Love in the Time of COVID-19: A Multi-Wave Study Examining the Salience of Sexual and Relationship Health During the COVID-19 Pandemic

Love in the Time of COVID-19: A Multi-Wave Study Examining the Salience of Sexual and Relationship Health During the COVID-19 Pandemic. Agnieszka E. Pollard & Ronald D. Rogge. Archives of Sexual Behavior Jan 27 2022. https://link.springer.com/article/10.1007/s10508-021-02208-0

Abstract: The current study used Family Systems Theory as a framework to clarify the impact of the COVID-19 pandemic on sexual, romantic, and individual functioning. Specifically, sexual and romantic functioning were modeled as key mechanisms linking COVID-19 related stressors (as predictors) to aspects of individual functioning over time (as outcomes). A sample of 1,241 sexually active adults in relationships (47% married/engaged) was recruited from March 5 to May 5, 2020: 82% White, 66% women, M = 34 years old, 58% heterosexual. All participants completed a baseline survey and 642 participants completed at least one of the six, monthly, follow-up surveys. Multilevel SEM models evaluated the model both at the level of stable between-person differences (i.e., level 2) and at the level of within-person change across time (i.e., level 1). The findings suggested that COVID-19 related stress was predictive of lower sexual, romantic, and individual functioning in both levels of the model. Significant indirect paths supported the proposed mediation at the level of within-person change across time: elevations in COVID-19 stress within specific months predicted corresponding drops in sexual functioning, which in turn predicted corresponding drops in romantic functioning, which in turn predicted corresponding drops in individual well-being (highlighting points of intervention). In contrast, at the level of between-person differences, stable levels of sexual and relationship satisfaction across the 6 months of the study were not associated with stable levels of COVID-19 stressors (representing sources of resilience that promoted well-being) and stable levels of stress from social isolation predicted stably higher amounts of communicating affection to one’s loved ones (suggesting a need for affiliation in the face of chronic stress) whereas stable difficulties with orgasms were linked to stable irritability toward partners and depressive symptoms. Multigroup analyses suggested that the findings generalized across gender, age, race/ethnicity, sexual orientation, relationship stage, and cohabitation groups. Spillover effects within a Family Systems Theory framework clarify how upheaval of the COVID-19 pandemic could have impacted sexual, romantic, and individual functioning in a process-oriented framework, highlighting sources of resilience (sexual satisfaction, communicating affection) and risk (orgasm difficulties).

Discussion

The current study sought to integrate key findings from the fields of individual psychopathology, research on sexual health, marital and couples research, and positive psychology by drawing key indicators from each of those fields into a large and comprehensive model. The primary goal of the study was therefore to draw upon those rich empirical traditions to develop a more nuanced understanding of precisely how the pandemic might have impacted sexual health, relationship health, and individual distress and well-being. The study applied Family Systems Theory (Broderick, 1993; Minuchin, 1985) as a conceptual framework to enrich our understanding of how the COVID-19 pandemic and the associated public health measures employed to flatten the curve (e.g., lockdowns, school and business closures, social distancing measures) might have impacted the lives of individuals in the US. Multilevel analyses in multi-wave data collected from a large online sample during the first 7–8 months of the pandemic in the US supported the proposed mediation at the level of within-person change across time. Thus, elevations in COVID-19 stress within specific months predicted corresponding drops in sexual functioning, which in turn predicted corresponding drops in romantic functioning, which in turn predicted corresponding drops in individual well-being. These findings highlight how the individual, sexual, and relationship systems are interconnected across time, such that disruptions in one system from an external stress (like a global health crisis) will likely spill over into other systems. In contrast, at the level of between-person differences, stable levels of sexual and relationship satisfaction across the 6 months of the study were unassociated with stable levels of COVID-19 stressors, representing sources of resilience that promoted well-being across the early stages of the COVID-19 pandemic in the US. Extending those positive results, stable levels of stress from social isolation predicted stably higher amounts of communicating affection to one’s loved ones, suggesting that individuals tend to reach out to those they love and strengthen those connections in the face of a massive world-wide crisis. Finally, stable difficulties with orgasms were linked to stably higher levels of irritability with partners and depressive symptoms, representing a key risk factor. Multigroup analyses suggested that the findings generalized across gender, age, race/ethnicity, sexual orientation, relationship stage, and cohabitation groups. Taken as a set, these findings underscored the critical nature of sexual and romantic functioning in the lives of individuals, highlighting potential sources of resilience/risk at the level of stable between-subject differences (e.g., stable levels of sexual and relationship satisfaction, and stable difficulties with orgasms), and potential warning signs and treatment targets on a monthly basis (e.g., sudden spikes in the stress of social isolation, sudden drops in current sexual and/or relationship functioning). Thus, these findings offer relevant insights for clinicians and therapists working with individuals and couples during periods of acute stress like the global health crisis brought on by the COVID-19 pandemic.

