title: State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations.
abstract: OBJECTIVE
  We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders.
  
  
  METHODS
  Data were from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study of noninstitutionalized US adults (N=34,653). States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation.
  
  
  RESULTS
  Compared with living in states with policies extending protections, living in states without these policies predicted a significantly stronger association between lesbian, gay, or bisexual status and psychiatric disorders in the past 12 months, including generalized anxiety disorder (F=3.87; df=2; P=.02), post-traumatic stress disorder (F=3.42; df=2; P=.04), and dysthymia (F=5.20; df=2; P=.02). Living in states with policies that did not extend protections also predicted a stronger relation between lesbian, gay, or bisexual status and psychiatric comorbidity (F=2.47; df=2; P=.04).
  
  
  CONCLUSIONS
  State-level protective policies modify the effect of lesbian, gay, or bisexual status on psychiatric disorders. Policies that reduce discrimination against gays and lesbians are urgently needed to protect the health and well-being of this population.
authors.affiliation: Department of Psychology, Yale University, PO Box 208205, New Haven, CT 06520, USA. mark.hatzenbuehler@yale.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Hasin
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001727:Bisexuality / Q000523:psychology*; D003415:Crime; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D016017:Odds Ratio; D011287:Prejudice; D011640:Public Policy / Q000331:legislation & jurisprudence; D019966:Substance-Related Disorders / Q000453:epidemiology