5 - (SYM 16) Policy, Relationships, and Well-being: Associations Between Mental Health and Main Partner Relationships Among Cisgender Sexual Minority Men in the Context of US State-level Policies

Mental health disparities are well documented among sexual minority men (SMM) and generally attributed to minority stress. Recent iterations of minority stress theory suggest one mechanism by which distal stressors – such as discriminatory state-level policies – impact mental health is through disruptions in interpersonal relationships. This hypothesis aligns with relationship research, wherein being in a primary partner relationship – particularly one of high quality – has been associated with better mental health. This study tested an integrated, multi-level 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=7705) completed an online survey between January and September, 2021. Measures included the Personal Health Questionnaire-4 (PHQ-4; an indicator of anxiety and depression) and subscales of the Perceived Relationship Components Questionnaire (PRCQ; to assess relationship quality). State-level policy was evaluated using State Equality Index (SEI) ratings from the Human Rights Campaign. Participants living in states with policies supportive of LGBTQ+ people were more likely to be partnered (B = -0.514, p < .001). Among partnered SMM, relationship status was negatively associated with PHQ-4 scores (B = -0.066, p < .001). As a result, the difference between single and partnered SMM varied with relationship quality. Single SMM had significantly higher PHQ-4 scores than partnered SMM with average relationship quality (B = 0.44, p =.005). They did not differ significantly from partnered SMM with relationship quality one standard deviation below the mean and their PHQ-4 scores were significantly lower than partnered SMM whose relationship quality was two standard deviations below the mean (B = -0.904, p < .001). State-level policy was significantly associated with mental health through an indirect pathway involving relationship status. This study was among the first to examine relationship status and relationship quality in an integrated model, utilizing a novel hurdle covariate modeling procedure developed by the research team. Results highlight the relevance of both relationship status and quality 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.