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Original Article

Factors Affecting Marriage in Schizophrenia:

A Cross-sectional Study
Vikas Deshmukh, Aparna Bhagat1, Nilesh Shah2, Sushma Sonavane2, Avinash Alan Desousa 2

Department of Psychiatry, Terna Medical College, Navi Mumbai, 'Department of Psychiatry, Rajawadi Municipal Hospital, "Department of Psychiatry, Lokmanya Tilak
Municipal Medical College, Mumbai, Maharashtra, India

Abstract
Background: Schizophrenia is a chronic psychiatric disorder which has a profound effect on the patients 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.

Key words: Age of onset, gender, marriage, schizophrenia

INTRODUCTION DOI:
10.4103/0971-8990.193432
The effects of marriage on psychiatric illness have been shown in

factors including symptoms of schizophrenia influence the outcome

the literature to have both protective and debilitating effects on the
course of psychiatric illness.[1] Schizophrenia is a chronic
psychiatric disorder with a variable course, fraught with stigma, and
outcomes that are determined by social support and family factors. [2]
Researchers have stated that in India, the status of being single
(unmarried) may face the same social disapproval as suffering from
schizophrenia itself.[3] 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. [4] The rate of marriage in patients
with schizophrenia has been reported to be lower than the general
population.[5] 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
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of marriage in schizophrenia.[6] Some studies even report that
marriage may enhance quality of life and protect against suicidal
ideation and attempts in schizophrenia. [7] 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
Address for correspondence: Dr. Avinash Alan Desousa, Carmel, 18,
St. Francis Road, Off S.V. Road, Santacruz (West), Mumbai - 400
054, Maharashtra, India. E-Mail: avinashdes888@gmail.com
general hospital psychiatry department. It was a cross-sectional
study and subjects were every patient diagnosed with schizophrenia
(acute and chronic) attending

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.
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Journal of Mental Health and Human Behaviour j September 2016 j Volume 21 j Issue 2
 mDeshmukh, et al.: Marriage in schizophrenia

the outpatient department in a 3-month period. No scales were used status (n=101)
to delineate the symptoms. Most patients were on medication except Married Unmarrie
for some who were seeking treatment. The patients selected were in (n=70) (n=31)
the age range 25-65 years and were diagnosed by a senior Male gender 40 17 2
X =0.05 0.9 (0.3-2.13)
psychiatrist with schizophrenia as per Diagnostic and Statistical NS
Manual of Mental Disorders, 4th Edition, Text Revision criteria.[8] Education below 24 4 X
2
=4.9 0.2 (0.08-0.9)
The presence of other psychiatric diagnoses was ruled out via primary P=0.027*
history and mental status examination though a diagnosis of Employment 60 21 X
2
=4.37 0.35 (0.12-0.96)
nicotine dependence was permitted. Patients with hypertension, (housewife) P=0.037*
2
diabetes, heart disease, and other major medical or surgical illness Age of onset of 26 22 X =9.85 4.13 (1.6-10.32)
illness <25 years P=0.002*
that would influence the course of schizophrenia were excluded
2
from the study. Only patients with a well-informed relative that Continuous course 14 10 X =1.78 1.9 (0.7-4.9)
NS
could corroborate the data collected were selected for the study. All
2
patients signed a written valid informed consent after being Good improvement 34 10 X =2.33 1.9 (0.8-4.8)
NS
explained the nature and purpose of the study. The study was 2
Duration of illness 38 18 X =0.12 1.2 (0.4-2.7)
approved by the Institutional Ethics Committee of our hospital. A >6 months NS
semi-structured pro forma was designed to collect data with regard Mean age of onset 28.219.16 22.74.78 t=3.15
to sociodemographic, illness, and other pertinent variables. The of illness (years) df=99
patients were initially divided into two groups married and (meanSD)# P<0.001
unmarried and various variables were studied among these groups. *Significant, #t test used in statistical analysis. Chi-square test used in all
In the second part of the analysis, the married patients were further statistics. NS: Not significant
divided into those with a good and poor marital outcome and data
were analyzed. Descriptive statistics and percentages, Chi-square
Table 2: Effect of various factors on outcome of marriage
test and odds ratio calculation were used where applicable via
computerized GraphPad statistical software (Graph Pad Software in schizophrenia
Inc., La Jolla, USA). Variable Married Statistics OR (CI)
patients (ft=70)
RESULTS Marriage Separated
The sample comprised 101 patients diagnosed with schizophrenia. stable or
(A=56) (n=14)
Of these 70 (69.3%) were married while 31 (30.7%) were 2
Male gender 34 6 X =1.46 0.48 (0.14-1.59)
unmarried. A significantly greater number of patients who were NS
educated were unmarried (P = 0.026) [Table 1]. It was also noted Education below 18 6 2
X =0.44 1.5 (0.4-5.24)
that employment (P = 0.03) was a significant factor in those primary NS
married. Age of onset of illness below 25 years (P = 0.002) was a Employment 49 11 2
X =0.66 0.5 (0.1-2.3)
significant factor in those who were unmarried. Mean age of onset (housewife) NS
of the illness was also significantly lower in those who were Age of onset of 26 8 2
X =0.51 1.54 (0.47-5.02)
unmarried (t = 3.15, df = 99, P < 0.001) [Table 1]. When marital illness <25 years NS
outcomes were considered, it was noted that greater male patients Continuous course 12 2 2
X =0.05 0.61 (0.12-3.11)
had stable marriages though not statistically significant while earlier NS
2
age of onset of illness was a significant factor that resulted in poor Good improvement 28 6 X =0.23 0.75 (0.23-2.44)
NS
marital outcome (t = 2.96, df = 68, P = 0.0021). Most other
2
variables studied had no effect on the outcome of marriage [Table Duration of illness 23 9 X =2.43 2.58 (0.76-8.71)
>6 months NS
2].
Mean age of 29.759.28 22.075.44 t=2.96
onset of illness df=68
DISCUSSION (years) (meanSD)# P<0.05*

Some studies have reported a low rate of marriage in patients with

schizophrenia.[9] 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. [10] In our
study, gender was not a significant factor

Table 1: Effect of various factors on marriage in schizophrenia

Variable Marital Statistics OR (CI)
 *significant, #t-test used in statistical analysis. Chi-square test used in all
statistics. NS: Not significant
for marriage. Employment was a significant factor for marriage as better prognosis and greater chances of marriage. [11] Earlier age of
patients with schizophrenia who are employed generally have a onset was a hindrance toward marriage in our study. This is i
 nDeshmukh, et al.: Marriage in schizophrenia
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. [12] 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. [13]
Marriage has also been shown to be protective in schizophrenia
with lower rates of hospitalization and later relapses being noted in
married patients.[14] 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.[15] 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.[16] 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
Nil.
Conflicts of interest
There are no conflicts of interest.
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