

 15.1

 329

 13.8

 700

 17.4

 9318

 13.9

 16,190

 15.0

 3.6

 5614

 3.6

 155

 4.5

 251

 4.1

 3180

 3.5

 5363

 3.6

 2.3

 9513

 2.2

 199

 1.9

 361

 1.9

 5350

 2.3

 9152

 2.2

 97.7

 105,968

 97.8

 2376

 98.1

 4059

 98.1

 69,054

 97.7

 101,909

 97.8

 51.2

 58,239

 44.8

 1583

 60.4

 2296

 49.1

 42,916

 50.9

 55,943

 44.6

 48.8

 57,242

 55.2

 992

 39.6

 2124

 50.9

 31,488

 49.1

 55,118

 55.4

 21.8

 36,792

 22.6

 617

 19.3

 1295

 20.6

 20,059

 21.9

 35,497

 22.7

 3.7

 7345

 8.3

 93

 3.7

 391

 10.6

 1957

 3.7

 6954

 8.2

*Psycho-Social Aspects of Human Sexuality and Ethics*

 74.4

 71,344

 69.1

 1865

 77.0

 2734

 68.7

 52,388

 74.3

 68,610

 69.1

 33.1

 47,180

 35.5

 1395

 44.4

 2195

 41.2

 30,149

 32.7

 44,985

 35.3

College Degree or Above

**80**

WRKST\_R:

Employed Unemployed,

Unemployed,

HHINCOME:

Household Income Under 350% FPL

Household Income Greater Than or Equal To 350% FPL

GEOGRAPHY:

Metro Non-Metro SELF\_HEALTH:

Poor

Fair Good Very Good

Excellent AGE\_DERIVED:

Mean (Standard Error)

 Age

 Self Health

 Geography

 Household Income

 Not Looking For Work

 Looking For Work

 Working status recode

 **wgt %**

 **n**

 **wgt %**

 **N**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **n**

 **wgt %**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

 **Pre-CSCD**

 **Post-CSCD**

**Lesbian women and gay men**

**Heterosexual**


experiencing at least moderate psychological distress by sexual identity, gender and marital status from 2005 through 2015. Joinpoint analyses were conducted separately for sub-groups by gender, marital status and sexual identity. Distress levels remain relatively stable over time among married and other heterosexual women and among married heterosexual males. Moderate distress percentages dip in 2013 among married/partnered lesbians and gays as a group (lesbians and gays) and

*Data in cells represent sample sizes, percentage married, mean and standard deviation for continuous version of the Kessler 6-item scale and percent reporting moderate mental distress (score of 5 or higher on the Kessler scale).*

*Mean scores of psychological distress and percent reporting moderate mental distress pre and post the 2008 California supreme court decision (CSCD) to legalize same-sex marriage: CHIS data 2005–2015.*

**Married/legally partnered Other**

**N wgt %**

**All Lesbian and Gay individuals**

> **Post-CSCD**

5.06 (0.13) 3.57

4.14 (0.22) 4.81

0.52 (0.33, 0.82)

50% 33% 43% 48%

43% 44% 29% 29%

**Pre-CSCD**

4.84 (0.13)

5.09 (0.38)

**n wgt %**

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples*

Mean (standard error) 5.09 0.38 4.14 0.22 4.81 0.14 5.40 0.17

Mean (standard error) 0.50 0.05 0.33 0.03 0.43 0.02 0.48 0.02

Poor/Fair 0.20 0.04 0.17 0.02 0.18 0.01 0.23 0.02

**Full sample of adults to compare lesbian/gay female, gay male, and heterosexual married/legally-**

Number of respondents 2575 4420 74,404 111,061 Percent married or legally partnered 11.1% 26.5% 57.2% 51.8%

**Sub-set of only adults who are lesbian and gay to compare between those married/legally-**

Number of respondents 279 1280 2300 3140

*Descriptive statistics for lesbian women and gay men by marital/partnered status.*

K6SUM: K6Sum

**Table 2.**

PSY\_INDICATOR: Psychological distress indicator

*DOI: http://dx.doi.org/10.5772/intechopen.90249*

Psychological Distress mean and standard deviation Kessler 6-item (K6) continuous score (0–24)

Percent reporting at least moderate mental distress

Psychological distress mean and standard deviation Kessler 6-item (K6) continuous score (0–24)

Percent reporting at least moderate mental distress

Conditional adjusted odds ratio & 95% CI of moderate

POORFAIR\_HEALTH: Poor/Fair Health

**partnered and otherwise single**

(yes/no) K6 score of > = 5

(yes/no) K6 score of > = 5

mental distress Post-CSCD vs. Pre-CSCD

**Table 3.**

**83**

**partnered and otherwise single**

**Pre-CSCD Post-CSCD Pre-CSCD Post-CSCD**

**n wgt %**

**N wgt %**

**All Heterosexual individuals**

> **Post-CSCD**

3.60 (0.03)

