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. Author manuscript; available in PMC: 2022 Oct 1.
Published in final edited form as: J Couns Psychol. 2021 Mar 22;68(5):515–525. doi: 10.1037/cou0000542

Examining Minority Stress, Dyadic Coping, and Internalizing Symptoms among Male Same-Sex Couples using Actor-Partner Interdependence Models

Elissa L Sarno 1,2, Camille Bundy 2, Christina Dyar 2, Michael E Newcomb 1,2
PMCID: PMC8455724  NIHMSID: NIHMS1712840  PMID: 33749295

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. Keywords: Men who have sex with men (MSM); couples; minority stress; anxiety; depression Public Significance Statement: For same-sex couples, an individual’s experience of stress as a result of their marginalized status may impact not only their own mental health, but also that of their partner. This study suggests that when male same-sex couples cope with that stress together, it can reduce this impact, but when engaged in very frequently, joint coping can exacerbate the effects of one partner’s stress on the other’s anxiety and depression.

Minority stress describes the excess stress that individuals from stigmatized social categories are exposed to as a result of their social minority position (Meyer, 2003). For sexual minorities, these stressors exist on a continuum from distal to proximal. Distal minority stressors are defined as external, objective stressful events and conditions (e.g., victimization, microaggressions). It has been argued that distal minority stressors have taken on more subtle forms in contemporary society, including microaggressions, or daily environmental, behavioral, verbal occurrences that convey negative messages to marginalized individuals (Sue et al., 2007). On the other end of the continuum are proximal minority stress processes, which include the internalization of negative societal attitudes (i.e., internalized heterosexism; Meyer, 2003); when these attitudes are integrated into one’s self-perception, mental health problems can result. Meta-analyses and longitudinal studies have consistently shown that experiences of microaggressions and internalized heterosexism are linked to internalizing symptoms among sexual minorities (Bostwick et al., 2014; Dyar et al., 2020; Newcomb & Mustanski, 2010; Pachankis et al., 2018).

Minority Stress in Couples

The vast majority of studies on minority stress and its effects on mental health have focused on individuals and have not examined the impact of these stressors on couples, despite evidence that for different-sex couples, experiences of stress can be detrimental not only to the wellbeing of individuals, but also to their partners. Stress proliferation theory describes that stress experiences beget more stress in people’s lives that is harmful to mental health, including between individuals within close relationships (Pearlin et al., 1981). Research in support of the effects of stress proliferation has shown that, among different-sex couples, an individual’s job stressors, stress from daily hassles, and immigration stress have been associated not only with their own, but also with their partner’s, emotional distress (Falconier, Nussbeck, et al., 2015; Howe et al., 2004; Rayens & Reed, 2014; Rook et al., 1991). Much less studied, however, are the effects of minority stress processes on mental health among same-sex couples. LeBlanc et al. (2015) make the distinction that stress proliferation research conducted with different-sex couples has primarily focused on stress emanating from one social role that then interferes with another role (e.g., work-to-family conflict, in which work conflicts or interferes with family; Whiston et al., 2012), whereas minority stress involves social stress emanating from disadvantaged social statuses, identities, or group membership. Because both partners have a stigmatized identity, when they enter into a romantic relationship with another person of the same sex, they become vulnerable to unique minority stressors that they may experience individually or jointly with their same-sex partners because their relationship, in and of itself, is socially stigmatized (LeBlanc et al., 2015). Thus, couples in same-sex relationships experience and respond to minority stressors as a dyad (Rostosky & Riggle, 2017).

Based on the unique stressors that can be experienced by same-sex couples unaccounted for by existing approaches, LeBlanc et al. (2015) proposed a model of minority stress contagion that integrates minority stress and stress proliferation approaches. Their framework describes that individual-level minority stressors faced by one partner can affect the mental health of both partners. They suggested that additional dyadic research on same-sex couples using actor-partner interdependence models (APIM; Cook & Kenny, 2005) was needed to generate a deeper understanding of these effects. APIM was developed as a flexible model for dyadic analysis, and is ideal to examine the mental health effects of minority stress contagion (Cook & Kenny, 2005; LeBlanc et al., 2015). Within the APIM, actor effects represent the effects of each partner’s individual experience of minority stress on their own mental health, whereas partner effects reflect the effect of one partner’s individual minority stress on their partner’s mental health.

Most dyadic studies using APIM to explore minority stress among same-sex couples, however, have focused on its impact on relationship quality and satisfaction (Feinstein et al., 2018; Otis et al., 2006), rather than on internalizing symptoms, despite overwhelming evidence of mental health disparities in this population (Ross et al., 2018). Rostosky and Riggle (2002) found that among male and female same-sex couples, lower levels of both actor and partner internalized heterosexism were associated with disclosing one’s sexual orientation at work. Although outness has been associated with internalizing symptoms for sexual minorities (Tabaac et al., 2015), this study does not provide direct evidence for associations of actor and partner minority stress on mental health. Starks et al. (2017) found significant actor and partner effects of relationship satisfaction on depression among male same-sex couples. Although this study did not examine effects of minority stress on mental health, it does provide some evidence that one’s partner’s experiences can affect one’s own mental health.

