A Relational Turbulence Model of Sexual Communication in Couples With Depression

Abstract

Couples coping with depression are prone to unique and pervasive sexual intimacy challenges and experience troubles communicating effectively. Successful sexual communication improves sexual and relationship satisfaction, making communication particularly important for couples facing sexual difficulties. In this study, the relational turbulence model serves as a framework to examine associations between sexual communication and both sexual and relationship satisfaction in couples (N = 106) in which one or both partners live with depression. Results of a cross-sectional survey suggest sexual communication mediates relationships between both relational uncertainty and interference from a partner with sexual/relationship satisfaction. Results illuminate functions of communication about sex as couples navigate sexual and relational effects of depression.

Keywords

depression relational turbulence romantic relationships sexual communication

Depression affects approximately 16 million American adults and has troubling effects on people’s romantic partnerships (Centers for Disease Control and Prevention, 2020; Gustavson et al., 2012; Hames et al., 2013). Couples coping with depression experience disruptions and difficulties in their sexual relationship, as well as communication problems (Cleveland Clinic, 2014; Delaney, 2019a; Gabriel et al., 2010; Sharabi et al., 2016). Sexual communication can improve relational quality (Coffelt & Hess, 2014; Cupach & Comstock, 1990), making communication particularly important for couples who are facing sex troubles. As depressed couples navigate shared challenges of the illness, conversations about sex could be instrumental in individual and relational outcomes. The purpose of this study is to examine the function of sexual communication in a sample of couples living with one or both partners’ depression.

The relational turbulence model (RTM, Solomon & Knobloch, 2004) centers on associations among qualities of the relationship, communication between partners, and outcomes for couples. Under conditions of relational uncertainty and interference from a partner, communicators may be more reactive and less effective, or they may avoid interactions altogether (Theiss & Estlein, 2014; Theiss & Solomon, 2006). The RTM has guided studies of communication in the depression context (e.g., Knobloch et al., 2016) and in the study of sexual communication (e.g., Theiss, 2011). Both variables of the model—relational uncertainty and interference from a partner—have been linked to sexual challenges in depression (Delaney, 2019b; Knobloch & Delaney, 2012), so a key next step is to consider sexual communication in couples with depression through the RTM lens. In this study, I propose and evaluate a model in which sexual communication mediates ties between mechanisms of relational turbulence and sexual and relationship satisfaction.

Three goals guide this study. First, I use the RTM as an organizing framework to theorize about sexual communication in couples affected by depression. Second, a cross-sectional study of romantic dyads will allow me to evaluate actor and partner effects. Given substantial interdependence in partners’ experiences with depression (Hames et al., 2013; Knobloch & Knobloch-Fedders, 2010), treating the dyad as the unit of analysis aids in understanding the relational climate of living with depression. Third, this study includes measures of both presence and effectiveness of sexual communication, allowing for a more robust investigation of sexual communication in romantic relationships. The current study adds to research using the relational turbulence model to understand depressive illnesses. Pragmatically, the results highlight sexual communication as an area for intervention to help couples navigate relational effects of depression.

Literature Review

Sexual Relationships in Depression

Depression can obstruct a couple’s ability to maintain a sexual connection because the illness is associated with diminished sexual desire, physical dysfunctions, decreases in self-esteem, difficulties experiencing pleasure, and trouble initiating sexual activity (Baldwin, 2001; Kennedy et al., 1999; Ostman, 2008). Non-depressed partners are affected by a depressed person’s sexual difficulties and can face similar challenges (e.g., difficulties with physical function) in response to their loved one’s illness (Ostman, 2008). Decreased libido is often assumed to be a symptom of depression or a side effect of medication used to treat depression (Higgins et al., 2010; Kennedy et al., 1999), but relational dynamics also drive sexual intimacy challenges in depression. Delaney (2019a, 2019b) identified several sexual intimacy challenges for couples with depression, including troubles with libido, cognitive challenges, and interactive barriers for both depressed and non-depressed partners. Depression-related sexual problems are well documented.

Couples facing sexual difficulties might find it particularly daunting to communicate about the physical relationship. Sexuality is a taboo conversational topic in most relational contexts (Anderson et al., 2011; Baxter & Wilmot, 1985). Partners are likely to avoid conversations about the sexual aspects of their relationship, and avoidance of these conversations typically associates with decreased sexual satisfaction (Anderson et al., 2011; Theiss & Estlein, 2014). Despite its importance in shaping the relationship climate, sexual communication is an under-researched process in the study of close relationships (Sprecher & Cate, 2004), and depressed couples can struggle to communicate generally (Sharabi et al., 2016). For couples living with depression and its sexual effects, in particular, communication about their sexual partnership stands to be uniquely challenging, so research into the dynamics of these sexual conversations will be useful in helping dyads navigate the individual and relational challenges of depressive symptoms.

Sexual Communication in Romantic Relationships

Sexual communication is both important and challenging for partners. These conversations influence emotional outcomes of sex, and frequency and quality of interactions about sex are tied to sexual and relationship satisfaction (Montesi et al., 2011; Sprecher & Cate, 2004; Theiss & Solomon, 2007). Yet, partners can struggle to engage in conversations about sex at various points in their relationships (Anderson et al., 2011; Baxter & Wilmot, 1985; Theiss, 2011; Theiss & Solomon, 2007). Communication about sexual intimacy is often passive and indirect, making it difficult for partners to decipher and for researchers to measure, particularly if scholars are defining the construct as open and direct (Theiss & Solomon, 2007). Sexual communication is challenging for partners because it can put them at risk of rejection, threaten their self-confidence, be embarrassing, or endanger the relationship (Montesi et al., 2011; Theiss & Estlein, 2014). Many couples do not see sex as an easy topic, making it difficult for scholars to pin down exactly what constitutes quality sexual communication. Published research on sexual communication includes multiple conceptualizations and measurements because it is a complex phenomenon.

