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Feeling low and unhappy together? An actor-partner-interdependence model uncovering the linkage between different operationalizations of relationship quality and depression in different-sex couples. PLoS One 2022; 17:e0274756. [DOI: 10.1371/journal.pone.0274756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Some studies suggest a bi-directional association between low relationship quality and depression. However, the social impact of depression and the potential preventative effects of healthy relationships are not yet sufficiently understood, as studies have shown heterogenous results for effects in both directions. Therefore, the main aim of this study was to differentiate the actor and partner effects of this association more comprehensively using two measures to capture characteristics of relationship quality–firstly regarding general aspects of social system quality and secondly considering specific aspects of the romantic relationship. 110 different-sex couples were included, being separated in partners with highly pronounced depressive symptoms in women (Cw/DW) versus partners with low depressive symptoms (LDCs). We investigated effects cross-sectionally using multi-group analyses to predict relationship (couple specific questionnaire: PFB) versus system quality (general system quality questionnaire: EVOS) in a step-by-step approach, modelling actor and partner effects with variation within and across both groups and then comparing the results to models with equal actor and partner effects. Depression was measured with the PHQ-9. With regard to the relationship between depressive symptoms and system quality, the model that constrained actor and partner effects to be equal across both groups was preferred and showed negative significant actor effects across gender and groups. Concerning the association between depressive symptoms and relationship quality, the model constraining actor and partner effects to be equal within groups had the best fit to the data and revealed a negative partner effect in LDCs.
Conclusions
Controlling for the moderating variable of clinically relevant depressive symptoms, we found evidence for actor and partner effects, which differed between the two relationship measures. This underlines the importance to reflect how relationship quality is operationalized. The negative partner effect on relationship quality in LDCs emphasizes that even in a non-clinical context, depressive symptoms negatively impact the perceived relationship quality of both women and men. This suggests that addressing the relationship is important in non-clinical preventive contexts and calls for integrating the partner into counselling or trainings.
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Crandall A, Phaleng H, Dacus JD, Bista O, Brouard P, Nel D, Reddy V, Sandfort T, Knox J. The social and sexual lives of Black sexual minority men 30 years of age and older in South Africa. BMC Public Health 2022; 22:1923. [PMID: 36243701 PMCID: PMC9569126 DOI: 10.1186/s12889-022-14303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Black sexual minority men (SMM) ages 30 and older are under-represented in HIV studies in sub-Saharan Africa, despite being at increased risk of HIV infection and contributing to potential onward HIV transmission. To better understand the social and sexual lives of older Black South African SMM, we conducted in-depth interviews with SMM who were > 30 years old. Methods From March–September 2016, we recruited a convenience sample of 37 SMM ages 30 and older by partnering with an LGBTQ+ organization in Tshwane, Pretoria. Men were interviewed about various aspects of their lives, including their sexual orientation, social connectedness, experiences with stigma and perspectives on participating in research. Results Participants described their experiences with their sexual identities, cultural and social implications of disclosure, and their perspective on South Africa’s political perspectives on the LGBTQ+ community. Men described how these experiences influence their trust in research and comfort participating in studies. Conclusions Inferences drawn from these findings provide direction on how to improve middle-aged SMM’s representation in research, such as recruiting a higher proportion of older and middle-aged SMM to serve as seed participants and building stronger community partnerships to disseminate study findings to settings where data collection is conducted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14303-5.
