The Psychological Impact of Marriage

I went to wedding recently. In my life it doesn’t happen very often – my friends’ children, though mostly involved in committed relationships, do not feel the need to formalise their relationships in this time honoured way. At this wedding a woman and a man made their vows on a beautiful beach at sunset in a fairly traditional ceremony, provided you are willing to ignore the fact that the “reading” consisted of some lovely quotes about love and relationships from the scripts of Dr Who!

At the reception, when the speeches were being made, the bride said something thought provoking and rather unexpected. She said that on this, the happiest day of her life so far, she was very sad for all her friends and all those others in the community who were unable to marry because the person that they loved happened to be the same gender as themselves.

This compassion is shared by many, but there are also many who do not agree. In clinical practice many of us see the sad results of homophobia and prejudice. The mental health toll of living a life forsaken by family or a life that you know is a lie, are huge.               

According to the Queensland AIDS Council website and the AIHW, Australians who are Lesbian, Gay or Bisexual (LGB) suffer significantly more mental health problems than their heterosexual peers (see table). For example LGBTI people in the 16-27 year age range are a horrifying 5 times more likely to attempt suicide than their heterosexual peers. For transgender people the numbers are even more alarming.

Add to this the fact that 12% of LGB Community members have no family support they can rely on (compared to 6% of the heterosexual population) and we have a lot of reasons to be concerned.

The figures about community safety tell another part of the story. In 2010 82% of the LGBTI community had experienced violence or harassment in their lifetime and 53% had had that experience in the previous 2 years. 75% of those who had experienced homophobic violence or harassment had not sought help or reported the incident out of fear that they would not be treated fairly or because they did not know where to go for help.

What difference would being able to legally marry make? A glance at the literature shows that it would greatly improve the disparity in mental health and wellbeing between these two groups.

In a 2010 study published in the journal of the American Public Health Association (AJPH) William C Buffie reported that “the medical and social science literature suggest that legal and social recognition of same-sex marriage has had positive effects on the health status of this at-risk community” and an extensive reference list supports this conclusion. In the same publication in 2013 Richard G Wright and his colleagues in California found that “Being in a legally recognised same-sex relationship, marriage in particular, appeared to diminish mental health differentials between heterosexuals and lesbian, gay, and bisexual persons” just as “married heterosexuals were significantly less distressed than nonmarried heterosexuals.”

Marriage aside, as GPs we need to know how to help members of the LGBTI community who are experiencing mental health problems. Youth websites such as ReachOut and Youth beyondblue go some way to address the issues. For more specific help there is QLife.

QLife is a federally funded site that provides information and support for LGBTI people. Between 3.00pm and midnight telephone and online chat support is available. The site also includes a series of guides for health professionals about important issues for LGBTI people and a community resources directory  listing support groups and services, a few psychologists but unfortunately no GPs.