In light of the complexity of sexual communication, in this study I consider two specific aspects of the sexual communication process—both presence and effectiveness. First, a global appraisal of sexual communication is rooted in Catania’s (2011) measure, which captures responses between partners, avoidance of interactions, and whether or not partners have ever had a conversation about sex. Dyadic sexual communication is about the degree of presence or absence of sexual communication in the partnership. Second, guided by communication competence, which positions perceptions of appropriateness and effectiveness as central to successful communication (Canary & Spitzberg, 1987; Spitzberg & Canary, 1985), perceiving conversations as effective is key to sexual communication. Thus, sexual communication effectiveness assesses outcomes of sexual communication, or perceptions of conversations as rewarding, beneficial, and successful. Indeed, these are not competing definitions of sexual communication, but are instead complementary facets of the process. Together, these two conceptualizations address both existence and effectiveness of sexual communication between partners. In the next section, I overview the RTM and consider its utility for studying sexual communication, particularly in the depression context.

The Relational Turbulence Model

The RTM (Solomon & Knobloch, 2004) explains that romantic partners perceive their relationship as chaotic when they experience relational uncertainty and interference from their partner in their daily routines (Knobloch, 2007). Relational uncertainty is the degree of confidence individuals have in their perceptions of involvement and stems from three sources (Solomon & Knobloch, 2004). Self uncertainty includes people’s questions about their own involvement in the relationship, whereas partner uncertainty focuses on people’s questions about their partner’s involvement. Relationship uncertainty centers on the dyad and encompasses questions about the nature and status of the relationship itself (Knobloch, 2008; Knobloch & Solomon, 1999). These three overlapping but discrete sources of ambiguity contribute to turmoil in relationships because partners become limited in their abilities to make sense of the relationship (Knobloch & Theiss, 2010). Interference from a partner is the degree to which a partner disrupts the ability to achieve day-to-day goals (Solomon & Knobloch, 2004). Under conditions of interference, people may experience frustration and negative emotions, making communication more reactive. The RTM shines light on ways that relational uncertainty and interference from a partner are tied to couples’ communication, and the model has proven useful in investigations of both depression and sexual communication.

Depression, relational turbulence, and sexual communication

The RTM is a valuable framework for examining depression in romantic relationships. Knobloch and Delaney (2012) observed depression-specific content areas of relational uncertainty and interference from a partner. Moreover, these variables mediate the link between depressive symptoms and relational quality (Knobloch & Knobloch-Fedders, 2010; Knobloch & Theiss, 2011). Evidence also exists in the depression context for ties between mechanisms of turbulence and specific communication behaviors such as reassurance-seeking, negative-feedback seeking, topic avoidance, and demand/withdraw (Delaney & Sharabi, 2020; Knobloch et al., 2011, 2016). Indeed, relational uncertainty and interference from a partner are relevant relational variables in the experience of depression within romantic partnerships.

The RTM also suggests that sexual communication is especially difficult in turbulent circumstances. Relational uncertainty and interference from a partner associate with polarized communication (Solomon & Knobloch, 2004) and are tied to topic avoidance, withdrawal, indirect communication, decreased openness, and destructive conflict behaviors (Knobloch & Theiss, 2011; Theiss & Nagy, 2013; Theiss & Solomon, 2006). In terms of sexual communication, for example, a partner experiencing ambiguity about the relationship might be hesitant to bring up sexual topics because they are not able to predict how their partner will react, and partners who are frustrated over disruptions to routines or goals being blocked might communicate in reactive and hostile ways.

Most sexual communication research guided by the RTM has featured relational uncertainty, but one study has tested both pieces of the model. Theiss and Estlein (2014) examined how sexual communication can be threatening for partners. In their study, relational uncertainty and interference from a partner associated with perceived threat of sexual communication, which corresponded with indirect sexual communication and avoidance of sexual conversations. Theiss (2011; Theiss & Estlein, 2014) provides a foundation for examining sexual communication through the RTM. Existing work, though, explores associations in general samples. Given that depressive symptoms create a climate for relational uncertainty and interference from a partner (Delaney, 2019b; Knobloch & Knobloch-Fedders, 2010), couples with depression may find these qualities of the relationship are particularly predictive of troubles with communicating about sex.

The RTM asserts that relational uncertainty and interference from a partner are linked with communicative reactivity (Solomon & Knobloch, 2001). For couples living with depression, these relational qualities could make it more difficult to engage in sexual communication, or could shift their perceptions of how effective a conversation is at addressing sexual challenges they encounter as a result of the depression (Delaney, 2019a). In short, conditions of relational turbulence could disrupt whether partners engage in a conversation about sex and could make conversations less effective. Thus, a first set of hypotheses predicts associations between relational uncertainty and interference from a partner and sexual communication in a sample of couples with depression.

H1: In couples living with one or both partners’ depression, (a) relational uncertainty and (b) interference from a partner will be negatively associated with dyadic sexual communication.

H2: In couples living with one or both partners’ depression, (a) relational uncertainty and (b) interference from a partner will be negatively associated with sexual communication effectiveness.

Sexual communication and sexual/relationship satisfaction

The dynamics of partners’ communication about sex can have both sexual and relational outcomes (Byers, 2005; Dewitte, 2014; Faulkner & Lannutti, 2010). Satisfying conversations about sex can have positive relational and sexual outcomes by helping individuals to better understand their partner (Faulkner & Lannutti, 2010). Sexual satisfaction should improve as couples are able to agree about frequency and nature of sexual activities, a process that likely necessitates communication about sex (Snyder & Berg, 1983). Sexual communication contributes to relationship satisfaction in ways that are unique and specific beyond the effects of non-sexual communication (Montesi et al., 2011). In general samples, substantial evidence exists that sexual communication boosts both sexual and relationship satisfaction (Babin, 2013; Byers, 2005; Coffelt & Hess, 2014; Cupach & Comstock, 1990; Montesi et al., 2011). Clearly, conversations about sexual intimacy are important for romantic couples.