In the only study that we are aware of that has used APIM to test actor and partner effects of minority stress on internalizing symptoms, Feinstein et al. (2019) examined relationship functioning as a mechanism underlying actor and partner effects of internalized stigma and microaggressions on depression among male same-sex couples. They found that participants who reported higher levels of internalized stigma and microaggressions reported increases in negative relationship interactions, which in turn was associated with greater depression. However, none of the direct effects of actor or partner minority stress on depression were significant. The authors note that because their study was longitudinal, there was a six-month interval between assessments of minority stressors and assessments of mental health outcomes. Previous studies with different-sex couples that have found significant actor and partner effects of stress on mental health have been cross-sectional (Falconier, Nussbeck, et al., 2015; Howe et al., 2004; Rook et al., 1991). Although longitudinal research is important to establish causal associations among variables, it is possible that minority stress contagion occurs over shorter periods of time. In addition, given the very limited research on moderators that could exacerbate, or buffer, the effects of minority stress contagion, it is possible that additional unexplored dyadic processes could affect the link between minority stress and health among same-sex couples.

Dyadic Coping

The concept of dyadic coping emerged to expand individually-oriented models of stress and coping to couple interactions and to emphasize partners’ interdependent processes (Bodenmann, 1997). Viewing stress and coping as interpersonal instead of intrapsychic phenomena changes the definition of coping from an individual’s responsibility to a process in which cognitive appraisals, emotions, and coping behaviors are shared between partners (Revenson et al., 2005), making it particularly important in the context of minority stress contagion, in which minority stress affects both partners (LeBlanc et al., 2015). The process of dyadic coping involves partners’ mutual communication of stress, the negative and positive support partners provide to each other, and conjoint strategies to cope with common stressors (Bodenmann, 1997). The process of dyadic coping involves positive and negative forms of coping. Joint dyadic coping is a form of positive coping that reflects collective efforts by both partners to cope with stress (e.g., joint problem-solving, joint information seeking, sharing of feelings, relaxing together; Bodenmann, 2005). A meta-analysis found that dyadic coping strongly predicted relationship satisfaction regardless of gender, age, relationship length, education level, or nationality (Falconier, Jackson, et al., 2015). This same meta-analysis found that, in terms of the relative contribution of each form of dyadic coping to relationship satisfaction, joint coping was the strongest predictor, emphasizing the central role of partners’ collaborative efforts to manage stress. However, none of these samples included same-sex couples, nor did they examine the impact of dyadic coping on associations of stress and mental health, leaving a significant gap in the literature.

Dyadic coping may be particularly important to study as a buffer of minority stress contagion, as previous research has shown that male and female same-sex couples endorsed higher levels of positive dyadic coping than heterosexual participants (Weaver, 2015), and that individuals in same-sex relationships may benefit more from dyadic coping behaviors than different-sex couples (Buzzella et al., 2012; Weaver, 2015). Two studies conducted with same sex couples found that dyadic coping weakened associations of sexual orientation discrimination with anxiety and depression (Randall, Tao, et al., 2017; Randall, Totenhagen, et al., 2017); however, neither of these used dyadic data to examine both actor and partner effects. Feinstein et al. (2018) found that dyadic coping was positively associated with relationship quality, and negatively associated with negative relationship interactions; however, they did not examine the interaction of minority stress and dyadic coping on internalizing symptoms. Taken together, this research provides some support for the notion that dyadic coping may be an important strategy for same-sex couples to lessen the impact of minority stress on one another’s mental health, but this hypothesis has not been directly tested in previous research.

Examining minority stress contagion may be particularly important among young male same-sex couples. First, sexual minority men experience higher levels of victimization, discrimination, rejection, stress associated with coming out, and internalized heterosexism than sexual minority women (Almeida et al., 2009; Birkett et al., 2015; Feinstein et al., 2012), and these have a stronger detrimental effects on mental health (Almeida et al., 2009). Second, psychological distress tends to be highest for sexual minority men in adolescence and emerging adulthood (Birkett et al., 2015). For young sexual minority men in same-sex relationships, this could mean a greater likelihood of minority stress contagion. Further, both minority stress and internalizing symptoms have been associated with higher HIV risk behaviors among young men who have sex with men (Lelutiu-Weinberger et al., 2019; Mustanski et al., 2007), and the majority of HIV transmission among YMSM occurs in the context of non-monogamous relationships (Goodreau et al., 2012; Sullivan et al., 2009); thus, understanding mechanisms of minority stress contagion in young male same-sex relationships can lead to the development of interventions to improve mental and sexual health in this population.

