Relationship stigma and well-being among adults in interracial and same-sex relationships

Abstract

Stigmatization of interracial and same-sex relationships persists, with negative consequences for relationship functioning and mental health. We extended past research to examine consequences of relationship stigma from different sources (family, friends, public) for well-being (anxiety, depressive symptoms, overall self-rated health), potential buffers (egalitarianism, dyadic coping), and possible mediated pathways (to overall self-rated health through anxiety and/or depressive symptoms). Among 467 U.S. adults in interracial and/or same-sex relationships, relationship stigma from friends was associated with greater depressive symptoms. Being in a same-sex relationship moderated the associations of relationship stigma from family with anxiety and depressive symptoms. Egalitarianism moderated the association of relationship stigma from public with anxiety symptoms, and dyadic coping moderated the association of relationship stigma from family with depressive symptoms. Relationship stigma from friends was also indirectly associated with poorer overall self-rated health through the mechanism of greater depressive symptoms. Findings support that relationship stigma may have adverse consequences for individual well-being. Further, egalitarianism and dyadic coping may be buffers. More research is important to identify how to support the increasing numbers of individuals in stigmatized relationships.

Keywords

Anxiety depression discrimination interracial relationship same-sex stigma well-being

Romantic relationships are ideally sources of happiness and support that contribute positively to individuals’ mental and physical well-being (e.g., Carr, Freedman, Cornman, & Schwarz, 2014). However, for individuals in marginalized relationships, including same-sex and interracial relationships, the relationship itself can be a target of stigma, with adverse effects on individual and relationship outcomes (LeBlanc, Frost, & Wight, 2015). Although the U.S. public’s attitudes toward same-sex and interracial marriages have improved and currently the majority of people approve of these relationships (Gallup Poll, 2013, 2015), societal stigmatization of these relationships persists. Rates of couples and households in the U.S. that are same-sex and/or interracial have been increasing, with recent estimates that 10% of lesbian, gay, bisexual, and transgender adults are married to same-sex partners (Gallup Poll, 2017) and 17% of new marriages are interracial (Pew Research, 2017). It is critical to understand factors that contribute to well-being among individuals in these relationships to inform interventions.

Much research demonstrates that stigma, including discrimination, has adverse consequences for individuals’ mental and physical health, helping to explain disparities (for reviews, see Hatzenbuehler, Phelan, & Link, 2013; Lewis, Cogburn, & Williams, 2015; Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009). Growing research also supports that couple-level or relationship stigma—stigma targeting a couple because of the type of relationship—has adverse consequences for relational functioning and individual well-being beyond consequences of individual-level stigma (e.g., Frost, 2011; Gamarel, Reisner, Laurenceau, Nemoto, & Operario, 2014; Lehmiller & Agnew, 2006; Rosenthal & Starks, 2015). The current investigation aimed to extend this research to explore consequences of relationship stigma from multiple sources (family, friends, public) for well-being (anxiety and depressive symptoms, overall self-rated health) among U.S. adults in same-sex and/or interracial relationships, as well as possible buffers (egalitarianism, dyadic coping) of these consequences.

Mental and physical health consequences of stigma

Substantial research demonstrates that various forms of stigma, including intrapersonal (internalized, self-endorsed), interpersonal (from other individuals), and structural or systemic (from societal institutions) discrimination, stereotyping, and inequality, have adverse consequences for mental and physical health outcomes across diverse populations around the world (for reviews, see Hatzenbuehler et al., 2013; Lewis et al., 2015; Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009). As examples, stigma has been associated with mental health, including greater anxiety and depressive symptoms (e.g., Banks, Kohn-Wood, & Spencer, 2006; Hatzenbuehler, O’Cleirigh, Mayer, Mimiaga, & Safren, 2011), greater post-traumatic stress disorder symptoms (e.g., Seng, Lopez, Sperlich, Hamama, & Reed Meldrum, 2012), higher rates of mental health diagnoses/disorders (e.g., McLaughlin, Hatzenbuehler, & Keyes, 2010), and higher rates of suicide mortality (e.g., Hatzenbuehler et al., 2014). Stigma has also been associated with physical health, including poorer overall self-rated health (e.g., Earnshaw et al., 2016), poorer health behaviors (e.g., Borrell et al., 2010), poorer sleep (e.g., Slopen & Williams, 2014), lower birthweight babies (e.g., Earnshaw et al., 2013), and higher rates of hypertension (e.g., Dolezsar, McGrath, Herzig, & Miller, 2014). Stigma is conceptualized as a chronic stressor (Clark, Anderson, Clark, & Williams, 1999; Meyer, 2003) and “fundamental cause” of health disparities that “gets under the skin” (Hatzenbuehler et al., 2013) to harm well-being among individuals from marginalized and oppressed groups.

Research also finds that mental health factors, such as stress, anxiety symptoms, and depressive symptoms, are associated with poorer physical health (e.g., Pearlin, Schieman, Fazio, & Meersman, 2005; Whooley et al., 2008). Therefore, mental health factors have been proposed as mechanisms explaining links between stigma and physical health (e.g., Williams & Mohammed, 2009). Supporting this, one study found indirect associations of stigma-based bullying with increased blood pressure, body mass index, and poorer overall self-rated health through the mechanism of greater emotional symptoms among adolescents (Rosenthal et al., 2015). Another study found indirect associations of discrimination with greater odds of visiting an emergency department and having a chronic disease, as well as with poorer overall self-rated health, through the mechanisms of stress and depressive symptoms among adults (Earnshaw et al., 2016). However, research directly testing these mechanisms is somewhat limited, and researchers have underscored the importance of better understanding mechanisms linking stigma and physical health (e.g., Puhl & Latner, 2007; Williams & Mohammed, 2009).

