LGBTQ+ policies in the United States and mental health: The mediating role of sexual orientation discrimination among sexual minority women and gender diverse individuals assigned female at birth.

Introduction: Research on the role of LGBTQ+ policies in the US has primarily examined how policies are associated with perceptions of LGBTQ+ communities, LGBTQ+ people's experiences of discrimination, or LGBTQ+ mental health. However, no research that we are aware of has examined the indirect effects of distinct LGBTQ+ policies on mental health outcomes among sexual minority women and gender diverse individuals assigned female at birth (SMWGD) through sexual orientation discrimination prospectively. Methods: We used state level data from the Movement Advancement Project in combination with baseline and follow up data from a sample of 429 SMWGD to understand associations between distinct LGBTQ+ policies, anxiety, and depression through sexual orientation discrimination. Participants were recruited online August 2020 through May 2021. Results: Only LGBTQ+ nondiscrimination policies, and no other policies, were significantly associated with sexual orientation discrimination. Participants living in states with more LGBTQ+ nondiscrimination policies experienced less sexual orientation discrimination at baseline, which in turn predicted less anxiety at follow-up (when controlling for anxiety at baseline). Additionally, living in states with better overall LGBTQ+ policies and youth policies were associated with significantly less anxiety, but not depression or sexual orientation discrimination. Conclusion: Results suggest that LGBTQ+ policies in the US have direct and indirect effects on the mental health of SMWGD. However, we must continue to monitor the role of LGBTQ+ policies on the lives of LGBTQ+ community members. Policy Implications: Policymakers should promote nondiscrimination policies and address the real-life impact of LGBTQ+ polices in the lives of their LGBTQ+ citizens.