In sum, although there is some support for the impact of actor and partner minority stress on identity-related outcomes (i.e., outness; Rostosky & Riggle, 2002), very few studies have used dyadic data to investigate actor and partner effects of minority stress on internalizing symptoms. Further, although dyadic coping has been shown to be an important protective factor for the impact of stress on wellbeing for different-sex couples, very few studies have used examined dyadic coping among same-sex couples. Understanding the potential of dyadic coping to buffer the negative effects of minority stress on mental health has important implications for relationship education interventions for male same-sex couples.

Present Study

To address these gaps in previous research, the goal of the present study was to use APIM to examine associations between actor and partner experiences of minority stress (i.e., heterosexist microaggressions and internalized heterosexism) and internalizing symptoms (i.e., anxiety and depression) among male same-sex couples, moderated by joint dyadic coping. The present study used dyadic data from baseline assessments for two ongoing randomized controlled trials (RCTs) of a relationship education and HIV prevention program for male couples. We hypothesized that actor and partner minority stressors would be positively associated with internalizing symptoms and that those with higher joint dyadic coping would have reduced associations of actor and partner minority stressors on internalizing symptoms.

Method

Participants and Procedure

Participants were 774 men who have sex with men (MSM; 387 dyads). Sample characteristics are reported in Table 1. Data for this study were collected as a part of baseline assessments from two ongoing RCTs of 2GETHER, a relationship education and HIV prevention program for young male couples (Newcomb, Sarno, et al., 2020). The first RCT, known as 2GETHER USA, is recruiting a national sample and participants receive the intervention online via video conferencing. The other RCT, 2GETHER Chicago, is recruiting couples from the Chicago area to participate in an in-person version of the intervention. All study procedures performed were approved by the Northwestern University Institutional Review Board (STU00202802; STU00202939). Although these data were part of a larger dataset, none of the variables we examined overlap with the primary or secondary outcomes of the RCTs, nor have any manuscripts been previously published that use these data or test similar hypotheses. For previous published manuscripts using baseline data from 2GETHER USA and 2GETHER Chicago see (Newcomb, Sarno, et al., 2020; Newcomb, Swann et al., 2020; Sarno, Bettin, et al., 2020).

Table 1.

Sample Characteristics

Individual-Level (N = 774) M SD
Age 28.26 6.44
Race/Ethnicity N %
 White 437 56.5
 Hispanic or Latino 156 20.2
 Black or African American 106 13.7
 Multiracial 41 5.3
 Asian 23 3.0
 Other 7 0.9
 Native Hawaiian or Other Pacific Islander 2 0.3
Sexual Orientation
 Gay 644 83.2
 Bisexual 77 9.9
 Queer 45 5.8
 Another orientation not listed 8 1.0
HIV Status
 Negative 577 74.5
 Positive 112 14.5
 Unknown (never tested or unsure of most recent test result) 85 11.0
Highest Level of Education Completed
 Some high school 9 1.2
 High school diploma or GED 93 12.0
 Trade school certificate 10 1.3
 Some college 250 32.3
 Undergraduate degree 213 27.5
 Some graduate school 59 7.6
 Graduate degree 140 18.1
Current Student 206 26.6
Employment Status
 Unemployed 131 16.9
 Employed part-time 136 17.6
 Employed full-time 507 65.5
Legal Partnership Status
 Not married or in a civil union/domestic partnership 557 72.0
 Married 103 13.3
 Civil union or domestic partnership 60 7.8
 Other 54 6.9
Dyad-Level (N = 387)
Age discordance (more than 10 years age difference between partners) 69 17.8
HIV Status
 Seroconcordant negative or unknown 289 74.7
 Serodiscordant 98 25.3
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Couples were eligible for both RCTs based on the following inclusion criteria: 1) both members were assigned male at birth and currently identified as male; 2) both members were at least 18 years of age and at least one member was aged 18–29; 3) couple reported oral or anal sex with each other in the last three months; 4) at least one member reported having condomless anal sex with a known serodiscordant serious partner or with any casual sexual partner in the last three months; 5) both could read and speak English at 8th grade level or better; 6) both had access to the Internet; and 7) both agreed to audio recording of intervention sessions. 2GETHER USA had the additional inclusion criterion that at least one member reported binge-drinking (i.e., five or more drinks on a single occasion) or illicit drug use in the last 30 days.

Participants for the current analytic sample were recruited between July 2017 and January 2020. In these analyses, we included data from couples who were eligible and completed baseline but were not randomized because they were either awaiting assignment to treatment condition or were lost to follow-up. Baseline assessments in both RCTs were administered online via REDCap survey software; participants of the in-person RCT completed their baseline study visit at our Northwestern University offices, and those in the national RCT could use their personal computer, tablet, or smartphone to complete their assessments remotely. Participants were recruited using paid advertising on social media (e.g., Facebook, Instagram), geospatial dating/hookup apps, and organic online engagement through social media posts (e.g., Reddit, Twitter). Participants of the in-person RCT were additionally recruited through clinic-based recruitment and local events. More information about the RCT of 2GETHER USA can be found in Newcomb, Sarno, et al. (2020).

