Restricted accessResearch articleFirst published online 2019-9
The Influence of Stress on Depression and Substance Use Problems Among Young Male Same-Sex Couples: Relationship Functioning as an Underlying Mechanism
Stress experienced by either partner in a couple can have a negative impact on each partner’s health, but most dyadic research on stress and health has focused on different-sex couples. We examined relationship functioning as a mechanism underlying the longitudinal actor and partner effects of stress on depression and substance use problems among 109 young male same-sex couples. There were significant indirect actor effects of internalized stigma and microaggressions on depression and alcohol use problems through negative relationship interactions. Participants who reported higher levels of internalized stigma and microaggressions reported increases in negative relationship interactions, which in turn was associated with reporting greater depression and alcohol use problems. In contrast, none of the indirect partner effects were significant. Findings implicate negative relationship interactions as a mechanism linking minority stress to health but raise questions about the influence of partner stress on individual health among young male same-sex couples.
AdamsonS. J.Kay-LambkinF. J.BakerA. L.LewinT. J.ThorntonL.KellyB. J.SellmanJ. D. (2010). An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence, 110, 137–143.
2.
ArnettJ. J. (2007). Emerging adulthood: What is it, and what is it good for?Child Development Perspectives, 1, 68–73.
3.
BaborT. F.Higgins-BiddleJ. C.SaundersJ. B.MonteiroM. G. (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care. Geneva, Switzerland. World Health Organization.
4.
BauerD. J.PreacherK. J.GilK. M. (2006). Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychological Methods, 11, 142–163.
5.
BenjaminiY.HochbergY. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B: Methodological, 57, 289–300.
6.
BontempoD. E.D’AugelliA. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374.
7.
BostwickW. B.BoydC. J.HughesT. L.McCabeS. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100, 468–475.
8.
BostwickW. B.BoydC. J.HughesT. L.WestB. T.McCabeS. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84, 35–45.
9.
BraithwaiteS.Holt-LunstadJ. (2017). Romantic relationships and mental health. Current Opinion in Psychology, 13, 120–125.
10.
BreitensteinC. J.MilekA.NussbeckF. W.DavilaJ.BodenmannG. (2018). Stress, dyadic coping, and relationship satisfaction in late adolescent couples. Journal of Social and Personal Relationships, 35, 770–790. doi:10.1177/0265407517698049
11.
BrubakerM. D.GarrettM. T.DewB. J. (2009). Examining the relationship between internalized heterosexism and substance abuse among lesbian, gay, and bisexual individuals: A critical review. Journal of LGBT Issues in Counseling, 3, 62–89.
12.
BusbyD. M.ChristensenC. M.CraneD. R.LarsonJ. H. (1995). A revision of The Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21, 289–308.
13.
BuzzellaB. A.WhittonS. W.TompsonM. C. (2012). A preliminary evaluation of a relationship education program for male same-sex couples. Couple and Family Psychology: Research and Practice, 1, 306–322.
14.
CaoH.ZhouN.FineM.LiangY.LiJ.Mills-KoonceW. R. (2017). Sexual minority stress and same-sex relationship well-being: A meta-analysis of research prior to the U.S. nationwide legalization of same-sex marriage. Journal of Marriage and the Family, 79, 1258–1277. doi:10.1111/jomf.12415
15.
ChoiS. W.SchaletB.CookK. F.CellaD. (2014). Establishing a common metric for depressive symptoms: Linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychological Assessment, 26, 513–527.
16.
DarwichL.HymelS.WaterhouseT. (2012). School avoidance and substance use among lesbian, gay, bisexual, and questioning youths: The impact of peer victimization and adult support. Journal of Educational Psychology, 104, 381–392.
17.
DuncanS. C.DuncanT. E.HopsH. (1996). Analysis of longitudinal data within accelerated longitudinal designs. Psychological Methods, 1, 236–248.
18.
EfronB.TibshiraniR. (1986). Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Statistical Science, 1, 54–75.
19.
EndersC. K.BandalosD. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430–457.
20.
EspelageD. L.AragonS. R.BirkettM.KoenigB. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have?School Psychology Review, 37, 202–216.
21.
FalconierM. K.HuertaM.HendricksonE. (2016). Immigration stress, exposure to traumatic life experiences, and problem drinking among first-generation Latino couples. Journal of Social and Personal Relationships, 33, 469–492.
22.
FalconierM. K.NussbeckF.BodenmannG.SchneiderH.BradburyT. (2015). Stress from daily hassles in couples: Its effects on intradyadic stress, relationship satisfaction, and physical and psychological well-being. Journal of Marital and Family Therapy, 41, 221–235.
23.
FeinsteinB. A.GoldfriedM. R.DavilaJ. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80, 917–927.
24.