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Affiliation(s)
- Amy Crandall
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
| | | | - Jagadīśa-Devaśrī Dacus
- Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, Chicago, IL, USA
| | - Oshin Bista
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Pierre Brouard
- Department of Sociology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Dawie Nel
- OUT LGBT Well-Being, Pretoria, South Africa
| | - Vasu Reddy
- Department of Sociology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Theo Sandfort
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Knox
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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3
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Sarno EL, Dyar C, Newcomb ME, Whitton SW. Relationship quality and mental health among sexual and gender minorities. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:770-779. [PMID: 34914423 PMCID: PMC9200904 DOI: 10.1037/fam0000944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sexual and gender minorities assigned female at birth (i.e., sexual minority women, transgender men, and gender diverse [SMW TGD] individuals) experience disproportionately high rates of anxiety, depression, and substance use problems. Romantic relationship involvement has been shown to be beneficial to mental health and substance use among sexual and gender minorities. However, few studies have explored the impact of relationship quality on mental health, or if high relationship quality can reduce the negative impact of minority stress on well-being in this population. The present study examined within-persons associations of romantic relationship quality with symptoms of anxiety and depression, and alcohol and cannabis use problems among SMW TGD individuals in romantic relationships, and tested relationship quality as a moderator of associations of minority stress with mental health and substance use. Participants were 213 SMW TGD individuals (mean age: 20.63; 70.9% cisgender women, 7.5% transgender men, and 19.2% gender diverse). Within-persons, higher relationship quality was associated with better mental health and substance use outcomes. Relationship quality at the between-persons level moderated the within-persons association of internalized heterosexism with depression, and of microaggressions with cannabis use problems. No other interaction effects were significant. The within-persons associations found in this study lend important support to relationship interventions based on theories that improvements in romantic relationship quality will result in improved well-being over time. Results can inform relationship education interventions to reduce mental health and substance use disparities in SMW TGD communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Liang Z, Huang YT. "Strong Together": Minority Stress, Internalized Homophobia, Relationship Satisfaction, and Depressive Symptoms among Taiwanese Young Gay Men. JOURNAL OF SEX RESEARCH 2022; 59:621-631. [PMID: 34219563 DOI: 10.1080/00224499.2021.1947954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Taiwan's legalization of same-sex marriage affords legal status for romantic relationships between sexual minority individuals. Yet, little is known about the role of intimate relationships in the experiences of minority stress and mental health among gay men. This study tested a model where internalized homophobia mediated the association between distal minority stress and depressive symptoms and relationship satisfaction was posited as a moderator. Data came from a sample (n = 557) of Taiwanese young gay men who were in a romantic relationship. Respondents completed the scales of distal minority stress, internalized homophobia, relationship satisfaction, and depressive symptoms. Mediation and moderation analyses were performed on the macro PROCESS. The Johnson-Neyman (J-N) technique was used to interpret the moderating effect of relationship satisfaction. Results show that both distal minority stress and internalized homophobia were positively associated with depressive symptoms. Internalized homophobia partially mediated the association between distal minority stress and depressive symptoms. Relationship satisfaction had a moderating effect. The effect of distal minority stress was lower among those who reported high satisfaction in their current romantic relationship. This study suggested that a satisfying relationship provides protection for gay men's mental health. Clinicians should attend to relationship issues when working with sexual minority clients.
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Affiliation(s)
- Zurong Liang
- Department of Social Work and Social Administration, University of Hong Kong
| | - Yu-Te Huang
- Department of Social Work and Social Administration, University of Hong Kong
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5
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Kreuzer M, Gollwitzer M. Neuroticism and satisfaction in romantic relationships: A systematic investigation of intra- and interpersonal processes with a longitudinal approach. EUROPEAN JOURNAL OF PERSONALITY 2022; 36:149-179. [DOI: 10.1177/08902070211001258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Relationship satisfaction—the degree to which a close relationship is perceived as rewarding and satisfying by both partners—is reliably predicted by both partners’ neuroticism, but the psychological mechanisms underlying this effect are not sufficiently well understood. By analyzing several cognitive, emotional, and behavioral processes simultaneously, the current longitudinal study looked at how both partners’ neuroticism affects their respective (and mutual) relationship satisfaction both on an intra- and on an interpersonal level. Dyadic data from 2090 heterosexual couples from the “Pairfam” study were analyzed with Actor-Partner Interdependence Mediation Models (APIMeM). Results support the assumption that neuroticism reliably predicts cognitive, emotional, and behavioral variables, which, in turn, predict both partners’ relationship satisfaction. Importantly, cognitive processes play a particularly important role both on an interpersonal as well as on an intrapersonal level. These findings help to shed light on the maladaptive cognitive, emotional, and behavioral processes underlying the effect of neuroticism on relationship satisfaction.