Measures

Demographics

The demographic questionnaire assessed participants’ age, HIV status, race/ethnicity, sexual orientation, legal partnership status, education, and employment.

Heterosexist Microaggressions

The Sexual Orientation Microaggressions Inventory (SOMI; Swann et al., 2016) consists of 26 items developed based on themes described by Nadal et al. (2010). Participants report how often in the last three months they have had each experience because they identify as gay, bisexual, or another sexual minority. Participants rate each item on a 5-point Likert-type scale from 1 (not at all) to 5 (almost every day). To reduce participant burden in 2GETHER USA and 2GETHER Chicago, only the 10 highest-loading items from Swann et al. (2016) were included, which represent all four subscales: anti-gay attitudes and expressions (e.g., “You were told not to ‘act so gay.’”), denial of homosexuality (e.g., “You were told that being gay is just a phase.”), heterosexism (e.g., “You were told you’re not a ‘real’ man.”), and societal disapproval (e.g., “Someone said homosexuality is a sin or immoral.”). Items are averaged into a single score, with higher scores indicating more frequent experiences of sexual orientation microaggressions. The measure showed convergent, criterion-related, and discriminant validity in two diverse samples of LGBTQ youth (Swann et al., 2016), and good reliability in the present sample (α = .82).

Internalized Heterosexism

Internalized heterosexism was measured using eight items from a 22-item adapted and validated scale (Puckett et al., 2017). The scale was developed using five items from the Homosexual Attitudes Inventory (Nungesser, 1983), which were adapted to be more interpretable for a youth population. Next, 17 items were added to the scale to capture a broader conceptualization of internalized heterosexism, based on the work of Ramirez-Valles et al. (2010). In the instrument validation study Puckett et al. (2017) found evidence for three distinct subscales of the internalized heterosexism measure. However, compared to the other factors, the Desire to be Heterosexual subscale of the measure most closely reflected the definition of internalized heterosexism as negative feelings and homophobic attitudes toward one’s self as a product of social bias against sexual minorities (Shidlo, 1994), and was the only subscale associated with mental health both at baseline and longitudinal analyses. Thus, Puckett et al. (2017) recommended only using the Desire to be Heterosexual subscale as a measure of internalized heterosexism, and 2GETHER USA and 2GETHER Chicago administered only the 8-item Desire to be Heterosexual subscale (e.g., “Sometimes I think that if I were straight, I would probably be happier”). Participants rate each statement on a 4-point Likert-type scale from 1 (strongly disagree) to 4 (strongly agree). Items are averaged into a single score, with higher scores indicating a higher level of internalized heterosexism. The measure showed good convergent, discriminant, and predictive validity in a sample of young MSM (Puckett et al., 2017), and good reliability in the present sample (α = .88).

Dyadic Coping

The Dyadic Coping Inventory (DCI; Bodenmann, 2008; Ledermann et al., 2010) is a 37 item instrument with six subscales that assess stress communication, supportive dyadic coping, negative dyadic coping, delegated dyadic coping, joint dyadic coping, and evaluation of dyadic coping. To reduce participant burden in 2GETHER USA and 2GETHER Chicago, and because joint dyadic coping has been shown to have the strongest effect on relationship outcomes (Falconier, Jackson, et al., 2015), only the five items from the joint coping subscale (e.g., “We engage in a serious discussion about stress and think through what has to be done”) were included. Participants are asked to rate how often they and their partners engage in each behavior when they are both feeling stressed on a 5-point Likert-type scale ranging from 1 (very rarely) to 5 (very often). Items are summed into a single score, with higher scores indicating more frequent engagement in joint coping. The DCI has well-established construct, content, and criterion validity, and internal consistencies in the initial validation of the DCI ranged from .74 to .93 (Bodenmann, 2008). The joint coping subscale of the DCI has been used in previous studies conducted with same-sex couples, and has showed good convergent validity and reliability (Feinstein et al., 2018; Rosenthal & Starks, 2015), and showed good reliability in the present sample (α = .84).

Anxiety

The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Item Bank (Cella et al., 2010; Pilkonis et al., 2011) measures self-reported fear (fearfulness, panic), anxious misery (worry, dread), hyper-arousal (tension, nervousness), and somatic symptoms (racing heart, dizziness). Participants are instructed to report how frequently they experienced these symptoms in the last seven days on a 5-point Likert-type scale from 1 (never) to 5 (always). Raw scores are calculated by summing item scores, multiplying by the total number of items, and dividing by number of answered items. The PROMIS Anxiety Item Bank was developed using rigorous psychometric methodology and has demonstrated strong internal consistency (.93–.95) and content validity, and has been used in previous studies conducted with sexual minority samples and showed good convergent validity and reliability (Dyar et al., 2020). The measure showed excellent reliability in the present sample (α = .94).