5.40 (0.17)

1.04 (0.85, 1.29)

**Pre-CSCD**

(0.02)

(0.14)

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


#### **Table 2.**

**Married/legally partnered Other**

**N wgt %**

**n wgt %**

Sample size (percentage) 275 9.1 1280 90.9 2300 22.5 3140 77.5

Women 184 66.9 763 59.6 1091 47.4 1488 47.4 Men 91 33.1 517 40.4 1209 52.6 1652 52.3

Latino 54 31.1 215 27.7 311 23.7 694 35.3 Asian/PI/AI/AN 38 15.4 84 8.9 112 8.4 195 11.1 African American 4 0.6 29 2.6 108 6.9 176 6.2 White 169 50.8 908 57.7 1663 57.5 1934 43.6 Other 10 2.1 44 3.1 106 3.5 141 3.9

Yes 135 50.9 362 35.6 331 18.4 475 20.9 No 140 49.1 918 64.4 1969 81.6 2665 79.1

<High school education 16 9.5 62 7.1 102 7.4 190 11.3 High school diploma or Some college 117 42.8 455 39.7 945 48.6 1518 51.8 College degree or above 142 47.7 763 53.2 1253 44.0 1432 36.9

Employed 194 72.6 858 72.3 1671 77.5 1876 67.5 Unemployed, looking for work 9 4.1 58 5.1 84 3.6 333 12.6 Unemployed, not looking for work 72 23.3 364 22.6 545 18.8 931 19.9

Household income under 350% FPL 113 44.3 390 32.8 879 39.1 1734 57.4

Metro 250 97.4 1185 98.4 2126 98.2 2874 98.0 Non-metro 25 2.6 95 1.6 174 1.8 266 2.0

Poor 11 4.4 54 3.0 144 4.5 197 4.4 Fair 36 15.5 183 14.1 293 13.6 517 18.6 Good 85 32.3 349 28.6 613 27.5 963 30.2 Very Good 89 27.8 445 36.5 744 32.4 980 29.2 Excellent 54 20.1 249 17.8 506 22.1 483 17.6

Mean (standard error) 40.64 1.04 44.01 0.65 38.41 0.42 35.61 0.43

162 55.7 890 67.2 1421 60.9 1406 42.6

Mean SE Mean SE Mean SE Mean SE

Gender

RACEETHN: Race/ethnicity

KIDCNTD: Have child aged 0–17 in household

*Psycho-Social Aspects of Human Sexuality and Ethics*

DEGREE: Educational attainment

WRKST\_R: Working status recode

HHINCOME: Household Income

GEOGRAPHY: Geography

SELF\_HEALTH: Self Health

AGE\_DERIVED: Age

**82**

350% FPL

Household income greater than or equal to

**Pre-CSCD Post-CSCD Pre-CSCD Post-CSCD**

**n wgt %**

**N wgt %**

*Descriptive statistics for lesbian women and gay men by marital/partnered status.*

**Full sample of adults to compare lesbian/gay female, gay male, and heterosexual married/legallypartnered and otherwise single**


*Data in cells represent sample sizes, percentage married, mean and standard deviation for continuous version of the Kessler 6-item scale and percent reporting moderate mental distress (score of 5 or higher on the Kessler scale).*

#### **Table 3.**

*Mean scores of psychological distress and percent reporting moderate mental distress pre and post the 2008 California supreme court decision (CSCD) to legalize same-sex marriage: CHIS data 2005–2015.*

experiencing at least moderate psychological distress by sexual identity, gender and marital status from 2005 through 2015. Joinpoint analyses were conducted separately for sub-groups by gender, marital status and sexual identity. Distress levels remain relatively stable over time among married and other heterosexual women and among married heterosexual males. Moderate distress percentages dip in 2013 among married/partnered lesbians and gays as a group (lesbians and gays) and

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

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples*

and -partnered gay and lesbian people even during this turbulent period.

relates to their overall health [3].

*DOI: http://dx.doi.org/10.5772/intechopen.90249*

and prosperity across communities.

the second most frequent cause of death [32–34].

while.

**85**

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

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,

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 worth-

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

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.

#### **Figure 1.**

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

separately (married/partnered gays, married partnered lesbians). Distress increased in this same year among other gay men and lesbian women. Distress scores 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 slopes for moderate psychological distress for any of the sub-groups.