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Affiliation(s)
- Marianne Kreuzer
- Department of Psychology, Philipps-Universität Marburg, Marburg, Germany
| | - Mario Gollwitzer
- Department of Psychology, Ludwig-Maximilians-Universität München, München, Germany
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Robles G, Dellucci TV, Gupta SK, Rosenthal L, Starks TJ. Identity and Relationship-Based Discrimination, and Mental Health in a Sample of Sexual Minority Male Couples. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 26:76-97. [PMID: 35211238 PMCID: PMC8863175 DOI: 10.1080/19359705.2021.1926389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The study explored the unique associations of individual identity-based discrimination and relationship-based discrimination with mental health among sexual minority male couples. It also examined whether couples' relationship functioning moderated associations between relationship-based discrimination, the experience of one's romantic relationship being devalued, and mental health outcomes. METHODS Baseline dyadic data drawn from a clinical trial involving 70 couples (N= 140) were analyzed using Actor-Partner Interdependence Modeling. The sample consisted of sexual minority men, of which 54.3% identified as a person of color. Each partner completed the computerized survey independently. Data were collected using the Relationship Marginalization Scale, Dyadic Adjustment Scale, Generalized Anxiety Disorder-7, and Center for Epidemiologic Studies Depression Scale-Revised scales. RESULTS Dyadic adjustment moderated (i.e., buffered against) the association between relationship-based discrimination and depressive symptoms. The effects appeared to follow an intra-individual pattern (B ACTOR = -0.06, p = .048 and B PARTNER = -0.07, p = .030) indicating the lack of evidence for crossover effects. The interaction terms predicting anxiety yielded non-significant results. CONCLUSIONS The current research suggests that dyadic functioning buffers against the effects of stigma. These findings point to the potential utility of interventions to improve relationship functioning into interventions addressing stigma among partnered sexual minority men.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ
| | - Trey V. Dellucci
- Doctoral Program in Health Psychology and Clinical Science, the Graduate Center of the City University of New York, New York, NY
| | - Sugandha K. Gupta
- Doctoral Program in Health Psychology and Clinical Science, the Graduate Center of the City University of New York, New York, NY
| | - Lisa Rosenthal
- Department of Psychology, Pace University, New York, NY, USA
| | - Tyrel J. Starks
- Doctoral Program in Health Psychology and Clinical Science, the Graduate Center of the City University of New York, New York, NY,Department of Psychology, Hunter College of the City University of New York, New York, NY
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Chen S, Yang Q, He J, Fan X, Liu Z, Qiu J, Zheng Z, Gu J, Cheng W, Hao Y, Li J, Hao C. The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model. BMC Infect Dis 2021; 21:593. [PMID: 34157968 PMCID: PMC8218385 DOI: 10.1186/s12879-021-06317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. METHODS Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI. RESULTS Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044). CONCLUSIONS Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.
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Affiliation(s)
- Sha Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Juan He
- Institution of Drug Clinical Trial, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Xiongzhi Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhongqi Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jialing Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhiwei Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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8
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Leung E. Thematic Analysis of My "Coming Out" Experiences Through an Intersectional Lens: An Autoethnographic Study. Front Psychol 2021; 12:654946. [PMID: 33967918 PMCID: PMC8103615 DOI: 10.3389/fpsyg.2021.654946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
For lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, identity development is one of the most critical developmental task. LGBTQ youth are shown to be at risk for a variety of risk factors including depression and suicidal ideation and attempts due to how their identities are appraised in heteronormative societies. However, most LGBTQ educational psychology research have highlighted protective factors that are primarily relevant to support LGBTQ white-youth. One of the major developmental theories, Erikson’s stages of psychosocial development, has identified adolescence as the period where identity development occurs. However, through an intersectional lens, identity development appears to encompass more than adolescence but also emerging adulthood, a developmental stage not accounted for by Erikson’s stages of psychosocial development. The primary goal of this study is to seek to understand and question Erikson’s stages of psychosocial development through an intersectional lens of an autoethnography of my LGBTQ experiences. An autoethnographic approach [diary entries (N = 9), conversations (N = 12), interview (N = 1), social media websites and blogs (N = 2), and drawing (N = 1)] is used to understand my LGBTQ-person of color (POC) experiences of “coming out” or self-disclosure during my adolescence through emerging adulthood. Data was collected on April 2020 and spanned from 2006 through 2020 to account for the developmental period of adolescence and emerging adulthood (ages 13 through 27). Thematic analysis revealed four themes across the two developmental periods: (1) confusion and conflict between my gay and ethnic identity as a closeted adolescent, (2) my first “coming out” as a gay adolescent and “it got better,” (3) frustration arising from the internal conflict between my gay and POC identity as an emerging adult, and (4) frustration arising from external experiences with the flaws of LGBTQ community inclusivity. Results reflected a continuous theme of identity exploration and struggle through both adolescence and emerging adulthood, highlighting the need for future research to replicate similar experiences from other intersectional individuals during emerging adulthood stage, a developmental stage that is considered in between Erikson’s adolescent and young adulthood developmental stage.
