Married Individuals with Schizophrenia Show Better Outcomes, Study Finds

14-year study of a rural sample in China shows those who were married had higher rates of remission from schizophrenia

Bernalyn Ruiz
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A new article, published in Schizophrenia Research, pulls data from a large epidemiological study in rural China to assess the impact of marriage on 14-year outcomes in a sample of people diagnosed with schizophrenia. The results suggest that being married is predictive of more favorable outcomes and enhanced community and family support.

Photo Credit: Flickr

While the cultural meaning of marriage can differ, generally the literature suggests that being married can have positive and important benefits for people diagnosed with ‘mental disorders.’ It is believed that improved outcomes may stem from stronger social networks and support resulting in better quality of life, and reduced risk of suicide attempts.

The positive effects of social support and inclusion have been documented extensively and include reduction in anxiety and/or depression, social isolation and loneliness, and support for hard to reach people. Moreover, for women in the postpartum period, those with more social supports and connections are less likely to develop postpartum depression. Placed as a proxy for social inclusion and increased social support, this study examines the relationship and impact of marriage on outcomes for persons diagnosed with schizophrenia.

The purpose of this study was twofold; first, to examine whether being married at baseline is linked with survival status at 14-years, and second, to identify correlates of marriage status. To do this, the data of 510 individuals identified as having schizophrenia was extracted from a longitudinal study on mental illness and mental health services in a rural county of China. Participants were assessed at baseline, 10-years, and 14-years.

Along with the key outcome variable of marital status, data on symptoms, level of social disability, functioning and survival were collected. Survival was classified as being alive and living in the community. Other variables gathered included sex, age, educational attainment, first onset of psychosis, duration of illness, suicidal attempt, whether or not the individual was taking psychiatric medication, mental health status (full remission, partial remission, or marked symptoms/deteriorated), family members, family economic status, caregiver status, maltreatment of participants by family members, and criminal behavior.

Of the participants followed up at both ten and fourteen-year follow ups, 72% were married, and 27% were unmarried at baseline. In the unmarried group, rates of survival were significantly lower, rates of suicide were 3.5-3.7 times more likely, and there were significantly higher rates of homelessness. Those who were unmarried were more likely to report being unable to work at all three time-points. At baseline and 10-year follow up, the unmarried group reported significantly lower rates of remission and lower social functioning scores.

Those who were married had lower symptom scores, lived in families with a higher socioeconomic status, were more likely to have a caregiver, and were surrounded by more family members. Married participants were also less likely to be maltreated by other family members, had higher rates of being on antipsychotic medication at all three time-points and, most interestingly, had significantly higher rates of remission.

This study highlights the beneficial effects of familial support for people diagnosed with schizophrenia. This study was conducted in a rural community in China and the authors emphasize that their findings might only be generalizable to people diagnosed with schizophrenia in rural, low- and middle-income communities with a family-centered culture and less developed social welfare system. Supporting marriage in this context could be helpful for increasing social inclusion and improving desirable outcomes and quality of life.

 

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Ran, M. S., Wong, Y. L. I., Yang, S. Y., Ho, P. S., Mao, W. J., Li, J., & Chan, C. L. W. (2017). Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study. Schizophrenia research182, 49-54. (Link)

24 COMMENTS

  1. It’s unfortunate the assault that marriage has been under since the 60’s. There ought to be a HUGE difference in commitment levels between living together and being married though easy divorces have certainly diminished that. Many times have the words, ‘for better or for worse’ come to mind as my wife and I have slugged it out against her d.i.d. And certainly her littles have wanted to know if I loved them ‘forever’ and would ‘never’ leave. Living together simply lacks the permanence that a trauma victim needs to feel safe enough to open the past back up and begin doing the hard work of healing. As well it’s quite the impetus to me to help her heal rather than both of us spend the rest of our lives in misery or me simply cut and move on.

    • Marriage is an institution which serves primarily patriarchal interests, and while I would not say it should be discouraged, it should not be held up as the prime model of a good life, or a way of getting extra perks from the system, tax breaks, etc.

