Relationship Marginalization and Everyday Discrimination: Examining Anxiety and Depression Among Same-Sex Male Couples

Background and Purpose: Gay, bisexual and other men who have sex with men (GBMSM) continue to face inequities across multiple health and mental health indicators. Stigma is an established predictor of these inequities. Minority stress theory has provided a context for understating the impact of stigma on health on GBMSM in general. Partnered individuals traditionally serve as form of social support for each other thereby buffering some negative effects of discrimination. However, the act of partnering may expose at least some GBMSM to discrimination directed at their relationship, which serves as a manifestation and signal of stigmatized sexual identity. To date, few studies, possibly none, have examined discrimination using dyadic data. Thus, this research aims to examine the interdependence between both partner’s experience of discrimination and mental health.

Methods: Data were analyzed from baseline surveys for We Test, an RCT testing adjunct components of couple’s HIV testing and counseling. Participants were recruited via social media and in-person venue-based methods.  Seventy enrolled couples (n_individuals = 140) completed a computer-assisted self-interviewing survey programed using Qualtrics. The Everyday Discrimination Scale (EDS) and Relationship Marginalization Scale (RMS) were used to assess discrimination at the individual and couple levels, respectively.  Symptoms of anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item (GAD-7), and the Center for Epidemiologic Studies Depression Scale—Revised (CESD-R). An Actor-Partner Interdependence Model (APIM) was utilized to examine the effect of each partner’s experiences of discrimination and relationship marginalization on depression and anxiety symptoms. All analyses controlled for age, race/ethnicity, education, HIV status, and the couple’s relationship length.

Results: Participants had mean age of 27.01 (SD = 0.48), average relationship of 26.5 months (SD = 24.6) and over half the sample were of ethnic minority background (54.3%).  APIM provided evidence of actor effects of discrimination (β = .24, p<.05) and relationship marginalization (β= .18, p<.05) on anxiety. Similarly, there were actor effects of discrimination (β = .36, p<.05), but not relationship marginalization (β = .12, p = .14) on depression. Partner effects of discrimination and relationship marginalization were not associated with either depression or anxiety.  

Conclusions and Implications: Sexual minority stress provides an understanding through which discrimination impact men’s mental health. The current study suggests that there are no cross-over effects. Specifically, one’s own experience of discrimination has a greater impact on the mental health of the couple rather than the experiences of their partner. Given the results, it appears that associations between stigma and mental health seem to follow an intra-individual pattern, even when that stigma is directed at an interpersonal unit (the relationship). Additionally, experiences of marginalization directed specifically at the relationship may impact specific mental health symptoms among partnered men. Relationship focused interventions tailored for individuals within a couple may be an approach to mitigate the effects of discrimination directed at both the individual and the relationship on adverse mental health.