Relationship stigma

Most stigma research has focused on direct consequences of individual-level stigma for the person experiencing it. However, increasing theory and research support the importance of understanding experiences and consequences of stigma beyond individuals, including in the context of romantic relationships. For example, some research has found that stigma experienced by one member of a couple can have adverse consequences for the well-being of that person’s romantic partner and the couple’s relationship quality (e.g., Otis, Rostosky, Riggle, & Hamrin, 2006; Trail, Goff, Bradbury, & Karney, 2012). Further, researchers have suggested that relationship stigma—stigma targeting a couple because of the type of relationship–can have adverse consequences for individuals and couples beyond consequences of individual-level stigma (e.g., Frost, 2011; Gamarel et al., 2014; LeBlanc et al., 2015; Lehmiller & Agnew, 2006; Rosenthal & Starks, 2015).

LeBlanc, Frost, and Wight (2015) recently built on Meyer’s (2003) minority stress theory to develop a dyadic minority stress framework. This framework incorporates the roles of stressors experienced by same-sex couples because of their relationships being socially stigmatized (i.e., couple-level minority stressors or relationship stigma), in addition to individual-level stigma and other life stressors, in order to better understand dyadic functioning and individuals’ well-being. In this framework, some stressors are conceptualized as parallel across couple and individual levels, but some couple-level stressors are unique from individual-level stressors (LeBlanc et al., 2015). Each level of minority stress is then thought to uniquely affect dyadic functioning and individual well-being, potentially through similar and/or different mechanisms, as couple-level minority stressors can be experienced individually and/or collectively as a couple. Although this framework was developed for same-sex couples, LeBlanc et al. (2015) note its applicability to other stigmatized couples, including interracial, interfaith, and age-gap. Frost et al. (2017) subsequently reported support for this framework from qualitative analyses of same-sex couples’ relationship timeline interviews, identifying stressors that were unique to being in a stigmatized relationship and in addition to individual-level stigma.

A growing body of research also supports that relationship stigma has adverse consequences for relationship and individual mental health outcomes. Lehmiller and Agnew (2006, 2007) found that people in interracial, same-sex, and age-gap relationships reported greater relationship marginalization than people in other relationships. Furthermore, relationship marginalization was associated with lower relationship commitment and investment and greater odds of relationship dissolution. Frost (2011) found that people in same-sex relationships experienced relationship stigma, with adverse consequences for relationship intimacy, satisfaction, and conflict. Gamarel, Reisner, Laurenceau, Nemoto, and Operario (2014) found among trans women and their cisgender male partners that not only was relationship stigma reported by trans women associated with their own lower relationship quality, but relationship stigma reported by either partner was also associated the other partner’s lower relationship quality. Further, both partners’ experiences of relationship stigma were associated with their own greater depressive symptoms (Gamarel et al., 2014). We (Rosenthal & Starks, 2015) found among individuals in same-sex and/or interracial relationships that relationship stigma was associated with lower relationship commitment, trust, love, and sexual communication, as well as greater odds of intimate partner violence victimization. Together, these findings suggest it is important to continue exploring consequences of relationship stigma. Particularly, consequences for individual well-being outcomes deserve further attention, as relatively more work has examined relational consequences. More research is needed to understand whether relationship stigma has similar or unique consequences for different aspects of well-being (e.g., anxiety, depression, physical health) and in comparison with relationship outcomes, which can help further develop theory on relationship stigma and inform approaches to clinical work tailored to the context (e.g., individual vs. couple or family therapy) and issues targeted (e.g., individual well-being vs. dyadic functioning).

Potential sources and buffers of relationship stigma

Past work has often combined different sources of relationship stigma into single measures (e.g., Gamarel et al., 2014; Lehmiller & Agnew, 2006). However, ecological frameworks (e.g., Bronfenbrenner, 1979; Cicchetti & Lynch, 1993) highlight the importance of examining consequences of different sources ranging from more proximal to distal in individuals’ lives. Further, some research finds that relationship stigma from different sources occurs at different rates and has distinct consequences. For example, Lehmiller and Agnew (2007) found that relationship marginalization from one’s social network (family and friends combined), but not from society, predicted greater likelihood of relationship dissolution. We (Rosenthal & Starks, 2015) found that although relationship stigma from friends was the least frequent, it was the only source of stigma (not family or public) associated with more negative relationship outcomes. Bell and Hastings (2015) also found that parental support versus disapproval of one’s relationship was particularly important among Black and White interracial couples, and Frost et al. (2017) found family contexts to be the most commonly reported for couple-level minority stressors among same-sex couples. Together, these findings suggest that relationship stigma from more proximal sources, including family and friends, may have more adverse consequences than from more distal sources, such as the general public. However, this has only been tested for relationship outcomes. Unique consequences of different sources of relationship stigma for individual well-being have yet to be explored, which we aimed to address.

It is also important to identify buffers that prevent or reduce adverse consequences of relationship stigma to inform interventions. We (Rosenthal & Starks, 2015) previously hypothesized and found evidence that egalitarianism—belief in equality for all people and groups (e.g., Katz & Hass, 1988)—and dyadic coping—collaborative coping efforts of couples (e.g., Revenson, Kayser, & Bodenmann, 2005)—might protect individuals in stigmatized relationships from negative consequences of and even promote positive responses to relationship stigma. In our sample of individuals in same-sex and/or interracial relationships (Rosenthal & Starks, 2015), relationship stigma from friends was associated with lower commitment, love, and sexual communication at low but not high levels of egalitarianism. Relationship stigma from friends was also associated with lower trust, and relationship stigma from family was associated with lower relationship satisfaction, at low but not high levels of dyadic coping (specifically on items assessing problem- and emotion-focused joint dyadic coping when both partners are feeling stressed as well as evaluation of the quality of dyadic coping). These findings suggest that high egalitarianism and dyadic coping are buffers, diminishing some of the negative consequences of relationship stigma from friends and family for relational functioning. Further, relationship stigma from family was associated with greater trust, love, and sexual communication, and relationship stigma from public was associated with greater relationship satisfaction, at high but not low levels of egalitarianism. And, relationship stigma from family was associated with greater sexual communication at high but not low levels of dyadic coping (Rosenthal & Starks, 2015). These findings suggest that high egalitarianism and dyadic coping are not only buffers, but may actually promote positive reactions to or consequences in the face of relationship stigma from family and public for some aspects of relational functioning.

