# Exploring the Role of Relationship Dynamics and Chronic Illness in Psychological Outcomes Among Cohabiting Couples During the COVID-19 Pandemic

## TL;DR

This study explores how relationship dynamics and chronic illness affect mental health in couples during the pandemic, finding that relationship quality and coping are more important than chronic illness.

## Contribution

The study uniquely combines regression and QCA to show that threat perception and relationship quality are key predictors of psychological distress during the pandemic.

## Key findings

- Hierarchical regression models showed that threat perception and relationship quality significantly predict mental health outcomes.
- QCA models revealed that low threat perception, high relationship quality, and coping skills correlate with lower psychological distress.
- Chronic illness was not significantly linked to psychological distress compared to other factors.

## Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic has exacerbated mental health difficulties among couples. Factors such as chronic physical illness, perceived threat of COVID-19, dyadic coping, and relationship quality may influence levels of psychological distress, including symptoms of anxiety, depression, and stress. This study aimed to examine how these individual and relational variables are associated with psychological outcomes in cohabiting couples during the first national lockdown in Portugal.

A mixed-methods study was conducted with a sample of 956 individuals (83.9% women), aged 18 to 81 years (M = 40.76, SD = 10.42), living with a romantic partner for at least one year. Participants completed validated self-report instruments: Depression, Anxiety, and Stress Scales - 21 Items (DASS-21) to assess anxiety, depression, and stress; the Brief Illness Perception Questionnaire (B-IPQ) to evaluate COVID-19 threat perception; the Perceived Relationship Quality Component – Short Version (PRQC-SV) to assess relationship quality; and the Dyadic Coping Inventory (DCI) to measure dyadic coping. Hierarchical linear regression and fuzzy-set Qualitative Comparative Analysis (fsQCA) were used to examine associations between variables. The study received prior approval from the Ethics Committee of the Faculty of Psychology and Educational Sciences of the University of Coimbra.

The regression models accounted from between 17% to 21% of the variances of the dependent variables. In the case of the Qualitative Comparative Analysis (QCA) models, the models explained between 11% and 85% of the cases. Hierarchical regression models (HRMs) showed that COVID-19 threat perception and relationship quality were significantly associated with mental health outcomes. In QCA models, low threat perception and high relationship quality and coping skills correlated with lower psychological distress.

Chronic illness was not significantly associated with psychological distress when compared to COVID-19 threat perception, relationship quality, and dyadic coping. These insights are vital for managing mental health of couples during crises. By underscoring the importance of threat perception, relationship quality, and coping for psychological well-being management during health crises, this study offers valuable insights for supporting couples through periods of adversity.