Implications

Family Systems Theory Offers an Effective Conceptual Framework The current study represents an early attempt to apply the broader family systems framework to romantic relationships which may or may not include children. As the romantic dyad is already recognized as a key system within the larger family unit, we would posit that this application of family systems theory is simply focusing in on aspects of that theory that are relevant to childfree family units, as well as to romantic dyads before they start having children. Even without a child in the home, romantic couples can be conceptualized as business partners, roommates, lovers, close friends and confidants. We would argue that from a family systems lens, each of those represent potentially distinct systems within the larger relationship. Consistent with the current findings and previous work supporting the spillover hypothesis (e.g., Sturge-Apple et al., 2006), disruptions or conflict within one of those systems can rapidly influence couples’ functioning in other systems. For example, conflict in the bedroom (i.e., poorer sexual functioning) could spillover into conflict over chores (affecting the roommate system), and drops in the support a couple provides one another (affecting the friendship system). The current study applied Family Systems Theory by examining sexual, romantic, and individual functioning as key systems within primary relationships. Consistent with Family Systems theory, the results suggested that external stressors from the COVID-19 pandemic indeed impacted all three of those systems across time, and suggested possible mechanistic paths for how those systems were interrelated. Future work in couples could therefore extend the current findings by using Family Systems theory as a conceptual framework for modeling the inter-relatedness of various dyadic processes.

There are Different Forms of COVID-19 Related Stress Although the two forms of COVID-19 related stress examined in the current study (i.e., COVID-19 concerns and social isolation stress) are by no means the only forms of stress individuals experienced during the pandemic, distinct patterns of results emerged for these two forms of stress. Specifically, COVID-19 related health concerns were significantly predictive at a between-person level across the 6 months. Greater overall levels of COVID-19 concerns across the 6 months predicted poorer sexual functioning (i.e., more orgasmic difficulties), poorer romantic functioning (i.e., greater irritability with partner), and poorer individual functioning (i.e., more depressive symptoms, lower vitality) across the 6 months. These findings are consistent with previous research indicating chronic health stress to be linked to greater depressive symptoms (e.g., Dalton et al., 2016) even 2 to 5 years later (e.g., Raposa et al., 2014), highlighting the broader links between external stress and lowered relationship functioning (see Randall & Bodenmann, 2017 for a review) and suggesting that higher COVID-19 related stress is linked to lower vitality (e.g., Peltz et al., 2020), less frequent sexual activity and affection (e.g., Luetke et al., 2020), and lower sexual satisfaction (e.g., Schmid et al., 2021). It is notable that after controlling for stable levels of COVID-19 related stress across the 6 months of the study, shifts in COVID-19 concerns within individuals within specific months failed to emerge as a significant predictor of corresponding shifts in sexual, romantic, or individual functioning. This begins to suggest that the COVID-19 health concerns assessed in the current study might reflect more chronic and stable concerns (e.g., COPD, diabetes, or some other comorbidity in oneself or in a loved one) which would be likely to impact an individual’s reactions to the pandemic in a more global manner, raising the personal relevance of the pandemic throughout the 6 months.

In contrast, current findings suggested that the stress associated with the social isolation impacted individuals both in its stable between-person differences across the 6 months, as well as through within-person fluctuations in specific months of the pandemic. Thus, this form of COVID-19 related stress demonstrated both stable trait-like properties (i.e., predictive between-person differences), as well as dynamic state-like properties (i.e., predictive within-person change across time), highlighting how both forms of differences helped to shape sexual, romantic, and individual functioning across the first 6–7 months of the pandemic in the US. These findings are consistent with previous research suggesting that greater social isolation during the COVID-19 pandemic is linked to lower vitality and psychological adjustment (e.g., Arslan, 2021), and greater strain on family relationships (e.g., Evans et al., 2020).