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Affiliation(s)
- Enoch Leung
- Department of Educational & Counseling Psychology, McGill University, Montreal, QC, Canada
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Sarno EL, Bundy C, Dyar C, Newcomb ME. Examining minority stress, dyadic coping, and internalizing symptoms among male same-sex couples using actor-partner interdependence models. J Couns Psychol 2021; 68:515-525. [PMID: 33749295 DOI: 10.1037/cou0000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Minority stress processes have been consistently linked to increased internalizing symptoms among sexual minority individuals. However, very little research has studied the impact of minority stress on the mental health of same-sex couples. The present study examined associations of actor and partner heterosexist microaggressions and internalized heterosexism with internalizing symptoms, moderated by dyadic coping, among male same-sex couples. Participants were 774 men who have sex with men (387 dyads). Results of actor-partner interdependence models showed that actor, but not partner, minority stress was positively associated with internalizing symptoms. Dyadic coping moderated the association of actor heterosexist microaggressions on internalizing symptoms such that for those who engaged in more dyadic coping, the association of heterosexist microaggressions with internalizing symptoms was weaker. Dyadic coping also moderated the association of partner internalized heterosexism on internalizing symptoms. For those who engaged in more dyadic coping, their partner's internalized heterosexism was associated with greater internalizing symptoms. Although dyadic coping may buffer the effects of minority stress on internalizing symptoms, if partners rely too heavily on one another to cope with stress, it may be detrimental to their mental health. Implications for relationship education interventions for same-sex couples are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Elissa L Sarno
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Camille Bundy
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
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Newcomb ME. Romantic relationships and sexual minority health: A review and description of the Dyadic Health Model. Clin Psychol Rev 2020; 82:101924. [PMID: 33002795 PMCID: PMC10472923 DOI: 10.1016/j.cpr.2020.101924] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/05/2020] [Accepted: 09/21/2020] [Indexed: 12/31/2022]
Abstract
A large body of literature has documented the health promotive effects of healthy committed relationships on the health and wellbeing of heterosexual people in different-sex relationships, including observational and longitudinal studies, couple-based intervention development and evaluation efforts, and articulation of theoretical frameworks. A much smaller but growing field of research has observed that same-sex relationships have similar effects on health outcomes but that these couples face unique stressors that may impact relationship functioning and health. Further, extant theoretical frameworks do not sufficiently address the multiple pathways by which psychosocial vulnerabilities and stressors impact same-sex relationship functioning, engagement in health-related risk behaviors, and the mental and physical health of sexual minorities in relationships. The purpose of this manuscript is to: a) review the existing literature on relationship functioning and health among sexual minorities, including both observational and intervention studies; and b) present an integrated model of relationship functioning and health for same-sex couples that can be used as a basis for further studies on sexual minority dyads, as well as the development of novel couple-based interventions to optimize the health promoting effects of relationships.
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States of America.
