Faculty from The Fenway Institute at Fenway Health published an Original Investigation in JAMA Psychiatry that quantified the effects of a 2020 Supreme Court decision on the mental health of adults who identify as lesbian, gay, or bisexual.
In their ruling in Bostock v. Clayton County, Georgia, the Supreme Court held that discrimination on the basis of sexual orientation or gender identity is tantamount to discrimination on the basis of sex. As a result of the decision, Title VII did not need to be amended to prohibit employment discrimination for LGBTQIA+ workers nationwide. All employers subject to Title VII can no longer discriminate based on a worker’s sexual orientation or gender identity, regardless of the state or municipality in which they are based.
This quasi-experimental study looked at 2018 – 2022 Behavioral Risk Factor Surveillance System data to compare changes in the mental health of sexual minority adults living in states that gained employment non-discrimination protections after the Bostock ruling relative to their counterparts in states that already had protections. Fenway faculty found that the Bostock decision was associated with a 12.1% relative reduction in the number of past-month poor mental health days and a 13.2% relative reduction in severe mental distress among employed sexual minority adults.
The policy was associated with smaller and less consistent benefits among the larger sample of all sexual minority adults, which is in line with Bostock specifically impacting members of the workforce, underscoring the importance of broadening non-discrimination protection to other social domains, which is the goal of the Equality Act currently under consideration by the US Senate.
“Our findings demonstrate that there are mental health consequences of public policies and laws that determine the fundamental rights of marginalized populations. This suggests that the unprecedented number of anti-LGBTQIA+ laws being proposed and enacted across the country will seriously harm the health of sexual and gender minority people,” said Michael Liu, student researcher at The Fenway Institute and lead author of the research paper.
The authors posit that the mental health benefits of the Bostock decision could stem from reduced stigma surrounding sexual orientation and gender identity, in addition to improved workplace conditions related to greater psychological safety, less interpersonal discrimination, and increased access to tangible employment benefits.
This JAMA Psychiatry Original Investigation adds to the growing evidence of the substantial health benefits of policies protecting the civil rights of LGBTQIA+ people, including a 2017 JAMA paper focused on the positive mental health impact of marriage equality laws on sexual minority youth, and studies of state and municipal LGBTQIA+ non-discrimination protections showing that they improve health outcomes; lessen homophobia and social stigma; and lead to improved economic and employment outcomes.
“Discrimination in many facets of civic life drives mental health disparities among sexually and gender diverse people. While our study found that the Bostock decision was associated with better mental health among employed sexually diverse people, comprehensive nondiscrimination protections are necessary for sexually and gender diverse populations in all sectors, including education, credit, health care, housing, and public accommodations. The Equality Act being considered by the United States Congress would confer such protections,” said Alex Keuroghlian, MD, MPH, Director of the Division of Education and Training at The Fenway Institute and the senior author of the JAMA Psychiatry study.