Extending these patterns beyond the context of the current pandemic, previous work has linked social isolation and social disconnectedness to poorer individual and relationship health, specifically demonstrating social isolation to predict not only greater depressive symptoms or diagnoses (e.g., Ge et al., 2017; Matthews et al., 2016; Suwinyattichaiporn & Johnson, 2020) and lower vitality (e.g., van Steenbergen et al., 2015), but also greater physical and verbal aggression towards a romantic partner (e.g., Stets, 1991). To that effect, a randomized clinical trial investigating the effectiveness of a social isolation prevention program for older adults has indicated a significant increase in life satisfaction 1 and 6 months post-program among those who received treatment, whereas those within the control group saw no change (Saito et al., 2012). The current study therefore builds on previous findings not only by demonstrating the impact of COVID-19 related social isolation on sexual and romantic functioning, and by highlighting sexual and romantic functioning as possible mechanisms, but also by distinguishing the between-person and within-person associations of social isolation.

Exploring Other Forms of COVID-19 Related Stress. Although the two forms of COVID-19 related stress examined in the current study yielded distinct and meaningful results, future work could extend the current findings by examining additional forms of stress that individuals might experience during a pandemic. For example, it could also be useful to examine how financial/employment instability or the stress of new parenting demands impacted various forms of interpersonal and individual functioning during the pandemic. The current results begin to suggest that those alternative forms of stress could very likely offer their own predictive patterns within the Family Systems Theory framework.

Sexual and Relationship Satisfaction Emerged as Key Mechanisms. At the within-person level, sexual satisfaction and relationship satisfaction significantly mediated the association between social isolation stress and individual functioning. Spikes in social isolation stress shaped corresponding decreases in sexual satisfaction and relationship satisfaction, which then let to more depressive symptoms and lower vitality. Thus, the adverse impact of social isolation on sexual and romantic functioning served to intensify the direct associations between social isolation stress and poorer individual functioning. These findings are consistent with spillover effects (e.g., Sturge-Apple et al., 2006) as conceptualized within Family Systems Theory (Broderick, 1993; Minuchin, 1985) as well as other research indicating links between greater sexual functioning and mental health (e.g., Costa & Brody, 2012; Levin, 2007; Palmore, 1982). The current findings build on previous research by examining associations between acute stress, sexual functioning, relationship functioning, and individual well-being within a broader multivariate, conceptual framework evaluated across time. This allowed us to directly model modeling how pandemic-related stress adversely impacted individual well-being through a cascade of lower sexual satisfaction and correspondingly lower relationship satisfaction. These findings may illuminate possible points of intervention, as the results suggested that partnered individuals with robust levels of sexual and relationship satisfaction would have experienced some protection from the adverse impact of social isolation stress across time via the direct and indirect links from those mechanisms to individual outcomes.

Stable Difficulties with Orgasms as a Mechanism. Higher chronic levels of COVID-19 stress across the 6 months of the study were directly linked to higher chronic levels of irritability within relationships. That association was also strengthened by chronic COVID-19 stress predicting chronic difficulties with orgasms, which in turn predicted greater irritability across the 6 months of the study. Thus, stable between-person differences in orgasm difficulties served as a potential mechanism more tightly linking those variables. These findings are consistent with previous work indicating that sexual dysfunctions have been linked to negative conflict in relationships (e.g., Metz & Epstein, 2002). Extending these quantitative findings, qualitative analyses of interviews of 20 Iranian women highlighted conflict and annoyance with a partner as key obstacles to reaching orgasm during sexual activity (Nekoolaltak et al., 2017). Those qualitative findings dovetail the current findings, suggesting that the links between orgasm difficulties and irritability within relationships might be transactional in nature, reciprocally influencing one another across time. The current findings further suggested that chronic levels of orgasm difficulties across the 6 months served to intensify the direct association between higher chronic COVID-19 stress and greater depressive symptoms across the 6 months of the study. This is consistent with previous findings linking orgasm difficulties to greater depressive symptoms (e.g., Castellini et al., 2010; Forbes et al., 2016; Shifren et al., 2008). The current study contextualizes those previous findings within the Family Systems Theory, helping to highlight the potential mediating roles of difficulties with orgasms.