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Robles G, Bosco SC, Dellucci TV, Starks TJ. Integrating intra-individual and dyadic factors in examining health among gay and bisexual men: A narrative review of recent literature. JOURNAL OF GLBT FAMILY STUDIES 2019; 16:488-513. [PMID: 33041710 PMCID: PMC7546157 DOI: 10.1080/1550428x.2019.1682740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current state of the relationship science literature using a health framework, Relationship Process and Health. We conducted a search for articles using PubMed, PsycInfo, and Web of Science for empirical articles in English published in the past 15 years on GBM in a relationship, assessing attachment, and relationship functioning as predictors of health outcomes. We found 649 articles. After screening, 23 articles were identified and reviewed. Findings overwhelming identified HIV risk as the primary health outcome. Attachment was associated with relationship functioning and sexual risk behaviors. Relationship-specific components were largely used as predictors of sexual HIV transmission risk behaviors. Together, these studies suggest that relationship functioning is a prospective link between attachment and health-related outcomes. The literature has yet to examine empirically dyadic-level mechanisms that may explain the association between individual attachment and health outcomes aside from HIV risk, and needs more examination of other health disparities affecting GBM.
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Affiliation(s)
- Gabriel Robles
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Stephen C. Bosco
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Trey V. Dellucci
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Tyrel J. Starks
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave, New York, NY 10065, USA
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Starks TJ, Robles G, Bosco SC, Doyle KM, Dellucci TV. Relationship functioning and substance use in same-sex male couples. Drug Alcohol Depend 2019; 201:101-108. [PMID: 31203148 PMCID: PMC6892167 DOI: 10.1016/j.drugalcdep.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research suggests that substance use among partnered sexual minority men will be inversely associated with the quality of dyadic functioning. We tested whether dimensions of relationship functioning implied within Couples Interdependence Theory (e.g., rewards, costs, barriers, alternatives, investment, and comparison to an ideal) predicted drug use and problematic alcohol use consistent with this hypothesis. METHODS This study utilized baseline data from a sample of 70 couples recruited in the New York City area. All participants were cis-gender male and 18 or older. In each couple, at least one partner reported recent drug use, at least one was aged 18 to 29, and at least one was HIV negative. Participants provided demographic information; completed measures of relationship functioning and problematic alcohol use; and reported recent (past 30 day) drug use. RESULTS Actor-partner interdependence models were calculated. The use of miscellaneous recreational drugs (excluding marijuana) was positively associated with participants' perception of rewards, costs, and barriers to leaving and negatively associated with comparisons to an ideal, alternatives, and investment. In addition, partner perceptions of rewards were positively associated with this outcome. AUDIT scores were negatively associated with comparison to an ideal; and positively associated with partner perceptions of alternatives. Relationship functioning was unrelated to marijuana use. CONCLUSIONS These findings provide support for the hypothesis that relationship functioning and substance use are related. Couples Interdependence Theory implies such an assumption and it underlies many couples-based approaches to drug use intervention. These findings point to the potential utility of integrating relationship skill building into substance use interventions for partnered sexual minority men.
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Affiliation(s)
- Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY USA,Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY USA
| | - Gabriel Robles
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY USA
| | - Stephen C. Bosco
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY USA
| | - Kendell M. Doyle
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY USA
| | - Trey V. Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY USA
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Starks TJ, Feldstein Ewing SW, Lovejoy T, Gurung S, Cain D, Fan CA, Naar S, Parsons JT. Adolescent Male Couples-Based HIV Testing Intervention (We Test): Protocol for a Type 1, Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc 2019; 8:e11186. [PMID: 31199341 PMCID: PMC6592501 DOI: 10.2196/11186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/24/2018] [Accepted: 11/16/2018] [Indexed: 01/29/2023] Open
Abstract
