*2.2.1 Sexual identity*

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

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

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 psychoso-

Our sample includes adult Californians surveyed before and after the California Supreme Court decision (CSCD) in 2008. We obtained data from CHIS for years 2005–2015. Initially fielded biennially, CHIS became a continuous survey in 2011. Administered in five languages, it employs a multi-stage probability design that selects subjects by random-digit dial within geographic strata. Respondents in this analysis include adults ages 18–70 who self-identified as heterosexual, lesbian/gay female, or gay male. CHIS did not ask sexual-identity questions of participants older than 70 [24]. We excluded respondents who said they were bisexual,

celibate, non-sexual, or provided no response because the CHIS survey did not ask the sex/gender of a respondent's spouse [19] and thus lacked the ability to safely intuit the sex/gender of each respondent's spouse. CHIS obtained human subject approval for participant recruitment and data collection through the University of California, Los Angeles (UCLA). The National Institutes of Health's Office of Human Subjects Research Protection determined our study to be exempt from review as it involved the study of existing data recorded such that subjects cannot

CHIS has fielded the Kessler 6-item (K6) scale to assess nonspecific psychological distress since 2005 [25]. The K6 measures symptoms during the past 30 days: felt nervous, hopeless, restless or fidgety, worthless, depressed, and felt that everything

heterosexual counterparts [19].

marriage licenses were issued once again.

*Psycho-Social Aspects of Human Sexuality and Ethics*

cial stress, health, and well-being [22, 23].

**2. Methods**

be identified.

**76**

**2.1 Dependent variable**

*2.1.1 Psychological distress*

CHIS participants self-reported as, "straight or heterosexual, as gay, lesbian or homosexual, bisexual, or other."
