This post continues our look at Starks, Hillesheim, Stephenson, and Robles (2023) recent study on policy, relationships, and mental health among sexual minority men. My previous post examined their finding that state-level policy is correlated with whether or not sexual minority men are in a relationship. Here, I examine a second take-away: Relationship quality determines whether being in a relationship is associated with better or worse mental health.

Terminology Check

  • “Relationship” refers to main or primary partner relationships. Terms vary, but people in these relationships might be thought of as boyfriends, partners, lovers, spouses, or significant others.
  • “Relationship quality” refers to how satisfied, committed, and emotionally connected partners are, as assessed using subscales of the Perceived Relationship Quality Components scale (Fletcher et al., 2000).
  • “Mental health problems” (in this study) are symptoms of anxiety and depression assessed using a 4-item screener called the Patient Health Questionnaire–4 (Lowe et al., 2010).

What Is New Here?

Decades of research indicates that people in relationships have better mental and physical health outcomes than those who are single (Braithwaite & Holt-Lunstad, 2017). Although most of this research has looked at heterosexual people in relationships, findings are consistent in studies of LGBTQ+ people (Newcomb, 2020).

Most studies on relationships and health do one of two things:

  1. Some focus on comparing single people to people in relationships. These help us understand group differences; however, it is difficult for these analyses to incorporate details about relationships — things like relationship quality, how long the couple has been together, main partner age etc. Single people are missing all those data.
  2. Other studies do test the association between relationship quality (or other relationship characteristics) and a health outcome. These typically exclude single people.

Starks and colleagues did something a little different: They developed an analysis that allowed them to compare partnered sexual minority men to those who were single, and their analysis controlled for relationship quality. (They also controlled for things like relationship length, partner age, and the couple’s sexual agreement.)

When they did that, they found a few interesting things.

  • Partnered sexual minority men who had average levels of relationship quality or better reported fewer mental health problems than single people. Since about half of the people in a sample have an average score or better (when scores are normally distributed), this means that a whole bunch (about half) of the sexual minority men in relationships have better mental health than those who were single. [Click here for a reminder of the normal distribution and standard deviations.]
  • Partnered sexual minority men who had low levels of relationship quality (1 standard deviation below the mean) did not differ from single people. These sexual minority men may not be doing better than the single guys, but they are not doing any worse either.
  • Partnered sexual minority men who had really low levels of relationship quality (2 standard deviations below the mean) reported significantly more mental health problems than single people. This is not a huge group: Only about 2.5% of a normal distribution is 2 standard deviations or more below the mean. But this finding suggests that sexual minority men in these really low-quality relationships are actually more depressed and anxious than those who are single.

Why Might This Happen?

Maybe being in a relationship keeps us healthy (a.k.a. experience models; e.g., Beach et al., 1990; Davila et al., 1997). Partners in a couple tend to look out for one another. They comfort and support one another. They might encourage each other to eat better, exercise more, or use fewer substances (or avoid substance use altogether). Psychologists call this kind of influence social control (Lewis et al., 2006). Partners in high-quality relationships are even better at motivating one another in these ways.

Maybe healthier people have an easier time finding and staying in a relationship (a.k.a. selection models; Braithwaite & Holt-Lunstad, 2017). Finding and maintaining a relationship can be challenging even when you are feeling your best. It can be even harder when you are not feeling physically or emotionally well.

Starks and colleagues used a cross-sectional survey design. So their findings cannot tell us which of these models is correct. They have no way of knowing whether people became less depressed and anxious after they got into a relationship or whether people who were less depressed and anxious had better luck starting a relationship. It is even possible that both theories are correct and each explains one part of how relationships impact mental health.

Relationships Essential Reads

Why Does This Have to Do With State Policy?

Remember that Starks and colleagues set out to study state policy, relationships, and mental health. They were investigating the possibility that discriminatory state policy might ultimately impact mental health by interfering with relationships. Understanding how relationship status and quality were associated with mental health was critical to getting that done.

Relationships do not have to be perfect in order to be associated with better mental health. All those sexual minority men who had average relationship quality or better scored lower than single guys on a measure of mental health problems.

Starks and colleagues found that sexual minority men in states with policies that supported LGBTQ+ rights were more likely to be partnered. They are therefore more likely to experience the benefits of a high-quality relationship (and the challenges of a lower-quality one). And, as Hatzenbuehler (2009) put it, that is one way discrimination might get “under the skin” and change the way we think and feel.