These findings with dyadic coping are consistent with theory and past research identifying dyadic coping as a buffer of effects of chronic stress on relational functioning (e.g., Bodenmann & Randall, 2012). For example, dyadic coping was found to buffer adverse consequences of immigration stress for relationship satisfaction among recently immigrated Latina women in heterosexual relationships (Falconier, Nussbeck, & Bodenmann, 2013). Theory and research also identify dyadic coping as a buffer of effects of stress on individual well-being (e.g., Bodenmann & Randall, 2012). For example, coping-oriented couples therapy was found to reduce depressive symptoms among members of couples who met criteria for major depressive disorder (Bodenmann et al., 2008). We hypothesized that when facing relationship stigma, which is a stressor targeting the couple jointly, engaging in problem- and emotion-focused coping collaboratively to deal with the shared stressor (i.e., joint dyadic coping) as well as feeling satisfied with those collective coping efforts could help to prevent adverse consequences of relationship stigma both for relationship functioning and individual well-being. Potential buffering by dyadic coping of consequences of relationship stigma for individual well-being has yet to be tested.

The findings with egalitarianism are consistent with past research finding greater endorsement of marital standards, including egalitarianism within the marriage, to be associated with greater marital satisfaction among heterosexual couples (Wunderer & Schneewind, 2008). However, the measure of egalitarianism in the current study is not about relationships specifically, but rather assesses broader egalitarian ideals (Ho et al., 2012). Conceptualizing this form of egalitarianism as another possible coping resource, we hypothesized that greater egalitarianism could help individuals in stigmatized relationships to more clearly understand stigma, maintain commitment and optimism for their relationships, and cope with stigma experiences, thereby protecting dyadic functioning and individual well-being (Rosenthal & Starks, 2015). For example, individuals who believe strongly that all people should be treated equally might be more likely to view experiences with stigma as morally wrong and recognize their roots in societal inequality, thereby reacting with motivation to reduce societal stigma and maintain their relationship and individual well-being. Alternatively, individuals who do not hold egalitarian beliefs might be more likely to internalize experiences with stigma and thereby question their relationship and individual self-worth. However, potential buffering of relationship stigma consequences for individual well-being by egalitarianism has also yet to be tested. Thus, more research is needed to explore the potential buffering roles of egalitarianism and dyadic coping to inform intervention.

The current investigation

Building on the research reviewed, the current investigation aimed to: (1) explore associations of relationship stigma from multiple sources (family, friends, public) with well-being (anxiety and depressive symptoms, overall self-rated health) among U.S. adults in same-sex and/or interracial relationships; (2) explore possible buffering factors (egalitarianism, dyadic coping) of associations between relationship stigma and well-being; and (3) explore whether relationship stigma has indirect associations with overall self-rated health through the mechanisms of anxiety and/or depressive symptoms. We used data from a larger online survey of U.S. adults in same-sex and/or interracial relationships, from which we have previously published results focused on consequences of relationship stigma for relationship outcomes (Rosenthal & Starks, 2015). The current investigation extends those previous results, focusing on consequences of relationship stigma for individual well-being, with the ultimate goal of informing clinical work and other intervention efforts to support same-sex and interracial couples and families.

Across all aims, we accounted for potentially confounding participant and relationship characteristics (age, if living with partner, length of relationship, relationship satisfaction, relationship commitment) as well as individual-level discrimination. We included participant and relationship characteristics relevant to well-being (e.g., Kamp Dush & Amato, 2005; Perelli-Harris & Styrc, 2018), as well as individual-level discrimination, which has established links to well-being (e.g., Lewis et al., 2015), to test whether relationship stigma has unique consequences for anxiety symptoms, depressive symptoms, and overall self-rated health. Across aims, we also tested whether type of relationship (same-sex regardless of if also interracial vs. heterosexual interracial) moderated findings. We (Rosenthal & Starks, 2015) previously found that participants in same-sex relationships (regardless of if also interracial) reported greater relationship stigma from public and family than participants in heterosexual interracial relationships. However, we did not find that being in a same-sex relationship moderated associations of relationship stigma with relationship functioning outcomes (Rosenthal & Starks, 2015), consistent with other research not finding type of relationship to moderate associations of relationship marginalization with relationship outcomes (Lehmiller & Agnew, 2006, 2007). Therefore, we did not predict moderation by type of relationship, but still thought it important to explore, as little work has tested this, and understanding differences by relationship type can help to inform tailoring of clinical work.

Method

Procedure

We recruited and screened participants through various websites and social media platforms (e.g., Facebook, Reddit, Tumblr, Twitter), including those specifically dedicated to interracial and/or same-sex dating and relationships, as well as through Amazon’s Mechanical Turk (MTurk). Participants completed the online survey through Qualtrics. First, participants read the consent form, and if they both agreed to participate and qualified for the study (screened as 18 or older, living in the U.S., and in an interracial and/or same-sex relationship for 3 or more months), they were brought to the full survey.

Participants recruited through any means other than MTurk were given the option to remain anonymous or to provide contact information to be entered into a raffle for one of multiple U.S.$50 Amazon.com gift cards. Participants recruited through MTurk were paid U.S.5¢ to answer screening questions, and those eligible were prompted to complete the full survey for U.S.$3 more. The Pace University Institutional Review Board approved of all procedures.

