Mental health disparities are well documented among sexual minority men (SMM) and generally attributed to sexuality-based minority stress. Separate research has established that being in a main or primary partner relationship-particularly one of high quality-is associated with better mental health. The current study tested an integrated model predicting mental health from relationship status and quality and evaluated the potential for these to indirectly link state-level policy with mental health. Adult cisgender SMM (n = 7,705) completed an online survey, which included the Patient Health Questionnaire-4 and subscales of the Perceived Relationship Quality Components questionnaire. State-level policy was evaluated using State Equality Index ratings from the Human Rights Campaign. The likelihood of being in a relationship was significantly greater for participants living in states with policies supportive of LGBTQ+ people. Partnered men with average levels of relationship quality or better reported significantly better mental health compared to single men. Single SMM did not differ significantly from partnered SMM with relationship quality 1 SD below the mean and their mental health was significantly better than partnered whose relationship functioning was 2 SDs below the mean. State-level policy was significantly associated with mental health through an indirect pathway involving relationship status. Results highlight the relevance of both relationship status and functioning to mental health among SMM. They also point to the need for ongoing advocacy to address structural inequality and to develop interventions that address the impact of stigma on close personal relationships in this population.
Public Significance StatementUsing an innovative analytic procedure-hurdle-covariate modeling-this paper illustrates two key things. First, individuals living in states with supportive LGBTQ+ policies were more likely to be in relationships. Second, the extent to which this increased likelihood of being partnered was subsequently a source of risk or resilience for mental health problems was determined by relationship quality.