Prior research has not yet documented these associations in couples with depression who are prone to challenges in their sexual partnership (Delaney, 2019a), likely to experience decreased relationship satisfaction (Kouros & Cummings, 2011), and may struggle to communicate effectively (Hames et al., 2013; Sharabi et al., 2016). In general samples, the presence and amount of sexual communication associates with sexual and relational outcomes (Jones et al., 2018; Mark & Jozkowski, 2013; Theiss & Estlein, 2014). Other work has operationalized the quality of sexual communication, including sexual self-disclosure, directness, and language used, to document links with sexual and relationship outcomes (Hess & Coffelt, 2012; Rehman et al., 2011; Theiss & Solomon, 2007). Although these findings are common in general samples, existing research has not specifically verified these associations in couples with depression. For couples with depression, the ability to engage in a conversation and to perceive that conversation as effective are both important considerations, and likely associate similarly with sexual and relationship satisfaction as in general samples. In light of the sexual and relationship challenges that depressed couples experience (Delaney, 2019a; Sharabi et al., 2016), sexual communication could be an important intervention point for partners. A second set of hypotheses evaluates associations between sexual communication and (a) sexual and (b) relationship satisfaction in a sample of couples with depression.

H3: In couples living with one or both partners’ depression, dyadic sexual communication will be positively associated with (a) sexual satisfaction and (b) relationship satisfaction.

H4: In couples living with one or both partners’ depression, sexual communication effectiveness will be positively associated with (a) sexual satisfaction and (b) relationship satisfaction.

Sexual Communication as a Mediator

Together, these hypotheses anticipate a model in which sexual communication is the mechanism by which relational uncertainty and interference from a partner predict sexual and relationship outcomes. Existing research has documented ties between the mechanisms of relational turbulence (relational uncertainty and interference from a partner) with both sexual and relationship satisfaction (Knobloch, 2008; Knobloch & Theiss, 2011; Theiss & Nagy, 2010). In a sample of married couples, uncertainty about communication and sex were the strongest predictors of relational quality (Knobloch, 2008), which hints that uncertainty, communication, and the sexual relationship may be tied in ways that associate with outcomes for couples. Timm and Keiley (2011) found that sexual communication mediated associations between differentiation of self and sexual and relationship satisfaction, providing initial evidence that communication about sex could be a link between perceptions of the self/relationship and satisfaction outcomes. Theiss (2011) found that communicative indirectness about sexual intimacy was a mediator between relational uncertainty and sexual satisfaction, indicating that difficulty in conversations about sex may be the tie between ambiguity about the partnership and perceptions of the sexual relationship. The current study will build upon Theiss’ findings by (a) also evaluating interference from partner and (b) testing these ideas in a sample of couples living with depression.

Substantial evidence exists that depression negatively affects people’s sexual (Baldwin, 2001; Delaney, 2019a) and relationship (Gustavson et al., 2012; Sharabi et al., 2016) satisfaction, and depression-focused relational turbulence research underscores relational uncertainty and interference from a partner as variables that influence couples’ experiences (Knobloch & Delaney, 2012; Knobloch & Knobloch-Fedders, 2010). More broadly, interpersonal perspectives on depression agree that communication is one mechanism of relational challenges for individuals with depression (Hames et al., 2013). For couples in this context, interactions about sex are likely one link between each partner’s perceptions of the relationship (relational uncertainty and interference from a partner) and their sexual and relationship satisfaction. A fifth hypothesis evaluates the assertion that relational uncertainty and interference from a partner are negatively linked with sexual communication, which in turn correlates with sexual and relationship satisfaction.

H5: In couples living with one or both partners’ depression, (a) relational uncertainty and (b) interference from a partner are indirectly associated with (c) sexual satisfaction and (d) relationship satisfaction through sexual communication.

Method

These data were collected as part of a larger study.¹ The hypotheses were assessed via a nationwide online survey of 106 different-sex couples (N = 212).² University IRB approved all procedures. Inclusion criteria were: (a) being involved in a romantic relationship in which (b) both partners were willing to enroll and (c) one or both partners had a professional depression diagnosis. Partners needed to be (d) 18 years of age or older and (e) have their own email address. The sample was recruited through national depression support organizations, mental health research/treatment centers, a study Facebook page, relationship therapists, and online depression and relationship blogs.

Eligible individuals and couples were invited to e-mail a study-specific e-mail account to verify their eligibility for the study and provide a name and e-mail addresses for both partners. Each partner received a unique login and password and a link to complete the online questionnaire. Couples were asked to complete the study within 7 days, and reminders were sent on the fourth and seventh days. Upon accessing the questionnaire, participants were provided with informed consent information. Both partners completed the same questionnaire and were encouraged to participate separately. The order of scales was consistent across participants, but items were randomized. Participation took 1 hour or less. After completing the questionnaire, participants e-mailed a study completion code to the author to end their participation. Couples in which both partners completed the study received $20 in e-gift cards to a national retailer.

Participants ranged from 19 to 73 years of age (M = 35.67; SD = 12.07), and reported their race/ethnicity as Caucasian/White (85.8%), African American/Black (5.7%), Asian American/Asian (4.2%), Hispanic/Latino/a (2.8%), Native American/Pacific Islander (0.5%), or other (1.0%). Couples were married (62.3%), seriously dating (17.0%), casually dating (14.2%), and engaged to be married (6.6%). The mean relationship length was 8 years (SD = 9.60, range = 2 months to 50.5 years). Most people (n = 174, 82.1%) currently lived with their partner.

