LAUSR

prior to same-sex marriage. We found that suicide attempts were stable over time prior to the implementation of state same-sex marriage policies, suggesting that improvements in outcomes that might be associated with increasingly supportive environments for sexual minorities did not predate changes in legal status of same sex marriage. We also agree that there is a need for further high-quality evidence to better understand the nature of the association between same-sex marriage and suicide attempts among both adolescent and adult populations. While KamtchumTatuene et al suggest that reduced teen suicide attempts may indicate delayed suicide attempts until adulthood, the available evidence indicates a positive association between suicide attempts in adolescence and adulthood2 and that the implementation of state same-sex marriage policies in Massachusetts was associated with improvements in adult mental health.3 Rather than hypothesizing that marriage is the ultimate goal of sexual minority populations, we suggest there are a number of potential mechanisms by which state samesex marriage policies may be associated with reduced adolescent suicide attempts, including reduced stigma. We agree that further research is critical to understand the mechanisms by which state same-sex marriage policies were associated with adolescent suicide attempts and to assess the association between policies affecting sexual and gender minority rights and health outcomes more broadly.