Sexual Satisfaction as a Source of Resilience. One of the strongest indirect paths to emerge in the model was at level 2 (the level of stable between-person differences on average levels of each construct across the 6 months of the study) and involved sexual satisfaction as a predictor. Contrary to our expectations, stable levels of COVID-19 related stress across the first 6 months of the pandemic in the United States were not significantly predictive of corresponding stable levels of sexual satisfaction. This would suggest that at an aggregate level (i.e., across all partnered participants) individuals’ overall levels of sexual satisfaction were on average unaffected by COVID-19 related stress. These results are consistent with the mixed findings concerning the impact of the COVID-19 pandemic on sexual health (e.g., Panzeri et al., 2020). They suggest that for individuals in relationships with high levels of sexual functioning, their sexual health could serve as a source of resilience whereas for individuals in relationships with low levels of sexual functioning, their sexual difficulties could serve as a source of risk. Consistent with this, stably high levels of sexual satisfaction across the six months of the study were not only directly predictive of higher stable levels of vitality, but were also strongly linked to higher stable levels of relationship satisfaction, which in turn predicted even higher vitality across the first six months of the pandemic. Thus, sexual satisfaction emerged as a key factor fueling well-being in the first six months of the COVID-19 pandemic, highlighting its key roles in individual health and well-being (e.g., Costa & Brody, 2012; Levin, 2007; Palmore, 1982).

Communicating Affection as a Source of Resilience. An unexpected finding emerged suggesting that stable between-person differences in COVID-19 health concern stress across the 6 months predicted greater stable levels of communicating affection to loved ones across those 6 months. Thus, fears over contracting COVID-19 and potentially getting sick themselves or losing loved ones seemed to help individuals prioritize their close relationships, spurring them on to share their love and affection with the people around them. These findings are consistent with the literature suggesting that connection with others is a fundamental human need (e.g., Baumeister & Leary, 1995) and that individuals are driven to affiliate (i.e., tend and befriend others) under conditions of stress (e.g., Taylor, 2002, 2006). In fact, the communication of affection has been shown to be an effective coping mechanism as it has been shown to help buffer couples from the strain of a new child on their romantic relationships (Shapiro et al., 2000). The current findings are also consistent with recent theoretical assertions (based on applying the Family Systems Theory to the pandemic) that adaptive relationship processes could likely buffer the link between pandemic stress and well-being (Pietromonaco & Overall, 2021). The current study therefore builds on previous work by demonstrating affiliation (via the communication of affection) as an effective coping mechanism during the COVID-19 pandemic.

Limitations and Future Directions

The current study builds on a body of predominantly cross-sectional work by analyzing longitudinal data collected from a robust sample during a critical time in history, while the COVID-19 pandemic began to spread through the United States. By drawing key constructs from multiple fields of study (individual psychopathology, positive psychology, sexual health, and couples and marital research) and integrating them within a Family Systems Theory framework, the current study also sought to provide a more nuanced understanding of the impact of the COVID-19 pandemic on the lives of individuals in the US. The results underscored the importance of sexual and romantic functioning as potential mechanisms linking COVID-19 related stress to individual well-being, thereby highlighting potential sources of resilience and risk.