Over half the sample (n = 128, 60.4%, 72 women, 56 men) had a professional depression diagnosis. Most reported they (n = 87, 41%) or their partner (n = 84, 39.6%) had depression. Forty-one participants (19.3%) reported that both partners had depression diagnoses. Participants had been diagnosed for an average of 6 years (SD = 7.54, range = 1 month to 46.75 years) with diagnoses of chronic mild depression/dysthymia (24.5%), major depression (26.9%), depression as a part of bipolar disorder (7.5%), seasonal affective disorder (4.2%), postpartum depression (3.3%), psychotic depression (1.4%), or other (0.9%). Of participants with a diagnosis, most (79.7%) were currently taking anti-depressant medication, and approximately a third (31.3%) used non-medicinal treatment, such as counseling or cognitive behavioral therapy. The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff & Locke, 1986) measured depressive symptoms. Additional information about depressive symptoms in this sample is available in Delaney (2019b).

Measures

Relational uncertainty

I measured relational uncertainty with abbreviated versions of Knobloch and Solomon’s (1999) scales, which have been previously validated (Knobloch et al., 2016; Knobloch & Knobloch-Fedders, 2010). Participants responded to 12 items, stemmed by the question “How certain are you about. . .?” on a 6-point scale (1 = completely uncertain, 6 = completely certain). I reverse scored items so that higher scores indicate greater relational uncertainty. Four items measured self (e.g., “your view of the relationship?”), partner (e.g., “how important your relationship is to your partner?”), and relationship uncertainty (e.g., “the future of your relationship?”). I calculated means for each variable: self uncertainty (M = 2.14, SD = 1.06, α = .92), partner uncertainty (M = 2.20, SD = 1.08, α = .90), relationship uncertainty (M = 2.25, SD = 1.02, α = .87).³

Interference from a partner

Solomon and Knobloch’s (2001) scale measured interference from a partner. The stem “My romantic partner. . .” preceded six items (e.g., (a) “interferes with the plans I make”). Participants responded on a 6-point scale (1 = strongly disagree, 6 = strongly agree). Each participant’s score was calculated as the mean (M = 2.18, SD = 1.29, α = .95).

Dyadic sexual communication

Catania’s (2011) Dyadic Sexual Communication Scale is a recognized measure of sexual communication. Ten of the original 13 items were unidimensional in CFA. Participants noted agreement on a 6-point scale (1 = disagree strongly, 6 = agree strongly). Items were scored such that higher scores represent higher perceived quality of sexual communication. The 10 items were: (a) my partner rarely responds when I want to talk about our sex life, (b) some sexual matters are too upsetting to discuss with my sexual partner, (c) there are sexual issues or problems that we have never discussed, (d) my partner and I never seem to resolve our disagreements about sexual matters, (e) when my partner and I talk about sex, I feel like he or she is lecturing me, (f) my partner complains that I am not very clear about what I want sexually, (g) my partner and I have never had a heart-to-heart talk about our sex life together, (h) my partner has no difficulty talking to me about his or her sexual feelings and desires, (i) even when angry with me my partner is able to appreciate my views on sexuality, and (j) I seldom feel embarrassed when talking about the details of our sex life with my partner. These 10 items produced acceptable fit in CFA procedures, χ²/df = 2.79, CFI = .91, RMSEA = .09. I calculated the mean for each participant (M = 4.18, SD = 0.92), and the scale demonstrated acceptable reliability (α = .82).

Sexual communication effectiveness

I developed a sexual communication effectiveness scale by adapting items from Spitzberg and Canary (1985). Participants responded to 20 items preceded by the stem “When we discuss our sexual relationship. . .” on a 6-point scale (1 = strongly disagree, 6 = strongly agree). Although previously documented as unidimensional when measuring communication competence (Canary & Spitzberg, 1987), several of the items focused on control (e.g., “My partner dominates the conversation.”) as opposed to effectiveness. After examining items for face validity, I removed six items that assessed control and retained 14 focused on goal achievement. These items did not acceptably fit the data, χ²/df = 4.96, CFI = .83, RMSEA = .14. Removing poor fitting items one-by-one revealed items highlighting the dyad’s effectiveness (e.g., “our conversations are very beneficial.”) as more cohesive than individually focused items (e.g., “I am effective in the conversations”). This pattern of adjustment led to a seven-item solution, and final CFA tests verified unidimensionality of the items, χ²/df = 2.88, CFI = .96, RMSEA = .09.

The seven items were: (a) our conversations are very beneficial, (b) our conversations are unsuccessful (reverse scored), (c) I get what I want out of the conversations, (d) the conversations are unprofitable (reverse scored), (e) conversations about our sexual relationship are advantageous, (f) the conversations are rewarding, and (g) I find the conversations to be very useful and helpful. Each participant’s score was calculated as the mean of the seven items (M = 4.06, SD = 1.07). The measure demonstrated strong reliability (α = .92).

Sexual satisfaction

Participants completed the General Measure of Sexual Satisfaction (Lawrance et al., 2011) to assess sexual satisfaction. Instructions asked participants to evaluate their sexual relationship on five sets of word pairs accompanied by a 7-point scale. In CFA tests, the full five-item measure did not meet fit criteria, but a four-item solution indicated acceptable fit (χ²/df = 2.63, CFI = .98, RMSEA = .09). The four items were: (a) very bad-very good, (b) very pleasant-very unpleasant (reverse scored), (c) very negative-very positive, and (d) very unsatisfying-very satisfying. Participants’ scores were calculated as a mean (M = 4.99; SD = 1.45), and the four-item scale demonstrated good reliability (α = .90).

Relationship satisfaction

Three items from Fletcher et al. (2000) assessed relationship satisfaction. Participants responded on a 7-point scale (1 = not at all, 7 = extremely) to items that asked how (a) satisfied, (b) content, and (c) happy they are with their relationship. Each participant’s score was calculated as the mean (M = 5.35, SD = 1.34, α = .95).