Participants

A total of 2448 people completed screening questions, and of those 661 were eligible and started the survey. However, 11 of those entries were removed, 6 because they were duplicates (e.g., name, MTurk ID, e-mail, and/or IP address) and 5 because it appeared the person was not taking the survey seriously (e.g., inappropriate and/or patterned responses). Of the 650 remaining participants, 501 (77%) completed the survey and 467 (72%) completed all measures of interest for the current investigation (participants could skip questions they did not want to answer) and therefore were in the analytic sample. Chi-square and t-test analyses comparing participants in the analytic sample to those excluded found that the analytic sample was more likely to be recruited from MTurk, χ²(1) = 108.09, p < .001, identify as heterosexual/straight, χ²(3) = 15.04, p = .002, be living with their partner, χ²(1) = 6.86, p = .009, be in an interracial relationship, χ²(2) = 12.63, p = .002, and be Asian or Black, χ²(7) = 42.52, p < .001, than those excluded, but there were no differences in gender identity, age, or relationship length.

Among the 467 participants in the analytic sample, 283 (60.6%) were in an interracial (but heterosexual) relationship, 94 (20.1%) were in a same-sex (but same-race) relationship, and 90 (19.3%) were in an interracial and same-sex relationship. Mean age was 30.26 years (SD = 9.03). Mean length of romantic relationship was 59.45 months (SD = 64.88), and 184 (39.4%) individuals reported living with their partner. The analytic sample included 250 (53.5%) people who identified as women, 214 (45.8%) as men, and 3 (0.6%) as transgender or another gender identity; 273 (58.5%) who identified as heterosexual, 133 (28.5%) as gay/lesbian, 44 (9.4%) as bisexual, and 17 (3.6%) as another sexual identity (e.g., asexual, pansexual, queer). For race/ethnicity, 267 (57.2%) people identified as European American/White, 62 (13.3%) as Asian, 44 (9.4%) as African American/Black, 30 (6.4%) as Latinx/Hispanic, 2 (0.4%) as Native American, and 62 (13.3%) as multiracial/ethnic.

Measures

As part of the larger survey, participants completed the following measures.

Participant and relationship characteristics

Participants reported their age, gender, sexual identity, and race/ethnicity, as well as if they were living with their partner and length of their relationship.

Relationship satisfaction and commitment

The relationship satisfaction (e.g., “How satisfied are you with your relationship?”; α = .93) and commitment (e.g., “How committed are you to your relationship?”; α = .94) subscales (3 items each) of the Perceived Relationship Quality Components Inventory (Fletcher, Simpson, & Thomas, 2000) were used as controls in the current investigation. Participants responded on a scale of 1 (not at all) to 7 (extremely). Mean scores for each subscale were created.

Individual-level discrimination

Participants completed the 10-item version of the Everyday Discrimination Scale (Lewis et al., 2006; Williams, Yu, Jackson, & Anderson, 1997), assessing individual-level discrimination in day-to-day life (e.g. “In your day-to-day life how often are you treated with less courtesy than other people?”). Participants reported frequency of experiences of discrimination on a scale of 1 (never) to 4 (often). Mean scores were created (α = .91).

Relationship stigma

Participants completed 25 items assessing relationship stigma from friends, family, and public. We expanded Lehmiller and Agnew’s (2006) measure of relationship marginalization to 6 items to distinguish family and friends as sources (e.g., “My family is not accepting of this relationship”). Participants responded to those 6 items on a scale of 1 (not true of my relationship at all) to 7 (very true of my relationship). We also created an additional 19 items that more clearly identified experiences attributed to relationship stigma (Rosenthal & Starks, 2015). For these items, participants reported how often they experienced various things because of being an interracial and/or same-sex couple from friends (e.g., “Friends make comments about your partner and/or relationship that offend you”), from family (e.g., “Family members do not acknowledge your relationship and/or refer to your partner as your ‘friend’”), and in public (e.g., “People are rude to you/give you an attitude”) on a scale of 1 (never) to 4 (often). Because not all 25 relationship stigma items were on the same response scale, items were converted to z-scores. A factor analysis reported in the work of Rosenthal and Starks (2015) supported a three-factor solution of relationship stigma from friends, family, and public. Mean scores based on z-scores were calculated for the three subscales and used in all analyses (α = .88 family, 6 items; α = .86 friends, 6 items; α = .92 public, 13 items).

Anxiety symptoms

Participants completed the 7-item Generalized Anxiety Disorder 7 Scale (Spitzer, Kroenke, Williams, & Löwe, 2006). Participants rated how frequently they experienced each symptom during the past 2 weeks on a scale of 0 (not at all) to 3 (nearly every day), with examples including “trouble relaxing” and “worrying too much about different things.” Sum scores were calculated (α = .93).

Depressive symptoms

Participants completed the 20-item Center for Epidemiological Studies Depression Scale (Radloff, 1977). Participants rated how frequently they experienced each symptom during the past 2 weeks on a scale of 0 (not at all [<1 day]) to 4 (nearly every day for 2 weeks), with examples including feeling lonely and having crying spells. Sum scores were calculated (α = .93).

Overall self-rated health

Participants reported their overall self-rated health by responding to the question “How would you rate your overall health?” on a scale of 1 (excellent) to 5 (poor) (e.g., Duffany et al., 2011; U.S. Bureau of the Census, 1985). This item was reverse-scored so higher scores indicate better self-rated health.

Egalitarianism

Participants completed the 8-item dimension of the social dominance orientation scale (SDO-Egalitarianism; Ho et al., 2012) to assess endorsement of egalitarianism (e.g., “Group equality should be our ideal”). Participants responded on a scale of 1 (very negative) to 7 (very positive). Mean scores were calculated (α = .93).