      • lol, I was waiting for someone to spew that feminist drivel. I have yet to see any of those ‘patriarchal benefits’ in my 29-year marriage, but even if my wife diidn’t have d.i.d., marriage is much more than the simplistic twaddle you seem to feel it is. There are all kinds of studies showing the personal and societal benefits of two people committing to love, honor and cherish each other over a lifetime. I’m sorry you have a such a low view of it, and I’m sorry so many people do a really bad job of ‘being married’, but even with all my wife’s issues and all the pain that her issues have caused me, I’m still glad I’m married, and I can still see how it has benefited her, me and our son.

        edit: and I guess I’ll add, before this becomes some kind of feminist flashpoint, that one of my wife’s ‘alters’, her defender, whom I love and who loves me and has asked for us to get engaged, she and a couple of the other girls are ardent feminists, and I’m ALL for supporting them and their feminist tendencies as I am not at all frightened by a strong woman, but neither am I cowed by one. I push them to grow, mature and strengthen, but I it doesn’t have to deteriorate into some kind of silly battle of the sexes stuff. I win when they win and vice versa.

  2. Given that, “Supporting marriage in this context could be helpful for increasing social inclusion and improving desirable outcomes and quality of life.” Perhaps the psychological and psychiatric “professionals” should then get out of the business of intruding into the lives of married couples, defaming one spouse to the other, then brainwashing the “well” spouse with books and DSM lies? Since, of course, such behavior does destroy marital relations and the mutual respect needed for marriages to survive and thrive.

    • Hi Someone Else,

      It seems like everybody is taken in with the uselessness of “schizophrenia”. I was taken in myself but I didn’t know the full facts.

      My main problem was disability on “medication” and High Anxiety on “medication” discontinuation.

      The real problem I think is the universal absence of Knowledge of the option of Full Recovery. A lot of non drug professionals also make very hard work out of a straightforward return to life.

      Also in the medical profession they daren’t expose the “emperor with no clothes”. Because they would be targeted and exited.

      • I am truly sorry you believe that, Rachel. There is nothing wrong with you, and though it might take a bit for a good man to get past the cultural tropes about people with SMI labels, it really didn’t take me long to figure out that I was still safe to sleep in the same bed at nights with my wife! 🙂

    • Hi,

      Its possible to overcome “Schizophrenia”

      When I came off “medication” (even carefully) my main problem was Terrible Anxiety. The anxiety was worse than any previous emotional problem I’d ever had, and it was rebound anxiety not normal anxiety.

      It didn’t respond to normal Psychotherapy either, but it did respond to Cognitive Behavioural (type) Therapy. Over the years with practice the anxiety reduced right down, and when it did – my problem was solved.

    • Slaying the Dragon,

      I wonder who’s diagnosing the “Schizophrenia” in Rural China. I think if no-one was diagnosing the “Schizophrenia”, there wouldn’t be any.

      In rural China marriages used to be arranged, and I think the brides family paid the dowry. Rural people have their own ways of measuring people up, and they are very good at it. In Ireland years ago the grooms personality was tested with alcohol.

      My mother came from a farming background in Ireland and I was chatting to her before my sister’s wedding. She told me she liked her new son in law “to be”, that he was a very nice man, “…though, I asked him to help me lifting the tables in the church and he didn’t seem very strong…”

  3. I would be interested in a Study on the rate of diagnosis of Schizophrenia of black men in Jamaica – in comparison to the rate of diagnosis of black men of Jamaican extraction in the UK.

    I would predict there to be a very large difference but not for genuinely valid reasons.

    I was told lots of times by girlfriends to throw away “my medication” – but when I did I ran into trouble. The test of time has proven though, that these were “Rebounds” not “Relapses”.

  4. I am not in any way a fan of antipsychotics, and I am fully aware that the bias of this webzine is against them. I am myself a writer for this webzine, and the last thing I would want to do is to support the use of drugs. However, in the spirit of fairness and science, it must be admitted that you have said that antipsychotic use is associated with better functioning, and this cannot be ignored.

    I have myself been on psych wards, and I have myself seen how various individuals who were psychotic and/or dangerous (I have been both threatened and assaulted by such individuals on psych wards) have actually improved, and improved greatly, with the use of antipsychotics. I have myself also benefited from them at various times. Now, I don’t actually like their use, or approve of it over the long term, but it is simply an undeniable fact that sometimes — SOMETIMES — the use of antipsychotics is helpful. Not always, but sometimes. And I think that this is worth thinking about. We are not here to condemn Big Pharma. That is what I usually do, but that is not our purpose in being here. It is to find out what helps, not what gets in the way.

    Thank you for your article. I find, when reading your work, that you are succinct, pithy, and very informative. Thank you.