Despite these strengths, a number of issues limit the current findings. First, the current data was analyzed in a sample predominantly made up of white individuals and women. Although our large sample size provided 419 men and 231 non-white individuals, future studies with more diverse samples are needed to explore the generalizability of the current findings. Second, the study relied solely on self-report data, raising concerns of responses being limited by: possible lack of insight (i.e., being unaware or out of touch with one’s own behavior and/or internal experiences and therefore having a difficult time accurately completing self-report scales), potential reporting biases, and social desirability. To address this, future studies could collect data from multiple informants (i.e., including data from participants’ friends, family members, and/or romantic partners), collect observational data, and assess possible response biases to ensure the results remain consistent when such limitations are addressed. Extending this point, although social desirability has been shown to be somewhat less of a problem for survey data collected online (Richman et al., 1999), the current study did not specifically assess levels of socially desirable responding. Thus, future studies could examine this as a possible source of additional variance in models of functioning during pandemics. Third, the current sample consisted of data from only one partner from each couple, providing a one-sided perspective on each relationship. Future research would benefit from collecting data from both romantic partners, providing a more balanced view of the relationships and enabling dyadic analyses. Fourth, although this study examined two specific forms of COVID-19 related stress, the pandemic and associated public health measures created a wide range of chaos and upheaval to daily life across the globe. Thus, future work could extend these findings and the Family Systems Theory by examining other sources of stress and upheaval as potential predictors. Fifth, recruitment for the current study just as the pandemic was beginning to draw national attention in the United States and as a result, the study did not include a truly pre-pandemic baseline for a majority of the participants and the baseline survey did not include measures of COVID-19 related stress. Thus, although the current findings speak to how the constructs examined fluctuated in response to one another across time during a pandemic, they do not provide insights on how those dynamics might have changed in comparison to pre-pandemic functioning. Future work could seek to examine components of this same model once the pandemic has largely resolved to determine the degree to which the associations between various relationship systems (i.e., sexual, romantic, and individual functioning) were specific to the context of the pandemic or were more broadly representative of relationship dynamics. Sixth, although the study title, “The Finding Pleasure in Sex Study” effectively communicated to prospective participants the contents of the survey, that title could have inadvertently encouraged the participation of people with more sex-positive attitudes and with greater comfort discussing sexuality and sexual behavior. Balancing this concern, for a majority of the respondents (i.e., those recruited after the mid-March 2020 modification of the study), the bulleted list presenting the details of the study immediately following that title included a bullet referring to tracking the effects of COVID-19 across time: “Track the impact of COVID-19 on the lives of individuals” thereby increasing the relevance of the study to a broader range of individuals. Future work could explore the current model using a less sexualized title to help reduce the risk of biasing the sample. Extending that concern, the study made use of a convenience sample, thereby introducing possible selection bias. Future work could use random sampling techniques to help ensure the representativeness of the final sample. Seventh, several of the measures used in the current study were developed by the authors given the tight timeframe for starting a COVID-19 focused project. Future work could therefore extend research on this model and these hypotheses by examining them using existing measures that are well validated within the current literature. Eighth, although the analyses demonstrated reasonable model invariance across multiple demographic groups and controlled for parent and employment status as possible confounds, it is still likely that factors not included in the current model might have also helped to shape the sexual, romantic, and individual functioning of individuals during the first six months of the pandemic. Thus, future work could extend the current findings by examining a broader set of potential confounds. Extending that point, despite highlighting sexual functioning and romantic functioning as key factors influencing the impact of the pandemic on people in relationships, those are not the only possible sources of risk and resilience for individuals. Thus, future work could extend the current work by examining a broader set of risk/resilience factors including: (1) background factors and traits (e.g., sex positivity/erotophilia, trait negativity, optimism, grit, mindfulness, psychological flexibility, adult attachment), (2) other relationship subsystems (e.g., friendship/support/intimacy, business/financial, roommate/chores/distribution of labor), and (3) other external factors (e.g., work stress, conflict or stress within individuals’ extended family/friend network). Ninth, although over 600 respondents provided follow-up data, roughly 40% of our baseline parents did not complete any follow-up surveys. This level of attrition is not uncommon for online studies involving no monetary compensation (e.g., Daks et al., 2021) and was likely due in part to the upheaval of the COVID-19 pandemic on the lives of individuals. Strengthening this concern, although attrition analyses failed to find differences on levels of income or vitality at baseline, those analyses suggested that the respondents providing follow-up data were somewhat more likely to be white, heterosexual, women, engaged/married, have graduate degrees, and who were slightly older with slightly fewer depressive symptoms. Thus, despite having roughly 1800 distinct longitudinal assessments from over 600 respondents supporting our models (above and beyond the baseline assessments from all respondents), future longitudinal studies could extend the current study by seeking funding to help reduce attrition, thereby ensuring that the subtle attrition differences within the current study are not unduly influencing the results. Tenth, although a majority of the sample were in fairly long-term relationships (63% together for 3 + years, 71% together for 2 + years), 18% of the individuals had been in their relationships for less than a year and 10% had been with their partners less than 6 months, suggesting fairly high levels of heterogeneity in the relationships represented in the sample. Fortunately, the model results remained invariant across relationship stages and across cohabiting vs non-cohabiting couples, suggesting that the results generalized across the wide range of relationship stages included in the study, thereby reducing concerns about relationship heterogeneity. Future work could serve to replicate the current findings by examining similar models within more specific stages of romantic relationships. Despite these limitations, the results offer compelling evidence suggesting sexual and romantic functioning as buffering mediators between COVID-19 related stress and poor individual functioning.