Dyadic coping

Participants completed 7 items from the Dyadic Coping Inventory (Ledermann et al., 2010) that assess problem- and emotion-focused joint dyadic coping when both partners are feeling stressed (e.g., “We try to cope with the problem together and search for ascertained solutions”) as well as evaluation of the quality of dyadic coping (e.g., “I am satisfied with the support I receive from my partner and the way we deal with stress together”). Participants responded on a scale of 1 (very rarely) to 5 (very often). Mean scores were calculated (α = .84).

Results

See Table 1 for means, standard deviations, and bivariate correlations. Relationship stigma from friends, family, and public, as well as individual-level discrimination were all positively correlated with anxiety and depressive symptoms. There were no significant correlations of any sources of relationship stigma or individual-level discrimination with overall self-rated health, but overall self-rated health was negatively correlated with both anxiety and depressive symptoms. Individual-level discrimination and each source of relationship stigma were all positively correlated with each other.

Table 1.
Bivariate correlations, means, standard deviations (N = 467).

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14

1. Age —

2. Living together −.07 —

3. Length of relationship in months .56** .01 —

4. Relationship satisfaction −.09 .04 −.10* —

5. Relationship commitment .00 .08 .07 .62 —

6. Individual-level discrimination −.01 .02 −.06 −.17 −.17 —

7. Relationship stigma from family −.04 .03 −.14 −.09 −.12 .30 —

8. Relationship stigma from friends .03 −.03 −.09* −.14 −.24 .45 .56 —

9. Relationship stigma from public .05 .12** −.06 −.05 −.11* .55 .53 .55 —

10. Anxiety symptoms −.18 .06 −.07 −.19 −.14 .27 .20 .19 .19 —

11. Depressive symptoms −.18** .04 −.11* −.30 −.25 .41 .27 .34 .27 .73 —

12. Overall self-rated health .04 −.09 −.00 .17 −.01 −.06 −.02 .05 .01 −.19 −.21 —

13. Egalitarianism .01 .01 .04 .18 .20 −.12* −.05 −.21 −.05 −.05 −.12 .05 —

14. Dyadic coping −.07 −.04 −.15 .50 .34 −.15 .00 −.12* −.02 −.05 −.16 .12 .22** —

Means 30.26 — 59.45 6.14 6.55 1.78 0.00 0.00 0.00 5.87 19.72 3.65 6.04 4.01

Standard deviations 9.03 — 64.88 0.90 0.75 0.61 0.80 0.77 0.72 5.19 13.93 0.92 1.04 0.70

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

Regression analyses testing associations of relationship stigma with well-being

We conducted three linear regression analyses to test associations of relationship stigma (from public, friends, and family) with well-being, one for each outcome (anxiety symptoms, depressive symptoms, overall self-rated health). In each regression analysis, control participant and relationship characteristic variables (age, if living with partner, length of relationship, relationship satisfaction, relationship commitment), individual-level discrimination, and the three sources of relationship stigma were included as simultaneous predictors (see Table 2 for full regression models). In these analyses, only individual-level discrimination was positively associated with anxiety symptoms, although relationship stigma from family approached a significant positive association (p = .054). Relationship stigma from friends and individual-level discrimination were each positively associated with depressive symptoms. No sources of relationship stigma or individual-level discrimination were associated with overall self-rated health. We also ran the same three linear regression analyses without covariates, including only the three sources of relationship stigma as simultaneous predictors, and the pattern of results was unchanged; relationship stigma from family approached a significant positive association with anxiety symptoms (β = .11, t = 1.96, p = .050), and relationship stigma from friends was positively associated with depressive symptoms (β = .24, t = 4.30, p < .001).

Table 2.
Results of regression analyses testing associations of relationship stigma with well-being (N = 467).

Anxiety symptoms Depressive symptoms Overall self-rated health

Variables β t β t β t

Age −.22 −4.20 −.20 −4.09 .05 0.88

Living together .05 1.03 .03 0.80 −.08 −1.64

Length of relationship in months .07 1.28 .01 0.27 .01 0.19

Relationship satisfaction −.16 −2.86 −.23 −4.38 .27 4.59

Relationship commitment .00 0.01 −.02 −0.47 −.16 −2.72

Individual-level discrimination .19 3.57 .28 5.64 −.08 −1.45

Relationship stigma from family .11 1.94 .08 1.55 −.06 −0.97

Relationship stigma from friends .02 0.36 .15 2.79** .10 1.69

Relationship stigma from public .02 0.26 −.01 −0.21 .03 0.39

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

Next, we fit follow-up regression analyses to test whether being in a same-sex relationship moderated any associations of relationship stigma with well-being outcomes, with all sources of stigma and the same covariates included simultaneously. These analyses revealed significant interactions between relationship stigma from family and being in a same-sex relationship in predicting anxiety (β = −.16, t = −2.11, p = .036) and depressive (β = −.19, t = −2.78, p = .006) symptoms. Separate follow-up analyses for those in same-sex versus heterosexual interracial relationships found that relationship stigma from family was associated with greater anxiety symptoms for those in heterosexual interracial relationships (β = .19, t = 2.75, p = .006), but not for those in same-sex relationships (β = −.01, t = −0.09, p = .929). Similarly, relationship stigma from family was associated with greater depressive symptoms for those in heterosexual interracial relationships (β = .19, t = 3.01, p = .003), but not for those in same-sex relationships (β = −.06, t = −0.74, p = .462).