FeinsteinB. A.McConnellE.DyarC.MustanskiB.NewcombM. E. (2018). Minority stress and relationship functioning among young same-sex male couples: An examination of actor-partner interdependence models. Journal of Consulting and Clinical Psychology, 86, 416–426.
25.
FrostD. M.FingerhutA. W. (2016). Daily exposure to negative campaign messages decreases same-sex couples’ psychological and relational well-being. Group Processes & Intergroup Relations, 19, 477–492.
26.
GoldbachJ. T.Tanner-SmithE. E.BagwellM.DunlapS. (2014). Minority stress and substance use in sexual minority adolescents: A meta-analysis. Prevention Science, 15, 350–363.
27.
HammenC. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319.
28.
HaysR. D.MerzJ. F.NicholasR. (1995). Response burden, reliability, and validity of the CAFE, Short MAST, and AUDIT alcohol screening measures. Behavior Research Methods, Instruments, & Computers, 27, 277–280.
29.
HendrickS. S. (1988). A generic measure of relationship satisfaction. Journal of Marriage and the Family, 50, 93–98.
30.
HoweG. W.LevyM. L.CaplanR. D. (2004). Job loss and depressive symptoms in couples: Common stressors, stress transmission, or relationship disruption?Journal of Family Psychology, 18, 639–650.
31.
JenkinsN.SaizC. C. (1995). The Communication Skills Test. Denver, Colorado: University of Denver.
32.
KennyD. A.JuddC. M. (2014). Power anomalies in testing mediation. Psychological Science, 25, 334–339.
33.
KennyD. A.KashyD. A.CookW. L. (2006). Dyadic data analysis. New York, NY: Guilford Press.
34.
LaursenB.Jensen CampbellL. A. (1999). The nature and functions of social exchange in adolescent romantic relationships. In FurmanW.BrownB. B.FeiringC. (Eds.), The development of romantic relationships in adolescence (pp. 51–74). New York, NY: Cambridge University Press.
35.
LeBlancA. J.FrostD. M.WightR. G. (2015). Minority stress and stress proliferation among same-sex and other marginalized couples. Journal of Marriage and the Family, 77, 40–59.
36.
LevittA.CooperM. L. (2010). Daily alcohol use and romantic relationship functioning: Evidence of bidirectional, gender-, and context-specific effects. Personality and Social Psychology Bulletin, 36, 1706–1722.
37.
MacKinnonD. P.LockwoodC. M.WilliamsJ. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–99.
38.
ManneS.BadrH.KashyD. A. (2012). A longitudinal analysis of intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Journal of Behavioral Medicine, 35, 334–346.
39.
MarshalM. P.DietzL. J.FriedmanM. S.StallR.SmithH. A.McGinleyJ.. . . BrentD. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49, 115–123.
40.
MarshalM. P.FriedmanM. S.StallR.KingK. M.MilesJ.GoldM. A.. . . MorseJ. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556.
41.
MaysV. M.CochranS. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876.
42.
McCabeS. E.HughesT. L.BostwickW. B.WestB. T.BoydC. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104, 1333–1345.
43.
McNeilS. N.FinchamF. D.BeachS. R. (2014). Does spousal support moderate the association between perceived racial discrimination and depressive symptoms among African American couples?Family Process, 53, 109–119.
44.
MeyerI. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
45.
MohrJ. J.FassingerR. E. (2006). Sexual orientation identity and romantic relationship quality in same-sex couples. Personality and Social Psychology Bulletin, 32, 1085–1099.
46.
MustanskiB.AndrewsR.PuckettJ. A. (2016). The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. American Journal of Public Health, 106, 527–533. doi:10.2105/AJPH.2015.302976
47.
MuthénL. K.MuthénB. O. (2017). Mplus user’s guide (8th ed.). Los Angeles, CA: Author.
48.
NewcombM. E.MacapagalK. R.FeinsteinB. A.BettinE.SwannG.WhittonS. W. (2017). Integrating HIV prevention and relationship education for young same-sex male couples: A pilot trial of the 2GETHER intervention. AIDS and Behavior, 21, 2464–2478.
49.
NewcombM. E.MustanskiB. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029.
50.
NgamakeS. T.WalchS. E.RaveepatarakulJ. (2016). Discrimination and sexual minority mental health: Mediation and moderation effects of coping. Psychology of Sexual Orientation and Gender Diversity, 3, 213–226.
51.
NungesserL. G. (1983). Homosexual acts, actors, and identities. New York, NY: Praeger.
52.
OtisM. D.RostoskyS. S.RiggleE. D. B.HamrinR. (2006). Stress and relationship quality in same-sex couples. Journal of Social and Personal Relationships, 23, 81–99.
53.