Data Analysis

Preliminary analyses

Bivariate correlations are available in Table 1. Independent samples t-tests revealed no statistically significant gender differences on the study variables; women did report greater depressive symptoms (M = 1.19, SD = .64) than men (M = 0.97, SD = .70), t(105) = 2.34, p < .05. I evaluated several potential covariates, including age, relationship length, depressive symptoms, depression diagnosis status, medication, marital status, cohabitation, and self-reported sexual intimacy challenges. Age associated with sexual satisfaction for both men (r = −.27, p < .01) and women (r = −.30, p < .01). Age also correlated with sexual communication effectiveness for women (r = −.23, p < .05). Depressive symptoms (but not depression diagnosis status) were also related to each study variable (Table 2). Independent samples t-tests (Table 3) revealed significant differences on study variables between participants who responded “yes” that depression affected their sexual relationship and those who responded “no.” More information about the sexual intimacy challenges in this sample can be found in Delaney (2019b). I included these three variables (age, depressive symptoms, and sexual intimacy challenges) as covariates in hypothesis tests.

Table 1.

Bivariate Correlations Among Men, Women, and Within Couples.

	V1	V2	V3	V4	V5	V6	V7	V8
V1: Self uncertainty	.58 **	.68**	.87**	.37**	−.46**	−.49**	−.57**	−.62**
V2: Partner uncertainty	.76**	.59 **	.81**	.32**	−.34**	−.41**	−.50**	−.45**
V3: Relationship uncertainty	.88**	.78**	.64 **	.42**	−.46**	−.46**	−.63**	−.59**
V4: Interference from a partner	.45**	.28**	.47**	.40 **	−.39**	−.29**	−.34**	−.40**
V5: Dyadic sexual communication	−.43**	−.38**	−.45**	−.53**	.71 **	.73**	.58**	.53**
V6: Sexual communication effectiveness	−.57**	−.54**	−.58**	−.45**	.71**	.56 **	.61**	.42**
V7: Sexual satisfaction	−.55**	−.52**	−.62**	−.47**	.59**	.66**	.78 **	.69**
V8: Relationship satisfaction	−.70**	−.64**	−.71**	−.54**	.57**	.66**	.75**	.67 **

Note. n = 106 men, women, or couples. Correlations for men appear above the diagonal, and correlations for women appear below the diagonal. Within-couple correlations appear on the diagonal and are underlined.

**p < .01.

Table 2.

Correlations Between Depressive Symptoms and Study Variables for Men and Women.

	Men	Women
Self uncertainty	.33**	.46**
Partner uncertainty	.22*	.47**
Relationship uncertainty	.37**	.48**
Interference from a partner	.34**	.33**
Dyadic sexual communication	−.45**	−.41**
Sexual communication effectiveness	−.24*	−.40**
Sexual satisfaction	−.46**	−.43**
Relationship satisfaction	−.52**	−.41**

p < .05. **p < .01.

Table 3.

Independent Samples t—Tests for Men and Women on Sexual Intimacy Challenges.

Men: Sexual intimacy challenges	Yes (n = 49)		No (n = 57)		t (104)
Men: Sexual intimacy challenges	M	SD	M	SD	t (104)
Self uncertainty	2.50	1.08	1.81	0.85	−3.71***
Partner uncertainty	2.53	1.06	1.90	0.85	−3.43**
Relationship uncertainty	2.62	1.14	1.90	0.68	−3.99***
Interference from a partner	2.59	1.39	1.92	1.06	−2.79**
Dyadic sexual communication	3.84	1.01	4.46	0.82	3.48**
Sexual communication effectiveness	3.68	1.19	4.53	0.68	4.61***
Sexual satisfaction	4.24	1.23	5.95	0.96	7.86***
Relationship satisfaction	4.79	1.33	5.89	1.13	4.62***
Women: Sexual intimacy challenges	Yes (n = 54)		No (n = 52)		t (104)
Women: Sexual intimacy challenges	M	SD	M	SD	t (104)
Self uncertainty	2.43	1.26	1.85	0.82	−2.80**
Partner uncertainty	2.56	1.37	1.86	0.78	−3.27**
Relationship uncertainty	2.59	1.19	1.94	0.80	−3.30**
Interference from a partner	2.47	1.42	1.78	1.12	−2.77**
Dyadic sexual communication	3.95	0.86	4.41	0.83	2.85**
Sexual communication effectiveness	3.49	1.14	4.47	0.83	5.02***
Sexual satisfaction	4.05	1.32	5.63	1.24	6.31***
Relationship satisfaction	4.73	1.37	5.92	1.06	5.02***

**p < .01. ***p < .001.

Substantive analyses

I used structural equation modeling (AMOS 20) with maximum likelihood estimation and began by regressing each study variable onto the covariates then used the residuals to construct the substantive model, forming parcels for latent variables. I set the error variance to (1-α)*σ² and standardized variables across the full sample (Bollen, 1989; Kenny et al., 2006). The model included self uncertainty, partner uncertainty, and interference from a partner as exogenous variables, with self and partner uncertainty predicting relationship uncertainty. Relationship uncertainty and interference from a partner predicted the two sexual communication variables (H1 and H2), which predicted sexual and relationship satisfaction (H3 and H4). Sexual satisfaction predicted relationship satisfaction, following prior literature (Montesi et al., 2011). See Figure 1 for the hypothesized model. Each model included both actor and partner effects for hypothesized associations, and I covaried exogenous variables and error terms for endogenous variables within couples (Ledermann et al., 2011).

Figure 1.

Hypothesized model (H1–H4; H5 predicts mediation).