Regression analyses testing egalitarianism and dyadic coping as moderators

Next, we conducted six linear regression analyses to test whether egalitarianism and dyadic coping moderated any associations of relationship stigma with well-being outcomes. Three of these analyses tested egalitarianism as a moderator, one for each outcome, and three tested dyadic coping as a moderator, also one for each outcome. In these analyses, the same covariates, the three sources of relationship stigma, and a centered version of the moderator were included as simultaneous predictors, and three interaction terms between each source of relationship stigma and the moderator were added as simultaneous predictors in a following step. For any significant interactions found, Hayes’ (2013) PROCESS macro was used to probe the associations at 1 standard deviation below the mean, the mean, and 1 standard deviation above the mean of the moderator.

There was a significant interaction between egalitarianism and relationship stigma from public in predicting anxiety symptoms (β = −.15, t = −2.13, p = .034). Follow-up analyses probing this interaction found there was a trend for the association between relationship stigma from public and anxiety symptoms to go from positive to negative as level of egalitarianism increased, but the association was not significant at 1 standard deviation below the mean (Effect estimate = 0.47, SE = 0.50, t = 0.95, 95% CI: −0.50 to 1.45, p = .341), the mean (Effect estimate = 0.04, SE = 0.45, t = 0.09, 95% CI: −0.83 to 0.91, p = .931), or at the highest level (Effect estimate = −0.37, SE = 0.53, t = −0.68, 95% CI −1.42 to 0.69, p = .495) on egalitarianism.

There was also a significant interaction between dyadic coping and relationship stigma from family in predicting depressive symptoms (β = −.12, t = −2.35, p = .019). The follow-up analysis probing this interaction found that relationship stigma from family was significantly positively associated with depressive symptoms at 1 standard deviation below the mean (Effect estimate = 3.11, SE = 1.23, t = 2.52, 95% CI: 0.69 to 5.53, p = .012) but was not associated with depressive symptoms at the mean (Effect estimate = 1.64, SE = 0.90, t = 1.83, 95% CI: −0.13 to 3.41, p = .069) or at 1 standard deviation above the mean on dyadic coping (Effect estimate = 0.17, SE = 1.07, t = 0.16, 95% CI: −1.92 to 2.26, p = .873).

We ran follow-up regression analyses to test whether being in a same-sex relationship moderated any of these moderation effects (i.e., testing three-way interactions between relationship stigma from any source, egalitarianism or dyadic coping, and being in a same-sex relationship). None of these three-way interactions were significant.

Bootstrap mediation analyses testing anxiety and depressive symptoms as mechanisms

Last, although there were no direct associations of relationship stigma with overall self-rated health, we conducted three bootstrap mediation analyses with Hayes’ (2013) PROCESS macro to test if any source of relationship stigma might have an indirect association with overall self-rated health through the mechanisms of anxiety and/or depressive symptoms. Each analysis included one source of relationship stigma as the main predictor, anxiety and depressive symptoms as simultaneous mediators, and overall self-rated health as the outcome. In each analysis, the same covariates as well as the other two sources of relationship stigma (not included as the main predictor) were included as controls. In these analyses, there is evidence of a significant indirect association if the confidence intervals do not include zero. There was evidence of a significant indirect association of relationship stigma from friends with poorer overall self-rated health through the mechanism of greater depressive symptoms (Indirect effect estimate = −0.03, SE = 0.02, 95% CI: −.08 to −.002). No other indirect associations were significant.

We ran follow-up bootstrap moderated mediation analyses to test if any indirect associations were moderated by being in a same-sex relationship. None of these moderated mediation effects were significant.

Discussion

Among our sample of U.S. adults in same-sex and/or interracial relationships, relationship stigma from friends, family, and public had significant bivariate associations with greater anxiety and depressive symptoms. However, in regression analyses with covariates and the three sources of stigma included simultaneously, only relationship stigma from friends was associated with greater depressive symptoms, and only relationship stigma from family approached being significantly associated with greater anxiety symptoms. These findings are consistent with past research suggesting different sources of relationship stigma have unique consequences, including specifically that relationship stigma from close others in one’s social network, namely, friends and family, may be more harmful than stigma from public or larger society (Lehmiller & Agnew, 2007; Rosenthal & Starks, 2015). Although there is evidence that societal stigma has adverse consequences for individuals and couples (e.g., Frost & Fingerhut, 2016), it may be particularly emotionally distressing for people’s romantic relationships to be stigmatized by those to whom they have close ties and from whom they expect support (Rosenthal & Starks, 2015).

Interaction analyses revealed that relationship stigma from family was associated with greater anxiety and depressive symptoms for individuals in heterosexual interracial, but not same-sex relationships. The reasons for this are unknown and deserve attention in future research. Although past research finds family support versus rejection are important for lesbian, gay, and bisexual individuals and same-sex couples (e.g., Frost et al., 2017; Puckett, Woodward, Mereish, & Pantalone, 2015), it may be that for those in same-sex relationships, individual-level stigma from their families temporally precedes relationship stigma and has more direct consequences for mental health. For example, research suggests LGB individuals tend to disclose their sexual orientation to close others, including family, at younger ages now than historically (Floyd & Bakeman, 2006). In contrast, for those in heterosexual interracial relationships, relationship stigma may present a novel experience of stigma from families that were not preceded by a related form of stigma based on an individual identity, therefore resulting in more direct consequences for mental health. Further, research supports that some LGB individuals turn to friends to stand in for unsupportive families and that peer support can buffer from negative consequences of family rejection (e.g., Parra, Bell, Benibgui, Helm, & Hastings, 2018), which may help explain why relationship stigma from friends was associated with greater depressive symptoms and previously was found to have more consistent associations with relationship outcomes (Rosenthal & Starks, 2015).