Depression

The PROMIS Depression Short From 8a (Cella et al., 2010; Pilkonis et al., 2011) was used to assess self-reported negative mood (sadness, guilt), views of self (self-criticism, worthlessness), social cognition (loneliness, interpersonal alienation), and decreased positive affect and engagement (loss of interest, meaning, and purpose). Participants are instructed to report how frequently they experienced these symptoms in the last seven days on a 5-point Likert-type scale from 1 (never) to 5 (always). Raw scores are calculated by summing item scores, multiplying by the total number of items, and dividing by number of answered items. The PROMIS Short Form 8a showed good psychometric properties in a sample of MSM (Kaat et al., 2017), and excellent reliability in the present sample (α = .94).

Analytic Plan

Analyses were conducted with Mplus using robust maximum likelihood estimation. Multilevel modeling was used to account for the nonindependence of dyadic data, with Level 1 (individual level) nested within Level 2 (couple level). Missing data were handled using full information maximum likelihood. Because depression and anxiety were highly correlated (r = .72), we created a latent internalized symptoms variable indicated by PROMIS Depression and Anxiety scores. We constrained the factor loading of both indicators be equal.

To test main effects of minority stress on internalizing symptoms, we used multilevel structural equation modeling to estimate one APIM including heterosexist microaggressions and internalized heterosexism as predictors (Kenny et al., 2006; Mustanski et al., 2014). Dyad members were treated as indistinguishable, such that the actor effect (i.e., the actor’s outcome regressed on the actor’s predictor) and the partner effect (i.e., the actor’s outcome regressed on the partner’s predictor) were estimated for both predictors. Next, we tested a second APIM with cross-level interaction effects of dyadic coping at the couple-level with actor and partner effects of heterosexist microaggressions and internalized heterosexism, respectively, on internalizing symptoms at the individual-level. Dyadic coping was a predictor of the slopes of the actor effects of both predictors and internalizing symptoms, and the slopes of the partner effects of both predictors and internalizing symptoms. We used the methods discussed by Preacher et al. (2006) to probe significant interaction effects (i.e., we examined the effects at one standard deviation above the mean and at one standard deviation below the mean).

Main effects and interaction effects models controlled for age, race/ethnicity, and sexual orientation at the individual level, based on previous research indicating that they may influence individuals’ likelihood of experiencing symptoms of depression and/or anxiety, including studies of sexual minorities (Feinstein & Dyar, 2017; Kiekens et al., 2020; Swann et al., 2018). Race/ethnicity was recoded into four categories: White, Black, Latinx, and Other; White was used as the referent group. Sexual orientation was recoded into three categories: Gay, Bisexual/Queer (combining these two groups), and Other; Gay was used as the referent group.

Results

Means, standard deviations, individual-level bivariate correlations, and intraclass correlation coefficients (ICC) are presented in Table 2. ICCs can be interpreted as the proportion of variance due to differences between couples. Conversely, (1 – ICC) can be interpreted as the proportion of variance due to differences between individuals within the same couple (plus error). All variables had ICCs below .5, indicating that there was a higher proportion of variance due to differences between individuals than variance due to differences across couples. On average, participants reported low levels of heterosexist microaggressions and moderate levels of internalized heterosexism, dyadic coping, anxiety, and depression. There was a small positive correlation between heterosexist microaggressions and internalized heterosexism, and small positive correlations between each minority stress variable and anxiety and depression. Dyadic coping had a small negative correlation with internalized heterosexism but was not significantly correlated with any other variables. Anxiety and depression had a large positive correlation.

Table 2.

Means, Standard Deviations, Individual-Level Bivariate Correlations, and Intraclass Correlations

Variable 1 2 3 4 5
1. Heterosexist microaggressions –
2. Internalized heterosexism .25* –
3. Dyadic coping .02 −.21* –
4. Anxiety .17* .19* .02 –
5. Depression .17* .25* −.05 .72* –
Mean 1.41 1.59 18.32 16.78 19.07
Standard Deviation .43 .60 4.12 7.30 7.60
Obtained Range 1–4 1–3.88 5–25 8–40 8–40
Possible Range 1–5 1–4 5–25 8–40 8–40
Intraclass Correlation Coefficient .12 .18 .41 .30 .22
Cronbach’s alpha .82 .88 .84 .94 .94
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Note.

*

p < .001.