Model fitting occurred in two steps: first by deleting statistically non-significant paths one-by-one, and then by consulting the modification indices to make theoretically reasonable additions one at a time. Criteria for model fit were χ²/df less than 3.00, CFI greater than .90, and RMSEA less than .10 (Kline, 2011). After achieving model fit, I examined each path that remained for both men and women, then added constraints to set those paths as equal (Kenny et al., 2006) and appraised model fit to determine if constrained paths offered a better fit. The fit was similar for unconstrained and constrained models, so the unconstrained paths are reported here. Bootstrapping procedures tested the indirect effects. If zero was not within the bias corrected confidence interval (BC CI), the mediation was evaluated as statistically significant (Preacher & Hayes, 2008).

Results

The initial hypothesized model was a poor fit to the data (χ² = 224.36, df = 60, p < .001; χ²/df = 3.74; CFI = .84; RMSEA = .16). A first round of one-by-one deletions eliminated partner paths between relational uncertainty, interference from a partner, and both sexual communication variables. A second set of deletions affected partner paths between both sexual communication variables and sexual satisfaction, as well as relationship satisfaction. The remaining partner paths between sexual satisfaction and relationship satisfaction were statistically non-significant. Two actor paths were also deleted: men’s paths from both sexual communication variables to their own relationship satisfaction. Together, these deletions suggest the data do not support the presence of partner effects in H1, H2, H3, and H4 and lack support for men’s actor effects for H3b and H4b. After removing these statistically non-significant paths individually, the model remained an inadequate fit to the data (χ² = 240.59, df = 80, p < .001; χ²/df = 3.01; CFI = .85; RMSEA = .14).

Next, the modification indices guided theoretically grounded additions. A first addition was an actor path from men’s dyadic sexual communication to sexual communication effectiveness. This made the actor path from men’s interference from a partner to sexual communication effectiveness non-significant. The data suggested a parallel path from women’s dyadic sexual communication to sexual communication effectiveness, also prompting the removal of women’s path from interference to sexual communication effectiveness. Paths between women’s dyadic sexual communication and relationship satisfaction and from men’s dyadic sexual communication to sexual satisfaction became statistically non-significant and were removed. The data supported two additional paths. First a direct path from women’s self uncertainty to relationship satisfaction was added, which made the path from sexual communication effectiveness to relationship satisfaction non-significant. Finally, a path directly from men’s relationship uncertainty to sexual satisfaction was included. At this point, two more paths became statistically non-significant: men’s relationship uncertainty to sexual communication effectiveness, and women’s partner uncertainty to relationship uncertainty.

This set of deletions (primarily of partner paths) and four theoretically supported additions resulted in an acceptably fitting model (χ² = 155.61, df = 88, p < .001; χ²/df = 1.78; CFI = .94; RMSEA = .09). The model includes statistically significant paths from relationship uncertainty and interference from a partner to dyadic sexual communication (H1a and H1b) for both men and women, and from relationship uncertainty to sexual communication effectiveness for women (H2a). The data also support associations between dyadic sexual communication and sexual satisfaction (H3a) for women, as well as sexual communication effectiveness and sexual satisfaction (H4a) for both men and women. The final model (with path coefficients) is available in Figure 2. Squared multiple correlations (variance explained) for the endogenous variables can be found in Table 4.

Figure 2.

Final model.

Table 4.

Squared Multiple Correlations for Endogenous Variables.

Variable	Women	Men
Relationship uncertainty	.94	.98
Dyadic sexual communication	.32	.21
Sexual communication effectiveness	.61	.66
Sexual satisfaction	.38	.51
Relationship satisfaction	.65	.42

In 12 of 14 tests, the bias corrected confidence intervals suggested statistically significant indirect effects in associations between both relational uncertainty and interference from a partner and sexual/relationship satisfaction (H5). Only the tests for men’s partner uncertainty were non-significant, although they did approach statistical significance (p = .065 for sexual satisfaction and p = .063 for relationship satisfaction). Indirect effect estimates and confidence intervals are available in Table 5. Together, these results suggest support for the hypothesis that sexual communication is one mechanism through which relationship variables (relational uncertainty and interference from a partner) are tied to both sexual satisfaction and relationship satisfaction.

Table 5.

Summary of Significant Indirect Effects of Sexual Communication on the Relationship Between Relational Uncertainty, Interference from a Partner, and Sexual/Relationship Satisfaction.

	β	95% BC CI (lower - upper)
Women
Self uncertainty to sexual satisfaction	−.23	[–.39, –.09]
Self uncertainty to relationship satisfaction	−.11	[–.22, –.03]
Relationship uncertainty to sexual satisfaction	−.25	[–.41, –.10]
Relationship uncertainty to relationship satisfaction	−.12	[–.22, –.04]
Interference from a partner to sexual satisfaction	−.22	[–.37, –.10]
Interference from a partner to relationship satisfaction	−.11	[–.20, –.04]
Men
Self uncertainty to sexual satisfaction	−.26	[–.60, –.10]
Self uncertainty to relationship satisfaction	−.21	[–.48, –.07]
Relationship uncertainty to sexual satisfaction	−.10	[–.20, –.03]
Relationship uncertainty to relationship satisfaction	−.32	[–.53, –.14]
Interference from a partner to sexual satisfaction	−.08	[–.17, –.03]
Interference from a partner to relationship satisfaction	−.06	[–.15, –.02]

Note. BC CI does not include zero; BC CI = bias-corrected confidence interval. All indirect effects are significant at p < .01.

Discussion

This study was dedicated to applying the RTM to understand sexual communication for romantic couples coping with depression. Both relationship uncertainty and interference from a partner were negatively associated with dyadic sexual communication, while only women’s relationship uncertainty predicted sexual communication effectiveness. Women’s dyadic sexual communication and both women’s and men’s sexual communication effectiveness were significant predictors of sexual satisfaction, which predicted relationship satisfaction. Across most tests, sexual communication did mediate associations between relational uncertainty and interference from a partner and sexual/relationship satisfaction. The findings, taken together, give valuable insight into the dynamics of couples with depression.