PachankisJ. E.SullivanT. J.FeinsteinB. A.NewcombM. E. (2018). Young adult gay and bisexual men’s stigma experiences and mental health: An 8-year longitudinal study. Developmental Psychology, 54, 1381–1393.
54.
PhillipsG.IITurnerB.SalamancaP.BirkettM.HatzenbuehlerM. L.NewcombM. E.. . . MustanskiB. (2017). Victimization as a mediator of alcohol use disparities between sexual minority subgroups and sexual majority youth using the 2015 National Youth Risk Behavior Survey. Drug and Alcohol Dependence, 178, 355–362.
55.
PilkonisP. A.ChoiS. W.ReiseS. P.StoverA. M.RileyW. T.CellaD.GroupP. C. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18, 263–283.
56.
ProulxC. M.HelmsH. M.BuehlerC. (2007). Marital quality and personal well-being: A meta-analysis. Journal of Marriage and the Family, 69, 576–593.
57.
PuckettJ. A.NewcombM. E.RyanD. T.SwannG.GarofaloR.MustanskiB. (2017). Internalized homophobia and perceived stigma: A validation study of stigma measures in a sample of young men who have sex with men. Sexuality Research & Social Policy, 14, 1–16.
58.
Ramirez-VallesJ.KuhnsL. M.CampbellR. T.DiazR. M. (2010). Social integration and health: Community involvement, stigmatized identities, and sexual risk in Latino sexual minorities. Journal of Health and Social Behavior, 51, 30–47.
59.
RandallA. K.BodenmannG. (2009). The role of stress on close relationships and marital satisfaction. Clinical Psychology Review, 29, 105–115.
60.
RandallA. K.TotenhagenC. J.WalshK. J.AdamsC.TaoC. (2017). Coping with workplace minority stress: Associations between dyadic coping and anxiety among women in same-sex relationships. Journal of Lesbian Studies, 21, 70–87.
61.
RayensM. K.ReedD. B. (2014). Predictors of depressive symptoms in older rural couples: The impact of work, stress and health. Journal of Rural Health, 30, 59–68.
62.
RobertiJ. W.HarringtonL. N.StorchE. A. (2006). Further psychometric support for the 10-item version of the Perceived Stress Scale. Journal of College Counseling, 9, 135–147.
63.
RodriguezL. M.NeighborsC.KneeC. R. (2014). Problematic alcohol use and marital distress: An interdependence theory perspective. Addiction Research & Theory, 22, 294–312.
64.
RookK.DooleyD.CatalanoR. (1991). Stress transmission: The effects of husbands’ job stressors on the emotional health of their wives. Journal of Marriage and the Family, 53, 165–177.
65.
RosarioM.Rotheram-BorusM. J.ReidH. (1996). Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly Black and Hispanic background. Journal of Community Psychology, 24, 136–159.
66.
RuckerD. D.PreacherK. J.TormalaZ. L.PettyR. E. (2011). Mediation analysis in social psychology: Current practices and new recommendations. Social and Personality Psychology Compass, 5, 359–371.
67.
SaundersJ. B.AaslandO. G.BaborT. F.de la FuenteJ. R.GrantM. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction, 88, 791–804.
68.
SchlomerG. L.BaumanS.CardN. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1–10.
69.
SchönbrodtF. D.MaierM.HeeneM.ZehetleitnerM. (2015). Voluntary commitment to research transparency. Retrieved from http://www.researchtransparency.org
70.
StoryL. B.BradburyT. N. (2004). Understanding marriage and stress: Essential questions and challenges. Clinical Psychology Review, 23, 1139–1162.
71.
SwannG.MinshewR.NewcombM. E.MustanskiB. (2016). Validation of the Sexual Orientation Microaggression Inventory in a diverse sample of LGBT youth. Archives of Sexual Behavior, 45, 1289–1298.
WhismanM. A. (2007). Marital distress and DSM-IV psychiatric disorders in a population-based national survey. Journal of Abnormal Psychology, 116, 638–643.
74.
WhismanM. A. (2013). Relationship discord and the prevalence, incidence, and treatment of psychopathology. Journal of Social and Personal Relationships, 30, 163–170.
75.
WhittonS. W.BuzzellaB. A. (2012). Using relationship education programs with same-sex couples: A preliminary evaluation of program utility and needed modifications. Marriage & Family Review, 48, 667–688.
76.
WhittonS. W.WeitbrechtE. M.KurylukA. D.HutsellD. W. (2016). A randomized waitlist-controlled trial of culturally sensitive relationship education for male same-sex couples. Journal of Family Psychology, 30, 763–768.
77.
WongC. F.WeissG.AyalaG.KipkeM. D. (2010). Harassment, discrimination, violence, and illicit drug use among young men who have sex with men. AIDS Education and Prevention, 22, 286–298.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