Background Young men who have sex with men (YMSM), particularly those who are partnered, are at unique risk for HIV. YMSM are among those at highest risk for HIV. Meanwhile, despite the fact that primary partners account for many—possibly most—new HIV infections, partnered men who have sex with men perceive themselves to be at much lower risk for HIV infection and therefore test less often than single men. In response to the risk of primary partner HIV transmission, couples HIV testing and counseling (CHTC) procedures have been developed for use in adult populations. Although promising, YMSM couples may require additional support to complete CHTC given their developmental context in which sexual and romantic relationships are relatively new, and communication skills are emergent. Objective The aim of this study was to test the additive benefit of adjunct treatment components tailored for YMSM, which enhance communication skills before the completion of CHTC. The intervention tests a continuum of prevention packages including assertive communication training videos and motivational interviewing focused on assisting with identification and development (MI-AID) before entering into the dyadic intervention components. This protocol is part of the Adolescent Medicine Trials Network (ATN) Scale It Up program described in this issue. Methods This is a comparative effectiveness trial that will be executed in 3 phases. Phase 1 will gather qualitative data related to intervention development and implementation from partnered YMSM at 4 subject recruitment venues (SRVs). Phase 2 will compare a continuum of these interventions in a pilot randomized controlled trial (RCT) at 2 SRVs. Phase 3 will compare the most successful adapted intervention package from phase 2 to CHTC as usual in a larger RCT at 4 SRVs. This phase is focused on implementation and sustainment phases of the Exploration, Preparation, Implementation, and Sustainment framework. Results Phase 1 data will be drawn from qualitative interviews with partnered YMSM (n=24) and staff from ATN sites (n=20). Baseline enrollment for phase 2 is expected to begin across 2 SRVs in June 2018 (ncouples=36). In phase 2, survey data collection along with HIV and sexually transmitted infection (STI) testing will occur at baseline, and 1- and 3-month (postintervention) follow-ups. Phase 3 will begin enrollment across 4 SRVs in September 2019 (ncouples=144) and follow-ups will occur at 1, 3, 6, and 9 months postintervention. Conclusions Although MI-AID, video-based assertive communication training, and CHTC have established efficacy when administered on their own, this study will be the first to evaluate the strongest adjunctive version of these interventions to address the specific developmental needs of partnered YMSM. Trial Registration ClinicalTrials.gov NCT03386110; http://clinicaltrials.gov/ct2/show/NCT03386110 (Archived by WebCite at http://www.webcitation.org/75mlO7GCx) International Registered Report Identifier (IRRID) DERR1-10.2196/11186
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Affiliation(s)
- Tyrel J Starks
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter College Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
| | | | - Travis Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Sitaji Gurung
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Demetria Cain
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Carolyn A Fan
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Sylvie Naar
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter College Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
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Starks TJ, Robles G, Bosco SC, Dellucci TV, Grov C, Parsons JT. The Prevalence and Correlates of Sexual Arrangements in a National Cohort of HIV-Negative Gay and Bisexual Men in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:369-382. [PMID: 30465312 PMCID: PMC6349557 DOI: 10.1007/s10508-018-1282-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/31/2018] [Accepted: 07/26/2018] [Indexed: 05/22/2023]
Abstract
Sexual agreements have received considerable attention as an aspect of dyadic functioning associated with HIV risk. To date, this research has primarily utilized convenience samples which overrepresented men from large urban areas and with higher HIV risk. The current study utilized a national cohort of 1061 HIV-negative gay and bisexual men recruited to be geographically diverse within the U.S. The sample included 531 (50.0%) men who identified as single. Of the 530 partnered men, 240 (45.3%) were monogamous; 238 (44.9%) were in open relationships (where sex with outside partners was permitted); and 52 (9.8%) were in monogamish relationships (where sex with outside partners was limited to instances where both primary partners were present). Regardless of urban (vs. non-urban) residence, men in monogamous relationships engaged in less anal sex generally and condomless anal sex (CAS) specifically with casual partners. Single men reported significantly more frequent anal sex with casual partners compared to open and monogamish men; however, there were no significant differences among these three groups with respect to CAS with casual partners. In multivariable models, monogamish men reported significantly more frequent marijuana use and alcohol consumption compared to all other groups. Urban (vs. non-urban) residence moderated associations between sexual arrangements and depression as well as the use of illicit drugs other than marijuana. These findings point to the need to better examine the potentially unique mechanisms which confer risk and resilience for gay male couples in urban versus non-urban settings. The observed association between sexual arrangements and substance use suggests interventions which facilitate the negotiation of sexual agreements may present an opportunity to engage in dyadic substance use intervention.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Gabriel Robles
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
| | - Stephen C Bosco
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Trey V Dellucci
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA.
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
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