    • Such drugs disable one’s ability to express both hostile AND “positive” emotions, so any “improvement” must be recognized as illusory, and the result of (at least temporary) drug-induced brain damage. This may be “helpful” to those in charge of maintaining order on the ward, but not much else.

    • I am here to condemn Big Pharma! I am probably going to die because of the progressing tardive dyskinesia I have. I can’t eat, digest, and I require twice a week colonics. I have terrible constant tight muscles with an inner crawling vibration that I would not wish on anyone. It wakes me up at night. Big Pharma lied about the side effects in order to market these drugs for long term use when they were never tested for that. Now they are being given to kids and people with insomnia! This is a crime against humanity! The reliance on these drugs has set back any progress that might have been made over my lifetime (I am 64) and has also resulted in many people living lives as zombies not even knowing that they are the walking dead. I did not know until I finally got off my medication that my brain was so impaired. My doctor denied any connection between my symptoms and the drugs. They very design of these drugs is to impair the brain. Behaviour control is not medicine. It is society imposing it’s colllective fear of mental illness on us. I was so afraid of myself I was a good compliant patient for twenty years! The only reason I was on an antipsychotic was because my kidneys were damaged by lithium. How can you have any kind of spiritual connection when you are not even in connection with your mind and your body? This is a delusion. Perhaps due to the state of the field these drugs are all we have for a crisis situation. I will give you that. I strongly believe that we could have progressed way past this point if Big Pharma and the researchers they paid to lie about their results had been honest and we never prescribed these drugs for chronic use. The coming tsunami of people with devastating side effects (also from polypharmacy) has yet to begin. Currently these effects are not being recorded because we are dying of dementia, diabetes, heart failure and suicide. How can we tolerate a mindset that says dying twenty years prematurely is preferable to treating the mentally ill with appropriate care which takes longer than a ten minute appointment with someone who doesn’t know about your trauma? Reading this article and some of these comments has just added to the trauma I feel.

    • “I have been both threatened and assaulted by such individuals on psych wards”

      Yes. This indeed does happen sometimes.

      However, in each case, it is important to know why the person is being violent. In one case, the person truly could be psychotic. In another case, something may have happened to the person to make them behave that way. Both cases are irrespective of the garbage they were labelled with.

    • Short term use for 4-6 weeks may be okay. These pills correct nothing but if someone is really stressed they can help them chill. Not as addictive as Xanax.

      A short term remedy at best though. Like using sleeping pills to break an insomnia cycle.

      And, I know, OH it would only be a consenting, informed individual over 18. Wouldn’t need a psychiatrist for this. No lies about “broken brains” or “chemical imbalances.”

  5. “The purpose of this study was twofold; first, to examine whether being married at baseline is linked with survival status at 14-years, and second, to identify correlates of marriage status. To do this, the data of 510 individuals identified as having schizophrenia was extracted from a longitudinal study on mental illness and mental health services in a rural county of China. Participants were assessed at baseline, 10-years, and 14-years.

    Along with the key outcome variable of marital status, data on symptoms, level of social disability, functioning and survival were collected. Survival was classified as being alive and living in the community. Other variables gathered included sex, age, educational attainment, first onset of psychosis, duration of illness, suicidal attempt, whether or not the individual was taking psychiatric medication, mental health status (full remission, partial remission, or marked symptoms/deteriorated), family members, family economic status, caregiver status, maltreatment of participants by family members, and criminal behavior.”

    Psychiatric gibberish. Until we meet these 510 people, we have no idea what their lives were/are like.
    Not to mention defaming these individuals with a “diagnosis” of “schizophrenia”.

    “The positive effects of social support and inclusion have been documented extensively”

    Right, because the common fact that having supportive people in life benefits a person is something to be “discovered” and “studied” and “documented”.

    Not to mention that they have successfully added to social isolation by defaming these individuals as “schizophrenics”.

    “The purpose of this study was twofold”

    Only one purpose I think. It adds a feather in the cap of the researcher doing the research work. Another publication in a journal, and more advancement in career.

  6. Labeling someone “schizophrenic” is a great way to ensure that they never marry.

    Even if they find a fellow outcast compatible the drugs make it hard to make relationships work. And the government will punish you by docking your income by more than a third. Great way to discourage “criminal types” from breeding.

    Eugenics is alive and well folks. 😛