Raifman J, et al. - Whether or not state laws permitting individuals to refuse services to sexual minorities were associated with changes in the proportion of sexual minority adults reporting mental distress. Data for this difference-in-difference-in-differences linear regression analysis with state fixed effects was extracted from Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). Findings revealed a 46% increase in the proportion of sexual minority adults experiencing mental distress in association with state laws permitting the denial of services to same-sex couples. Hence, the association between these laws and increases in the proportion of sexual minority adults experiencing mental distress should be taken into consideration by lawmakers and courts considering laws permitting denial of services to sexual minorities.