Main Actor and Partner Effects

Results of main effects of actor and partner minority stress, and covariates, on internalizing symptoms are presented in Table 3. The actor effects of heterosexist microaggressions and internalized heterosexism on internalizing symptoms were significant. Participants who reported more frequent heterosexist microaggressions and higher levels of internalized heterosexism had more internalizing symptoms. No partner effects were significant. Age was significantly negatively associated with internalizing symptoms, and Black/African American participants had significantly lower internalizing symptoms compared to Whites. There were no significant differences in internalizing symptoms based on sexual orientation.

Table 3.

Main Effects of Actor and Partner Minority Stress on Internalizing Symptoms

Predictor b (SE) p
Heterosexist microaggressions
 Actor effect .41 (.11) <.001
 Partner effect .10 (.11) .374
Internalized heterosexism
 Actor effect .49 (.09) <.001
 Partner effect .03 (.08) .686
Age −.02 (.01) .004
Race/Ethnicity
 White Referent –
 Black −.28 (.14) .043
 Latinx −.07 (.12) .551
 Other −.02 (.17) .932
Sexual Orientation
 Gay Referent –
 Bisexual/Queer .02 (.13) .905
 Other .66 (.45) .140
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Note. Values are unstandardized regression coefficients. N = 774.

Interaction Effects

Results of cross-level interactions of dyadic coping and minority stress on internalizing symptoms are displayed in Table 4. Dyadic coping moderated the actor effect of heterosexist microaggressions on internalizing symptoms. The association of heterosexist microaggressions and internalizing symptoms was significant and positive for those who engaged in low levels of dyadic coping but was not significant for those who engaged in high levels of dyadic coping. Simple slopes of the interaction effect are displayed in Figure 1a. Dyadic coping did not moderate the partner effect of heterosexist microaggressions on internalizing symptoms. Dyadic coping did not moderate the actor effect of internalized heterosexism on internalizing symptoms. However, dyadic coping did moderate the partner effect of internalized heterosexism on internalizing symptoms. For participants who engaged in high levels of dyadic coping, their partners’ internalized heterosexism had a significant positive association with their internalizing symptoms. For participants who engaged in low levels of dyadic coping, their partners’ internalized heterosexism was not significantly associated with their internalizing symptoms. Simple slopes of the interaction effect are displayed in Figure 1b.

Table 4.

Cross-Level Interaction Effects and Simple Slopes of Dyadic Coping with Actor and Partner Minority Stress on Internalizing Symptoms

Predictor b (SE) p
Heterosexist microaggressions
 Actor effect × Dyadic coping −.12 (.05) .018
  High dyadic coping .05 (.16) .763
  Low dyadic coping .66 (.19) .000
 Partner effect × Dyadic coping −.03 (.04) .473
Internalized heterosexism
 Actor effect × Dyadic coping .00 (.04) .907
 Partner effect × Dyadic coping .10 (.04) .009
  High dyadic coping .30 (.14) .035
  Low dyadic coping −.22 (.12) .060
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Note. Values are unstandardized regression coefficients. Age, race/ethnicity, and sexual orientation were included as covariates at the individual level. Significant interaction effects were probed by examining effects at one standard deviation above the mean (i.e., high dyadic coping) and one standard deviation below the mean (i.e., low dyadic coping). N = 774.

Figure 1.

Figure 1.

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Simple slopes of the significant interaction effects. A. Dyadic coping × actor heterosexist microaggressions on internalizing symptoms. B. Dyadic coping × partner internalizing herosexism on internalizing symptoms.

Discussion

The present study adds to the limited existing literature on minority stress and internalizing symptoms among same-sex couples by using APIM to test associations of actor and partner heterosexist microaggressions and internalized heterosexism on internalizing symptoms. We also examined joint dyadic coping as a moderator of actor and partner effects. We found significant actor effects of heterosexist microaggressions and internalized heterosexism on internalizing symptoms, but no partner effects. In other words, those who experienced more frequent heterosexist microaggressions and had higher internalized heterosexism also had more symptoms of anxiety and depression – an expected finding given the vast literature on minority stress theory (e.g., Meyer, 2003; Nadal, 2013; Newcomb & Mustanski, 2010). However, an individual’s partner’s frequency of experiences of heterosexist microaggressions or internalized heterosexism were not associated with their own internalizing symptoms. These results stand in contrast to research on different-sex couples, which has shown that one’s partner’s stress can affect one’s own health (Falconier, Nussbeck, et al., 2015; Howe et al., 2004; Rayens & Reed, 2014; Rook et al., 1991). Our lack of significant partner effects may be due to our relatively younger sample, who represent mostly emerging adults. This developmental period is unique in that it is characterized by a period of individuation, which can mean that emerging adults have less of a tendency to take the perspective of their partners or prioritize their partners’ needs over their own (Arnett, 2000). This may mean that the couples in our sample have decreased interdependence, which characterizes relationships that occur later in life (Arnett, 2007), such that their partners’ experiences of minority stress, on average, did not have an impact on their own internalizing symptoms.

