Examining Perceived Effects of Same-Sex Marriage Legalization Among Sexual Minority Women: Identifying Demographic Differences and Factors Related to Alcohol Use Disorder, Depression, and Self-Perceived Health

Introduction Reductions in structural stigmas, such as gaining access to legalized same-sex marriage, are associated with positive psychological and physical health outcomes among sexual minorities. However, these positive outcomes may be less robust among sexual minority women (SMW). Methods This study examined how perceptions of the impact of legalized same-sex marriage among SMW may (1) differ by demographic characteristics and (2) predict alcohol use disorder, depression, and self-perceived health. A diverse sample of SMW ( N =446) completed an online survey in 2020 assessing the perceived impact of legalized same-sex marriage across six social-ecological domains: (1) personal impact, (2) stigma-related concerns, (3) couple impact, (4) family support, (5) work/school impact, and (6) local social climate towards LGBTQ people. Results Perceived impact across multiple domains differed by relationship status and sexual identity (e.g., lesbian compared to bisexual identity); only family support differed by race/ethnicity. Stigma-related concerns (e.g., experiencing or witnessing hostility or discrimination because of sexual identity, despite legalized same-sex marriage) were associated with greater odds of depression and lower odds of reporting excellent, very good, or good health. Odds of depression were lower among participants who reported higher personal impact, a greater number of family members supportive of same-sex marriage, and a more positive local social climate. Family support also predicted self-perceived health. However, participants who perceived increased support in work/school contexts after legalized same-sex marriage had higher odds of alcohol use disorder. Conclusions Overall, findings underscore the importance of policy in improving health outcomes through reducing stigma-related concerns and improving social acceptance. Policy Implications Policies that protect the rights of sexual minorities at the federal level are important to the health and well-being of sexual minority women.