**1. Introduction**

The U.S. federal government continues to increase the collection of sexualorientation data in its surveys [1–4], recognizes the need to develop a model for LGBT health that integrates behavioral, environmental, and socioeconomic factors, and intends to develop a framework, "to improve the health and well-being of people, … enhancing prosperity in the community and for its residents and businesses" [5] Marriage is one social contract long associated with health, longevity, and prosperity for people in such relationships [6–10]. During the period that preceded local, state, and then national legalization of same-sex marriage in the U.S. [11], researchers analyzed secondary data and proposed that such legal recognition could ensure some of the health and financial benefits that opposite-sex married couples have long-enjoyed [9, 12, 13].

Research on effects of state-based same-sex marriage or legal-partnerships found more nuanced results [14–16], for example, increased health insurance coverage among California legally-partnered lesbians compared to heterosexual women with no change among gay men compared to heterosexual men [17]. An Illinoisbased study found similar findings among sexual minority women with even more profound effects of insurance coverage among racial/ethnic sexual minority women [18]. Another study found higher odds among legally-partnered California gay men to cite continuous health insurance coverage and regular medical providers than married heterosexual men—yet self-reported poorer health and well-being than heterosexual counterparts [19].

was an effort—using Likert scales from 0 representing none of the time, to 4 representing all the time. The K6 scale is summed with scores of 0 representing lowest, and 24 representing the highest psychological distress level. Dichotomized moderate mental distress is defined as the sum of K6 scores at or above 5, the optimal lower threshold indicative of moderate mental distress [13]. The K6 continuous measure and the dichotomized moderate mental distress scores have demonstrated reliability and validity in population datasets, including CHIS [26, 27]. We used the dichotomous measure given our small subsample of married and

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

CHIS participants self-reported as, "straight or heterosexual, as gay, lesbian or

CHIS asked all participants the standard marital question, "Are you now married, living with a partner in a marriage-like relationship, widowed, divorced, separated, or never married?" The response options do not include same-sex marriage or legal partnership. Previous research has shown that lesbian/gay women and gay men under-report marriage and legal partnership when responding to standard marital status questions [19]. To address under-report of marriage and to reflect the 2008 CSCD, CHIS asked all participants who reported having sex with someone of the same sex within the preceding 12 months whether that sexually-active respondent had a legal same-sex spouse or domestic partner. In addition to legallypartnered and married, we consolidated remaining status into *other*, a category including unmarried people who may be divorced, widowed, never-married, or living with a partner without legal recognition. We also constructed a binary variable for married/legally-partnered to increase the power of the data to find statistically significant results. There is no way to separate married and legally-partnered for data prior to 2009 because of questionnaire wording. In 2009, revised question wording distinguished married from legally-partnered. We compared percent of moderate psychological distress between married and legally-partnered lesbian women and gay men and found no statistical difference. Therefore, we collapsed married/legally-partnered as one group for our analyses in order to compare pre to

We performed all statistical analyses using CHIS data pooled from survey years 2005–2015 and weighted to the California population. Lesbian/gay women and gay men were compared to their heterosexual counterparts on sociodemographic variables. Data collected before 2008 were considered prior to the CSCD and data collected in 2008 and later were considered after the legal decision. The proportion of the sample experiencing moderate mental distress was plotted over time by gender, sexual identity, and couple status. Joinpoint analysis tested if trends in moderate psychological distress changed at specific years. Joinpoint uses weighted least squares to fit the trend model, using the inverse of the standard error as the

partnered same-sex couples.

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

**2.2 Independent variables**

homosexual, bisexual, or other."

*2.2.2 Legal marriage and partnership*

*2.2.1 Sexual identity*

post CSCD.

*2.2.3 Statistical analyses*

weight variable.

**77**

Since 2008, the California Health Interview Survey (CHIS) asked questions on same-sex marriage and legal partnerships [20] to reflect the state's policy progression from requiring employer-sponsored health insurance to same-sex partners in 2005, to locality-based same-sex marriage, to a 2008 State Supreme Court decision that affirmed same-sex marriage. Litigation regarding a statewide ballot initiative led to a suspension of issuing same-sex marriage licenses until 2013 when same-sex marriage licenses were issued once again.

The aim of this article is to explore whether Californians in same-sex legal partnerships and marriages reported lower levels of psychological distress after the 2008 California Supreme Court Decision that legalized same-sex marriage. The stress of homoprejudicial experiences has cumulative negative influences on the actual and perceived mental and physical health among lesbian and gay people [21]. Moreover, there is literature that demonstrates reciprocal links between psychosocial stress, health, and well-being [22, 23].