Theoretical Implications

The findings add to a corpus of research theorizing about turbulent processes in romantic dyads affected by depression. The RTM was originally formulated to examine relationships as they increase in intimacy, but has since evolved to focus on how relational uncertainty and interference from a partner operate in couples and how dyads adapt to changing circumstances (Solomon, 2016). Prior work has established themes of relational uncertainty and interference from a partner in depression and used the RTM to document communication outcomes for couples in this context (Delaney & Sharabi, 2020; Knobloch & Delaney, 2012; Knobloch et al., 2011, 2016). The current findings document sexual communication as a communication variable that is linked with both relational uncertainty and interference from a partner in couples with depression.

Mechanisms of turbulence and sexual communication

Depression has been previously associated with both mechanisms of turbulence (Knobloch & Delaney, 2012; Knobloch et al., 2011). Much of the prior work on relational turbulence in depression has primarily emphasized relational uncertainty, focusing on associations across depression, relational uncertainty, relationship satisfaction, and communication outcomes such as topic avoidance and negative-feedback seeking (Knobloch et al., 2011, 2016; Knobloch & Knobloch-Fedders, 2010). The current findings document cross-sectional associations between relationship uncertainty (predicted by self and partner uncertainty) and both measures of sexual communication for women and dyadic sexual communication for men. This suggests that when individuals in the context of depression grapple with ambiguity about the status of their partnership, they are less likely to engage in conversations about sex, and for women, they see those conversations as less effective. Similarly, the data documented associations between interference from a partner and dyadic sexual communication. When facing disruptions to day-to-day routines and goals as a result of interdependence with their partner, people might feel embarrassed, frustrated, or hesitant to engage in a conversation about sex.

The findings offer broad support for the core of the relational turbulence model: that under conditions of relational turbulence, people are less likely to engage in communication and are less effective when they do (Solomon & Knobloch, 2004; Theiss & Nagy, 2010; Theiss & Solomon, 2007). This study extends Theiss’ (2011; Theiss & Estlein, 2014) findings to emphasize processes of relational turbulence and sexual communication in a sample of couples living with depression. Couples with depressive symptoms are prone to relational turbulence (Knobloch & Delaney, 2012; Knobloch & Knobloch-Fedders, 2010), sexual problems (Delaney, 2019b; Kennedy et al., 1999), and communication difficulties (Gabriel et al., 2010; Sharabi et al., 2016). The current findings apply the RTM to empirically establish associations among relational uncertainty, interference from a partner, and sexual communication in the depression context.

By including interference from a partner as a relevant turbulence variable in depression and sexual communication, this study supplements two literatures that have examined relational uncertainty without highlighting the RTM’s other mechanism (e.g., Knobloch et al., 2011, 2016; Theiss, 2011). Interference from a partner produces frustration and negative emotions, diminishing communication quality and prompting polarized communication behaviors (Solomon et al., 2010; Solomon & Knobloch, 2001, 2004). In these data, interference from a partner negatively predicted dyadic sexual communication for men and women, but it was not associated with sexual communication effectiveness. Coupled with Theiss and Estlein’s (2014) findings that interference from a partner predicts perceiving sexual communication as threatening, the current findings illuminate the role that interference from a partner may play in how partners perceive and choose to engage or disengage from conversations about sex. In other words, Theiss and Estlein (2014) found that interference from a partner associates with seeing communication about sex as threatening, and these results document that under conditions of interference, both women and men report less dyadic sexual communication in their romantic partnership. Thus, in line with the RTM, disruptions to individual goals and routines can prompt extremes in communication (Solomon et al., 2010), in this case associating with less communication about sex.

The current study confirms that the RTM—including both relational uncertainty and interference from a partner—offers a structure for theorizing about depressed partnerships. These contributions represent a step forward in applying the RTM to the depression context and clarifying the nature of its cognitive and interpersonal mechanisms of turbulence. These findings point to both mechanisms of turbulence as negatively associating with sexual communication. Couples who can minimize perceptions of relational uncertainty and interference from a partner may be stronger communicators. Feeling secure and certain in the relationship might make sexual communication easier and more effective, and when couples are able to coordinate routines and collaborate to meet goals, they might be better equipped to navigate a tricky conversation about sex.

The importance of sexual communication

The links between depressive illnesses and relationship troubles are well documented (Hames et al., 2013; Sharabi et al., 2016; Whitton & Whisman, 2010). Past research has uncovered negative ties between relational uncertainty and interference from a partner with sexual and relationship satisfaction, both in general samples and in the context of depression (Knobloch & Knobloch-Fedders, 2010; Knobloch & Theiss, 2011; Theiss, 2011; Theiss & Nagy, 2010). These results establish sexual communication as one mediating variable between those mechanisms of turbulence and sexual/relationship satisfaction. The findings are noteworthy in two ways. First, by documenting the indirect effect through sexual communication, the findings lend insight into the dyadic paths through which relational uncertainty and interference from a partner link to relationship outcomes. Relational uncertainty and interference from a partner are individual perceptions of relational qualities—each partner’s ambiguity about the partnership and perceived disruptions to individual goals and routines. The indirect effects point to sexual communication as an area where those variables manifest in dyadic interactions about sex, both the extent to which conversations between partners occur and how effectively those conversations help partners navigate their sexual partnership. Although partner effects were not apparent in these data, the findings point to links between individual perceptions of the partnership and the couple’s sexual conversations as a route to sexual/relationship satisfaction. The dynamics of sexual communication in couples living with depression are clearly meaningful for partners’ outcomes.