Dyadic coping significantly moderated actor effects of heterosexist microaggressions on internalizing symptoms. For those who engaged in dyadic coping more frequently in their relationships, the association of an individual’s experiences of microaggressions with their own internalizing symptoms was weakened. Two previous studies found that dyadic coping weakened associations of sexual orientation discrimination with anxiety and depression among same-sex couples (Randall, Tao, et al., 2017; Randall, Totenhagen, et al., 2017). However, these studies did not use dyadic data or APIM to test these associations, nor did they examine joint dyadic coping specifically. The present study thus makes an important contribution on the ways that joint dyadic coping can help buffer the effects of microaggressions on internalizing symptoms, which may be particularly important for young sexual minority men in relationships, given that they may experience particularly high levels of minority stress, and have more detrimental mental health outcomes, relative to other sexual minority groups (Almeida et al., 2009).

Dyadic coping did not moderate actor effects of internalized heterosexism on internalizing symptoms. However, dyadic coping did significantly moderate partner effects of internalized heterosexism on internalizing symptoms. Interestingly, the effects were in the opposite direction as hypothesized: for those who engaged in high levels of joint dyadic coping, their partner’s internalized heterosexism was associated with greater internalizing symptoms; for those who engaged in low levels of dyadic coping, their partner’s internalized heterosexism was not associated with their internalizing symptoms. These results are somewhat consistent with results of a study by Rottmann et al. (2015) showing that participants who provided more supportive coping to their partners also experienced more depressive symptoms; however, joint coping was associated with fewer depressive symptoms for both partners. Our results appear to indicate that there may be an optimal level of dyadic coping, such that when couples cope with stress together too frequently, one’s partner’s stress can become detrimental to their own mental health. It is possible that when couples reported engaging in dyadic coping with a high frequency, it was an indication that they were relying solely on one another as a way to cope with their experiences of stigma-related stress, and lacked support outside of their relationship. Previous research has shown that social isolation was related to increased romantic dependency among couples, and that having social support outside of the relationship is important for the wellbeing of couples (Barton et al., 2014; Hasan & Clark, 2017). It is also particularly likely for sexual minorities in relationships to rely heavily on their partners for support, given that they often lack supportive relationships with their families or origin (Newcomb et al., 2019). Thus, although dyadic coping was associated with less frequent internalizing symptoms, on average, couples who engage in a high level of joint dyadic coping may experience their partner’s internalized heterosexism as burdensome, exacerbating their anxiety and depression symptoms.

It is notable that this pattern of interaction effects was found only for internalized heterosexism, but not for partner effects of heterosexist microaggressions on internalizing symptoms. Microaggressions and internalized heterosexism represent distal and proximal minority stressors, respectively, which have unique impacts on mental health. Previous research has found that proximal stress processes were stronger predictors of negative mental health outcomes than distal stress processes (Ramirez & Paz Galupo, 2019). According to minority stress theory, internalized heterosexism is described as being “in the most proximal position along the continuum from the environment to the self” (Meyer, 2003, p. 682), and so insidious that it may be present even in the absence of overt negative events. Internalized heterosexism has also been found to be higher among sexual minority men compared to sexual minority women (Feinstein et al., 2012). Microaggressions are more related to one’s environment, and although a persistent source of stress, may not necessarily be as detrimental to one’s identity and mental health. For male same-sex couples, it may be easier for partners to help each other cope with their reactions to brief events than with thoughts and feelings of chronic shame around their identities. Thus, when participants’ partners experienced internalized heterosexism, coping with that stress together as couple (i.e., engaging in frequent dyadic coping) may have created a greater strain on their own mental resources, resulting in more internalizing symptoms.

Clinical Implications

These findings have important implications for interventions focused on sexual minority individuals in same-sex relationships. Interventions that use relationship education to teach effective communication and conflict resolution skills have been shown to improve relationship quality and communication skills among different-sex couples (Hawkins et al., 2008), and adaptations for same-sex couples have had similar outcomes (Buzzella et al., 2012; Whitton et al., 2016). For example, the Strengthening Same-Sex Relationships Program (SSSR) was adapted to be relevant and culturally appealing to male couples specifically (Whitton et al., 2016). The SSSR includes six core content areas, including coping with minority stress and discrimination, and building social networks that support the relationship. Although dyadic coping is typically seen as a healthy way that couples cope with stress together, results of this study indicate that for some couples, possibly those who lack support outside of the relationship, dyadic coping may be occurring with a frequency that is detrimental to mental health. Existing interventions should teach couples how to effectively use dyadic coping to reduce the effects of minority stress, particularly internalized heterosexism, on mental health, and how to avoid engaging in dyadic coping in a maladaptive way. 2GETHER, the relationship education program being tested in the RCTs from which these data were taken, includes content on coping with stress as a couple, and emphasizes not relying solely on one’s partner for support and establishing adequate support outside of the relationship. Increasing awareness of when one is relying too heavily on one’s partner to cope with stress, and helping to identify sources of support outside of the relationship, may optimize the effects of dyadic coping on mental health.