Consistent with much past research, individual-level discrimination was associated with greater anxiety and depressive symptoms (Lewis et al., 2015; Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009). This supports existing theory that suggests relationship and individual-level stigma can have unique consequences (LeBlanc et al., 2015). It also supports the assertion that the overall impact of stigma may be underestimated because specific forms and levels of stigma tend to be studied separately although they often have unique, cumulative, and/or interactive effects (Hatzenbuehler et al., 2013). The growing research on relationship stigma supports this as another form or level of stigma that should be addressed in research and intervention. Current findings build on past research focused more on relationship functioning outcomes to support that relationship stigma also has unique consequences for individual well-being, even accounting for relationship functioning. Research and theory should continue addressing interconnections among different forms and levels of stigma, relationship functioning, and individual well-being for stigmatized couples.

Dyadic coping moderated the association of relationship stigma from family with depressive symptoms, suggesting dyadic coping may be a buffer. More specifically, relationship stigma from family was associated with greater depressive symptoms for individuals with low levels of dyadic coping, but that association was nonsignificant for individuals with higher levels of dyadic coping. Facing relationship stigma from family can be particularly upsetting. However, engaging in more joint dyadic coping and feeling satisfied with those collective coping efforts may help to prevent relationship stigma from family from leading to depressed mood. Specifically, problem- and emotion-focused dyadic coping may help couples work collaboratively to address stigma and de-stress through intimacy, and feeling satisfied with that joint effort may encourage them to continue using these strategies. Knowing that one is not facing this stressor alone but instead with a partner committed to overcoming it together may be critical in avoiding internalization of stigma and improving mood. Egalitarianism also moderated the association of relationship stigma from public with anxiety symptoms, and there was a trend for the direction of that association to change from positive to negative as egalitarianism increased; however, when probing that interaction, the association was nonsignificant at 1 standard deviation below the mean, the mean, and the highest level of egalitarianism, so this interaction should be interpreted with caution. These findings are somewhat consistent with our prior findings (Rosenthal & Starks, 2015) suggesting egalitarianism and dyadic coping may buffer individuals from some adverse consequences of relationship stigma, although there were many nonsignificant findings also, suggesting these factors may be buffers more for relationship functioning than individual well-being.

Finally, although no source of relationship stigma was directly associated with overall self-rated health, there was an indirect association of relationship stigma from friends with poorer overall self-rated health through the mechanism of greater depressive symptoms. This is consistent with theory and research suggesting that mental health factors may be important mechanisms linking stigma to physical health (Earnshaw et al., 2016; Puhl & Latner, 2007; Rosenthal et al., 2015; Williams & Mohammed, 2009).

Strengths, limitations, and future directions

This study built on and extended past research, contributing to growing research on relationship stigma, and specifically to our understanding of consequences for individual well-being, which little past work has directly examined. Although there was evidence of adverse consequences of relationship stigma for individual well-being, the findings were mixed, with many nonsignificant findings. This suggests that relationship stigma alone may not have large effects on well-being, but rather it is an additional form or level of stigma that has some unique consequences for well-being beyond individual-level stigma. As this was a cross-sectional survey, we cannot determine causality, even in tests of indirect associations. We cannot rule out other directions of effects or possible third variables not accounted for, such as mental or physical illness that predated one’s romantic relationship. Future longitudinal and experimental research can help to determine causality and patterns of change over time.

Data were collected online, so the sample may be biased toward individuals who spend more time online and specifically in places we advertised the study. However, the online platform allowed us to recruit several hundred participants from across the U.S. Future work may want to explore whether findings replicate when using different recruitment and data collection strategies, as well as in other places around the world. Measures were presented in the same order to all participants, with relationship stigma items preceding well-being measures, which may have influenced responding. We also collected data with individuals, not both members of a couple. Both members of some couples may have completed the survey without us knowing, preventing us from statistically account for interdependence of their data. Further, different members of a couple may have different experiences with, perceptions of, and reactions to relationship stigma, which could affect their well-being in different ways. Future dyadic studies will be important to further understand dynamics and consequences of relationship stigma. The measure of overall self-rated health being a single item is also a limitation that may have contributed to the mostly null findings with this outcome, although this measure has been used widely in past research and nationally representative surveys (e.g., Duffany et al., 2011; Earnshaw et al., 2016; U.S. Bureau of the Census, 1985), and responses were fairly well-distributed across the 5-point response scale (n = 5, 1.1% “Poor”; n = 45, 9.6% “Fair”; n = 144, 30.8% “Good”; n = 189, 40.5% “Very good”; n = 84, 18.0% “Excellent”). Future work would benefit from examining associations of relationship stigma with larger measures of self-rated health and objective health assessments.

Future work should also continue exploring potential buffers of adverse consequences of relationship stigma. These and our past findings (Rosenthal & Starks, 2015) suggest that egalitarianism and dyadic coping may be buffers worth further exploration, but there may be other important buffers to examine. For example, social support may be a moderator, as it has been theorized as a buffer of stigma (e.g., Brondolo, ver Halen, Pencille, Beatty, & Contrada, 2009), and some research suggests that couples’ use of social networks to maintain their relationships has positive associations for interracial couples (Dainton, 2015). A qualitative study of interracial couples also suggested that parental approval of one’s relationship may buffer individuals and couples from adverse consequences of stigma from other sources, including broader society (Bell & Hastings, 2015). If couples have stronger social support systems, the onus of protecting the relationship and individual well-being from adverse consequences of stigma can potentially be shared among members of that system. Thus, more research is needed on potential buffers as well as interactions between different levels and sources of stigma, including structural stigma. Although the current study assessed relationship stigma from public, it did not specifically address structural stigma, such as laws, other policies, and community norms that may support or discriminate against individuals and couples, and have been found to have consequences for well-being (e.g., Hatzenbuehler et al., 2014), which future research should address.

Societal and clinical implications

With growing evidence that relationship stigma is associated with poorer relationship functioning and individual well-being for individuals in same-sex and interracial couples, it is critical that attitudes toward same-sex and interracial relationships continue to be improved in society as a whole, thereby reducing stigma from any and all sources. Various activist efforts aimed at improving these attitudes, including increasing positive representations of same-sex and interracial couples and families in media, should continue, with the goal of reducing relationship stigma that these couples and families face.

