Policy, Relationships, and Well-Being: Associations Between Mental Health and Main Partner Relationships Among Cisgender Sexual Minority Men in the Context of U.S. State-Level Policies.

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 (=7705) completed an online survey, which included the Patient Health Questionnaire-4 and subscales of the Perceived Relationships Quality Components questionnaire. State-level policy was evaluated using State Equality Index (SEI) 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 one standard deviation below the mean and their mental health was significantly better than partnered men whose relationship functioning was two standard deviations 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.