Limitations and Future Directions

Our findings should be interpreted light of several limitations. First, our analyses were cross-sectional, which limits our ability to draw conclusions about causal relationships among variables. For example, it is possible that those who experience internalizing symptoms are less likely to engage in dyadic coping in their relationships, which could explain our result that dyadic coping moderated the actor effect of heterosexist microaggressions on internalizing symptoms. Future longitudinal research is necessary to clarify the direction of these associations. Second, because our data were taken from an RCT of an intervention for male same-sex couples, our sample was limited by the inclusion criteria to cisgender men in relationships with other cisgender men, meaning that our results are not generalizable to other sexual and gender minority populations. The experiences of gender minority individuals, sexual minority individuals assigned female at birth, and sexual and gender minorities in different-sex relationships are not captured by this sample. These populations have unique experiences in relationships that undoubtedly would impact the ways that their own and their partner’s minority stress affect their mental health. For example, bisexual men have been found to experience unique forms of prejudice based on the gender of their relationship and sexual partners (Feinstein & Dyar, 2017; Sarno, Newcomb, et al., 2020), and gender minority individuals are more likely than cisgender sexual minorities to experience high rates of intimate partner violence, and, consequently, internalizing mental health problems (James et al., 2016). Future research is needed to understand the unique ways that these populations experience minority stress and internalizing symptoms in relationships. Third, the couples in our sample volunteered to participate in a relationship education intervention, which may have biased the sample toward those who had more difficulty coping with stress in their relationships. However, given that the trials are intended to be preventative and are not specifically recruiting distressed couples, the possibility of differences between these couples and the broader population is likely somewhat reduced. Fourth, the average age of our sample may have limited the generalizability of our results to emerging adults, whereas an older adult sample may be more interdependent and have experienced more partner effects of minority stress on mental health.

Fifth, we only administered the joint coping subscale of the Dyadic Coping Inventory (Bodenmann, 2008); thus, it is unclear how our results would have been different had we included all subscales, and makes it challenging to compare our results to studies that focused on other dimensions of dyadic coping among same-sex couples (Randall, Tao, et al., 2017; Randall, Totenhagen, et al., 2017). Lastly, scholars have argued that research on micoraggressions lacks conceptual and methodological rigor, highlighting the need for additional research to clearly operationalize and validate comprehensive assessments of the construct (Lilienfeld, 2017). These limitations notwithstanding, our findings suggest that for sexual minority men in same-sex relationships, experiences of minority stress negatively impact mental health, and although dyadic coping can act as a buffer of these effects, it can also exacerbate them at certain levels, and relationship education interventions for same-sex couples must take this into account. This study is one of very few that has used APIM to examine actor and partner effects of minority stress on mental health among same-sex couples, and additional research is needed to replicate findings and examine additional mechanisms that can buffer, or intensify, minority stress among sexual minority individuals in relationships.

Acknowledgments

This research was supported by grants from the National Institute on Drug Abuse (DP2DA042417; PI: Newcomb) and the National Institute on Alcohol Abuse and Alcoholism (R01AA024065; PI: Newcomb). Elissa Sarno’s time was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (F32AA028194; PI: Sarno). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. All study procedures performed were approved by the Northwestern University Institutional Review Board (STU00202802; STU00202939).

Footnotes

This manuscript utilizes data from baseline assessments of two ongoing randomized controlled trials (RCTs) of 2GETHER, a relationship education and HIV prevention program for STRESS, COPING, AND INTERNALIZING SYMPTOMS male couples. All previous manuscripts that have been published using baseline data from 2GETHER RCTs are listed below:

Newcomb, M. E., Sarno, E. L., Bettin, E., Carey, J., Ciolino, J. D., Hill, R., Garcia, C. P., Macapagal, K., Mustanski, B., Swann, G., & Whitton, S. W. (2020). Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER. JMIR Research Protocols, 9(1), e15883. https://doiorg.turing.library.northwestern.edu/10.2196/15883

Newcomb, M. E., Swann, G., Ma, J., Moskowitz, D., Bettin, E., Macapagal, K., & Whitton, S. W. (2020). Interpersonal and intrapersonal influences on sexual satisfaction in young male couples: Analyses of actor-partner interdependence models. Journal of Sex Research. https://doiorg.turing.library.northwestern.edu/10.1080/00224499.2020.1820933

Sarno, E. L., Bettin, E., Jozsa, K., & Newcomb, M. E. (2020). Sexual health of rural and urban young male couples in the United States: Differences in HIV testing, pre-exposure prophylaxis use, and condom use. AIDS and Behavior. https://doiorg.turing.library.northwestern.edu/10.1007/s10461-020-02961-8

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