|Year : 2016 | Volume
| Issue : 2 | Page : 122-124
Factors affecting marriage in schizophrenia: A cross-sectional study
Vikas Deshmukh1, Aparna Bhagat2, Nilesh Shah3, Sushma Sonavane3, Avinash Alan Desousa3
1 Department of Psychiatry, Terna Medical College, Navi Mumbai, India
2 Department of Psychiatry, Rajawadi Municipal Hospital, Mumbai, Maharashtra, India
3 Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
|Date of Web Publication||4-Nov-2016|
Avinash Alan Desousa
Carmel, 18, St. Francis Road, Off S.V. Road, Santacruz (West), Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Schizophrenia is a chronic psychiatric disorder which has a profound effect on the patient's life course. Marriage has been shown to be both protective and detrimental to the course of recovery in schizophrenia. The study was planned to elucidate the factors that influenced marriage and the sustainability of marriage in patients with schizophrenia. Materials and Methods: The study sample was 101 patients with schizophrenia that attended the outpatient department of tertiary general hospital. Informed consent was taken and data collected from the patients and/or relatives on a special semi-structured pro forma. The data collected were subjected to appropriate statistical analysis after further subdividing the sample into subgroups. Results: About 69.3% of the total samples were married while 30.7% were unmarried. A significantly greater number of patients who were educated were unmarried (P = 0.026). Age of onset of illness below 25 years (P = 0.002) was a significant factor in those who were unmarried. When marital outcomes were considered, it was noted that greater male patients had stable marriages though not statistically significant, whereas earlier age of onset of illness was a significant factor that resulted in poor marital outcome (t = 2.96, df = 68, P = 0.0021). Conclusions: The effect of marriage on schizophrenia and factors that may influence marital sustainability in patients with schizophrenia need further study and are multipronged. Larger studies in this area of research are warranted.
Keywords: Age of onset, gender, marriage, schizophrenia
|How to cite this article:|
Deshmukh V, Bhagat A, Shah N, Sonavane S, Desousa AA. Factors affecting marriage in schizophrenia: A cross-sectional study. J Mental Health Hum Behav 2016;21:122-4
|How to cite this URL:|
Deshmukh V, Bhagat A, Shah N, Sonavane S, Desousa AA. Factors affecting marriage in schizophrenia: A cross-sectional study. J Mental Health Hum Behav [serial online] 2016 [cited 2019 Oct 15];21:122-4. Available from: http://www.jmhhb.org/text.asp?2016/21/2/122/193432
| Introduction|| |
The effects of marriage on psychiatric illness have been shown in the literature to have both protective and debilitating effects on the course of psychiatric illness.  Schizophrenia is a chronic psychiatric disorder with a variable course, fraught with stigma, and outcomes that are determined by social support and family factors.  Researchers have stated that in India, the status of being single (unmarried) may face the same social disapproval as suffering from schizophrenia itself.  It is not uncommon in clinical practice in India to encounter situations where patients that suffer from schizophrenia are married while the history of psychiatric illness is denied and hidden from the spouse. Medications are stopped around the time of marriage and results in a relapse of symptoms few months after the marriage with in-laws and spouses realizing the presence of a psychiatric disorder.  The rate of marriage in patients with schizophrenia has been reported to be lower than the general population.  A number of factors influence the outcome in schizophrenia and marriage is one such important factor. Studies in India have revealed that a number of clinical and sociodemographic factors including symptoms of schizophrenia influence the outcome of marriage in schizophrenia.  Some studies even report that marriage may enhance quality of life and protect against suicidal ideation and attempts in schizophrenia.  Data regarding marriage, marital outcome, and factors influencing the schizophrenia in India is sparse. The following study was planned to elucidate the factors that influenced marriage and the sustainability of marriage in patients with schizophrenia.
| Materials and Methods|| |
The study was carried out over a 3-month period in a tertiary care general hospital psychiatry department. It was a cross-sectional study and subjects were every patient diagnosed with schizophrenia (acute and chronic) attending the outpatient department in a 3-month period. No scales were used to delineate the symptoms. Most patients were on medication except for some who were seeking treatment. The patients selected were in the age range 25-65 years and were diagnosed by a senior psychiatrist with schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition, Text Revision criteria.  The presence of other psychiatric diagnoses was ruled out via history and mental status examination though a diagnosis of nicotine dependence was permitted. Patients with hypertension, diabetes, heart disease, and other major medical or surgical illness that would influence the course of schizophrenia were excluded from the study. Only patients with a well-informed relative that could corroborate the data collected were selected for the study. All patients signed a written valid informed consent after being explained the nature and purpose of the study. The study was approved by the Institutional Ethics Committee of our hospital. A semi-structured pro forma was designed to collect data with regard to sociodemographic, illness, and other pertinent variables. The patients were initially divided into two groups married and unmarried and various variables were studied among these groups. In the second part of the analysis, the married patients were further divided into those with a good and poor marital outcome and data were analyzed. Descriptive statistics and percentages, Chi-square test and odds ratio calculation were used where applicable via computerized GraphPad statistical software (Graph Pad Software Inc., La Jolla, USA).