As stigma has been identified as a unique challenge facing stigmatized couples that is important to address in therapy (e.g., Leslie & Young, 2015), and with growing research suggesting adverse consequences of relationship stigma for relationship functioning and individual well-being, it is also critical for clinicians working with individuals, couples, or families involved in stigmatized relationships to be aware of and prepared to address experiences of and dynamics related to relationship stigma. The current along with past findings (e.g., Lehmiller & Agnew, 2007; Rosenthal & Starks, 2015) suggest that it may be particularly important to pay attention to relationship stigma from close others, including friends and family, as these sources of stigma may be more harmful than more distal sources. These issues can be addressed in the contexts of individual, couple, and family therapy. Clinicians may be able to suggest ways to cope with, address, and raise awareness of the damaging effects of relationship stigma with family and friends. However, given that all sources of stigma had significant bivariate associations with anxiety and depressive symptoms, it is important for clinicians to address experiences of relationship stigma from any and all sources. Further, current along with past findings (Rosenthal & Starks, 2015) suggest that working to increase egalitarianism and dyadic coping in clinical settings may help to alleviate some of the adverse consequences of relationship stigma for both individual well-being and relationship functioning.

Conclusion

In a sample of U.S. adults in same-sex and/or interracial relationships for at least 3 months, relationship stigma from friends was directly associated with greater depressive symptoms and indirectly associated with poorer overall self-rated health through the mechanism of greater depressive symptoms. For those in heterosexual interracial relationships, but not same-sex relationships, relationship stigma from family was also associated with greater anxiety and depressive symptoms. These associations were in addition to the associations of individual-level discrimination with greater anxiety and depressive symptoms. Egalitarianism and dyadic coping were also found to moderate some associations of relationship stigma with well-being outcomes, suggesting they may be buffers. Consequences and buffers of relationship stigma deserve further attention in research to inform societal change and clinical intervention, as the numbers of same-sex and interracial couples and families in the U.S. continue to grow.

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13	14
1. Age	—
2. Living together	−.07	—
3. Length of relationship in months	.56**	.01	—
4. Relationship satisfaction	−.09	.04	−.10*	—
5. Relationship commitment	.00	.08	.07	.62**	—
6. Individual-level discrimination	−.01	.02	−.06	−.17**	−.17**	—
7. Relationship stigma from family	−.04	.03	−.14**	−.09	−.12**	.30**	—
8. Relationship stigma from friends	.03	−.03	−.09*	−.14**	−.24**	.45**	.56**	—
9. Relationship stigma from public	.05	.12**	−.06	−.05	−.11*	.55**	.53**	.55**	—
10. Anxiety symptoms	−.18**	.06	−.07	−.19**	−.14**	.27**	.20**	.19**	.19**	—
11. Depressive symptoms	−.18**	.04	−.11*	−.30**	−.25**	.41**	.27**	.34**	.27**	.73**	—
12. Overall self-rated health	.04	−.09	−.00	.17**	−.01	−.06	−.02	.05	.01	−.19**	−.21**	—
13. Egalitarianism	.01	.01	.04	.18**	.20**	−.12*	−.05	−.21**	−.05	−.05	−.12**	.05	—
14. Dyadic coping	−.07	−.04	−.15**	.50**	.34**	−.15**	.00	−.12*	−.02	−.05	−.16**	.12**	.22**	—
Means	30.26	—	59.45	6.14	6.55	1.78	0.00	0.00	0.00	5.87	19.72	3.65	6.04	4.01
Standard deviations	9.03	—	64.88	0.90	0.75	0.61	0.80	0.77	0.72	5.19	13.93	0.92	1.04	0.70

	Anxiety symptoms	Depressive symptoms	Overall self-rated health
Age	−.22	−4.20**	−.20	−4.09**	.05	0.88
Living together	.05	1.03	.03	0.80	−.08	−1.64
Length of relationship in months	.07	1.28	.01	0.27	.01	0.19
Relationship satisfaction	−.16	−2.86**	−.23	−4.38**	.27	4.59**
Relationship commitment	.00	0.01	−.02	−0.47	−.16	−2.72**
Individual-level discrimination	.19	3.57**	.28	5.64**	−.08	−1.45
Relationship stigma from family	.11	1.94	.08	1.55	−.06	−0.97
Relationship stigma from friends	.02	0.36	.15	2.79**	.10	1.69
Relationship stigma from public	.02	0.26	−.01	−0.21	.03	0.39

Footnotes

Authors’ note

Some of the findings presented in this manuscript were presented at the 2016 Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a Scholarly Research Grant from Pace University awarded to Lisa Rosenthal.

Open research statement

As part of IARR’s encouragement of open research practices, the authors have provided the following information: This research was not pre-registered. The data and materials used in the research are available upon request by emailing lrosenthal@pace.edu.

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	Anxiety symptoms		Depressive symptoms		Overall self-rated health
Variables	β	t	β	t	β	t
Age	−.22	−4.20**	−.20	−4.09**	.05	0.88
Living together	.05	1.03	.03	0.80	−.08	−1.64
Length of relationship in months	.07	1.28	.01	0.27	.01	0.19
Relationship satisfaction	−.16	−2.86**	−.23	−4.38**	.27	4.59**
Relationship commitment	.00	0.01	−.02	−0.47	−.16	−2.72**
Individual-level discrimination	.19	3.57**	.28	5.64**	−.08	−1.45
Relationship stigma from family	.11	1.94	.08	1.55	−.06	−0.97
Relationship stigma from friends	.02	0.36	.15	2.79**	.10	1.69
Relationship stigma from public	.02	0.26	−.01	−0.21	.03	0.39