Second, by including two complementary measures of sexual communication in the same test, the results add nuance to a literature that often uses “sexual communication” as a term to encompass multiple related but distinct pieces of sexual communication processes, such as self-disclosure, directness, and openness (Coffelt & Hess, 2014; Montesi et al., 2011; Theiss, 2011). These findings diverge from other studies finding direct links between sexual communication and relationship satisfaction (Coffelt & Hess, 2014; Cupach & Comstock, 1990; Montesi et al., 2011), an outcome that may be an artifact of differences in measurement or of the depressed status of this sample in comparison to general samples in previous work. In short, the current findings shine a light on the importance of investigating and understanding processes of sexual communication. Communication scholarship is valuable for dissecting the mechanisms that link depression with couples’ outcomes, and communication between romantic partners represents a potential area for intervention as couples navigate depression together.

Implications for Practice

Practitioners who work with individuals and couples living with depression can turn to these findings to target relational uncertainty, interference from a partner, and sexual communication as relevant areas for intervention. The current findings document that in the context of depression, relational uncertainty and interference from a partner are associated with lower extent and effectiveness of communication about sex. Given documented ties between depression and these mechanisms of turbulence (e.g., Delaney, 2019b; Knobloch & Knobloch-Fedders, 2010; Scott & Stafford, 2018), the findings indicate that trouble with communication about sex is one route through which the effects of depression are tied to relationship challenges. Couples may find it useful to address topics of ambiguity or areas of interference in their relationship, and practitioners can help couples pinpoint strategies to minimize those mechanisms of turbulence. Additionally, a next phase of theorizing and pragmatic application can highlight protective mechanisms of strong communication between partners. Positive interactions about sex might minimize the damage on the sexual relationship. Rosier and Tyler (2017) tested the effectiveness of an online sexual communication training program for a general sample of married couples and found that completing the program led to lower sexual communication apprehension, improved sexual communication knowledge and skills, and enhanced sexual and relationship satisfaction. A similar intervention that helps couples living with depression to understand and address their sexual intimacy challenges (Delaney, 2019b) and improve their engagement and effectiveness in conversations about sex has potential to help couples manage the dyadic effects of depressive illnesses.

Limitations and Directions for Future Research

The findings should be considered in light of methodological limitations. Although it is a nationwide sample representing a diverse age range, the sample is primarily white and does not reflect the experiences of same-sex couples. Additionally, the sample was recruited through depression support organizations and treatment centers, meaning that it does not represent couples coping with depression that is undiagnosed or untreated. Continued research on samples that represent diverse depression experiences is necessary. Additionally, although the findings offer insight into the importance of measurement and conceptual clarity in the consideration of sexual communication, the two measures evaluated here are by no means the final word in this discussion. Conceptualizing and measuring sexual communication is difficult. This study includes measures that primarily frame sexual communication in ways that emphasize the couple’s ability to engage in verbal conversations about sex and the individual’s evaluation of the efficacy of those conversations. These are perceptions certainly worthy of study, yet neither measure captures the content or process of those interactions. Different measures of sexual communication can produce varied patterns of results. When comparing across studies, scholars must be attentive to conceptual and operational differences, and perhaps we should be more specific in defining our concepts of interest. Instead of using “sexual communication” as an overarching term for any communication about sex, more precise language (e.g., sexual self-disclosure, sexual communication effectiveness, direct sexual communication) will shed light on the specific processes and behaviors under investigation.

Several directions for future research are apparent. Since these data were collected, Solomon et al. (2016) advanced the RTM into a theory, articulating testable propositions about distinct and causal processes that link relational uncertainty and interference from a partner to turbulence. Relational Turbulence Theory (RTT; Solomon et al., 2016) emphasizes how relational uncertainty and interference from partners can manifest in specific communication episodes, for example in a conversation about sex. While RTM research has focused on interference as a feature of interdependence that can be disruptive for partners, RTT also attends to facilitation from a partner, or ways that a partner makes goals more attainable (Knobloch & Solomon, 2004; Solomon et al., 2016), and future studies should include measures of facilitation to see ways positive instances of interdependence might create positive outcomes in interactions. RTT also suggests future research can measure and evaluate cognitive and emotional processes that link mechanisms of turbulence to communication outcomes. With the RTT emphasis on turbulence as a global quality of relationships, additional investigation is needed into ways conversations about sex might accumulate into overarching perceptions of tumult or chaos in the relationship for depressed couples.

RTT also provides a framework for efforts to better conceptualize and measure sexual communication. Solomon and colleagues (2016) emphasize communicative engagement and communication valence as two central features of communication in specific episodes that can manifest in perceptions of relational turbulence. In the current study, dyadic sexual communication aligns with communicative engagement, or people’s decisions to interact as opposed to avoid, and the extent of that communication. Sexual communication effectiveness aligns more with communication valence, which is the “tenor” of the interaction (Solomon et al., 2016, p. 516). In future work considering a relational turbulence approach to sexual communication, the engagement/valence framework will be useful for articulating a specific conceptualization of sexual communication.

Conclusion

This study establishes communication about sex as a mediator between relational turbulence variables and sexual and relationship satisfaction for depressed couples. The findings provide insight into the relational processes of couples with depression and illustrate issues of operationalization in studies of sexual communication. Most broadly, the results of this study demonstrate the continued utility of a relational turbulence framework for investigating the experience of depression in romantic relationships and the dynamics of sexual communication.

Footnotes

Acknowledgements

The author would like to thank her dissertation committee, her UIUC undergraduate research assistants, and especially her graduate advisor Dr. Leanne Knobloch for contributions and guidance across the project.

Author’s Note

A previous version of this manuscript was presented at the 2018 annual convention of the National Communication Association.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This manuscript represents a portion of the author’s dissertation, which was funded by the Ruth Anne Clarke Student Scholar Award and the University of Illinois Graduate College Dissertation Completion Fellowship.

ORCID iD

Amy L. Delaney

Notes

Author Biography

Amy L. Delaney (PhD, University of Illinois at Urbana-Champaign, 2016) is an assistant professor at Millikin University.

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