title: Marriage outcome and relationship with urban versus rural context for individuals with psychosis in a population-based study in China.
abstract: OBJECTIVE
  While social integration among individuals with psychosis differs by social context, this has rarely been investigated across urban vs. rural settings. For individuals with psychosis, marriage may be a key component of social integration. This study aims to compare marriage outcomes for individuals with psychosis in urban vs. rural settings in China, where marriage has been almost universal among individuals without psychosis.
  
  
  METHODS
  In a large community-based study in four provinces representing 12% of China's population, we identified 393 individuals with psychosis (112 never treated). We used adjusted Poisson regression models to compare marriage status for those living in urban (n = 96) vs. rural (n = 297) contexts.
  
  
  RESULTS
  While urban and rural residents had similar impairments due to symptoms, urban female residents were 2.72 times more likely to be unmarried than their rural counterparts (95% CI 1.19-6.22, p < 0.0176). Stratified analyses indicated that this marital disadvantage occurred primarily among urban females with an earlier age of onset. No differences were found among males.
  
  
  CONCLUSIONS
  Our findings indicate that urban contexts impeded opportunities for marriage for female individuals with psychosis. These data suggest that urban women with earlier age of onset have difficulty in marrying which may be related to economic expectations of women in urban areas. Research examining contextual mechanisms that affect marriage may further understanding of social integration in China and other contexts.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 1610, New York, NY, 10032, USA. lawrenceyang@columbia.edu.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Yang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.|Departments of Psychiatry and Global Health, Emory University, Atlanta, USA.|WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Hui Long Guan Hospital, Beijing, China.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
authors.affiliation: WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Hui Long Guan Hospital, Beijing, China.
authors.forename: Xianyun
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Yu
authors.affiliation: Shandong Provincial Mental Health Center, Jinan City, Shandong Province, China.
authors.forename: Jingxuan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Li Tong De Hospital, Hangzhou City, Zhejiang Province, China.
authors.forename: Qichang
authors.initials: Q
authors.lastname: Shi
authors.affiliation: 3rd People's Hospital, Xining City, Qinghai Province, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Song
authors.affiliation: Tianshui City Mental Hospital, Tianshui City, Gansu Province, China.
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Ding
authors.affiliation: Qingdao Mental Hospital Centre, Qingdao City, Gansu Province, China.
authors.forename: Shutao
authors.initials: S
authors.lastname: Pang
authors.affiliation: Global Mental Health Program at Mailman School of Public Health, Columbia University, New York, USA.|New York State Psychiatric Institute, New York, USA.
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D016012:Poisson Distribution; D011618:Psychotic Disorders / Q000453:epidemiology*; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Cross-cultural; Epidemiology; Marriage; Psychosis; Schizophrenia; Social integration; Urbanicity