| Results|| |
The sample comprised 101 patients diagnosed with schizophrenia. Of these 70 (69.3%) were married while 31 (30.7%) were unmarried. A significantly greater number of patients who were educated were unmarried (P = 0.026) [Table 1]. It was also noted that employment (P = 0.03) was a significant factor in those married. Age of onset of illness below 25 years (P = 0.002) was a significant factor in those who were unmarried. Mean age of onset of the illness was also significantly lower in those who were unmarried (t = 3.15, df = 99, P < 0.001) [Table 1]. When marital outcomes were considered, it was noted that greater male patients had stable marriages though not statistically significant while earlier age of onset of illness was a significant factor that resulted in poor marital outcome (t = 2.96, df = 68, P = 0.0021). Most other variables studied had no effect on the outcome of marriage [Table 2].
|Table 2: Effect of various factors on outcome of marriage in schizophrenia |
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| Discussion|| |
Some studies have reported a low rate of marriage in patients with schizophrenia.  In contrast to the same our study found that approximately 70% of the sample size had been married indicating a higher rate of marriage. While male gender was not a significant factor for marriage studies in the past have reported males having lower rates of marriage than women in schizophrenia.  In our study, gender was not a significant factor for marriage. Employment was a significant factor for marriage as patients with schizophrenia who are employed generally have a better prognosis and greater chances of marriage.  Earlier age of onset was a hindrance toward marriage in our study. This is in keeping with studies that have demonstrated patients with a later onset of schizophrenia often have better premorbid personalities and thus have greater chances of marriage.  Presence of children and being married before the onset of illness has been shown to be a protective factor in the marriage in patients with schizophrenia.  Marriage has also been shown to be protective in schizophrenia with lower rates of hospitalization and later relapses being noted in married patients.  On studying factors that influenced sustainability of the marriage, no effect of gender was noted. This is not in keeping with previous work with female gender with schizophrenia has been predisposed to increased chances of divorce or broken marriages.  On various factors assessed, none of the factors were significant for sustainability of marriage except for an earlier onset of illness. Early onset of illness in schizophrenia has been associated with greater marital discord and longer course and poorer prognosis.  The current study is based on a small sample visiting a general hospital psychiatry setup and cannot be generalized. There is an absence of control group in the study as it would have been inappropriate to compare normal populations to the schizophrenia group while there was a need to study factors within the same sample while subdividing the sample into subgroups. Further larger studies across diverse patient populations with schizophrenia and appropriate control groups are warranted. Marriage is an important life event which is a determinant of the long-term course in schizophrenia. The study done is important as in the Indian setting marriage, and social support of the spouse plays a vital role in the recover from schizophrenia. This is an important study as it looks at factors that affected the sustainability and outcome of marriage in patients with schizophrenia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma I, Pandit B, Pathak A, Sharma R. Hinduism, marriage and mental illness. Indian J Psychiatry 2013;55 Suppl 2:S243-9.
Walker EF. Schizophrenia: A Life-Course Developmental Perspective. New York: Academic Press; 2013.
Koschorke M, Padmavati R, Kumar S, Cohen A, Weiss HA, Chatterjee S, et al.
Experiences of stigma and discrimination of people with schizophrenia in India. Soc Sci Med 2014;123:149-59.
Nambi S, Sarkar S. Mental illness and nullity of marriage: Indian perspective. Indian J Psychol Med 2015;37:366-9.
Thara R, Kamath S. Women and schizophrenia. Indian J Psychiatry 2015;57 Suppl 2:S246-51.
Rangaswamy T. Twenty-five years of schizophrenia: The Madras longitudinal study. Indian J Psychiatry 2012;54:134-7.
Srivastava A. Marriage as a perceived panacea to mental illness in India: Reality check. Indian J Psychiatry 2013;55 Suppl 2:S239-42.
American Psychiatric Association. Diagnostic and Statistical Manual for the Classification of Psychiatric Disorders - 4 th
Edition - Text Revised (DSM-IVTR). New York: American Psychiatric Association; 2000.
Li XJ, Wu JH, Liu JB, Li KP, Wang F, Sun XH, et al
. The influence of marital status on the social dysfunction of schizophrenia patients in community. Int J Nurs Sci 2015;2:149-52.
Eranti SV, MacCabe JH, Bundy H, Murray RM. Gender difference in age at onset of schizophrenia: A meta-analysis. Psychol Med 2013;43:155-67.
Luciano A, Bond GR, Drake RE. Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res 2014;159:312-21.
Vibha P, Saddichha S, Khan N, Akhtar S. Quality of life and marital adjustment in remitted psychiatric illness: An exploratory study in a rural setting. J Nerv Ment Dis 2013;201:334-8.
Kang T, Kang G, Han HR, Roh S. Marital and sexual satisfaction among patients with schizophrenia. J Korean Neuropsychiatr Assoc 2012;51:263-70.
Seeman MV. When and how should I tell? Personal disclosure of a schizophrenia diagnosis in the context of intimate relationships. Psychiatr Q 2013;84:93-102.
Narayan CL, Narayan M, Shikha D, Shekhar S. Indian marriage laws and mental disorders: Is it necessary to amend the legal provisions? Indian J Psychiatry 2015;57:341-4.
Doron H, Sharabi-Nov A, Trablus M, Amory V, Benbenishty Y, Skuza Y, et al
. Couple relationships in persons with schizophrenia: Intimacy, passion, and commitment. Am J Health Sci 2014;5:155-64.
[Table 1], [Table 2]