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Employment outcome for people with schizophrenia in rural v. urban China: population-based study
Lawrence H Yang1, Michael R Phillips, Xianyun Li
1Lawrence H. Yang, PhD, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA; Michael R. Phillips, MD, MPH, MA, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China, Departments of Psychiatry and Global Health, Emory University, Atlanta, USA, and WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Hui Long Guan Hospital, Beijing, China; Xianyun Li, BMed, MMed, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Hui Long Guan Hospital, Beijing, China; Gary Yu, MPH, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA; Jingxuan Zhang, BMed, Shandong Provincial Mental Health Center, Jinan City, Shandong Province, China; Qichang Shi, BMed, Tong De Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, China; Zhiqiang Song, BMed, The 3rd People's Hospital of Qinghai Province, Xining City, Qinghai Province, China; Zhijie Ding, BMed, Tianshui City Mental Hospital, Tianshui City, Gansu Province, China; Shutao Pang, BMed, Qingdao Mental Health Centre, Qingdao City, Shandong Province, China; Ezra Susser, MD, DrPH, Global Mental Health Program at Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, USA.
Background:
Although outcomes among people with schizophrenia differ by social context, this has rarely been examined across rural v. urban settings. For individuals with schizophrenia, employment is widely recognised as a critical ingredient of social integration.
Aims:
To compare employment for people with schizophrenia in rural v. urban settings in China.
Method:
In a large community-based study in four provinces representing 12% of China's population, we identified 393 people with schizophrenia (112 never treated). We used adjusted Poisson regression models to compare employment for those living in rural (n = 297) v. urban (n = 96) settings.
Results:
Although rural and urban residents had similar impairments due to symptoms, rural residents were three times more likely to be employed (adjusted relative risk 3.27, 95% CI 2.11-5.07, P<0.001).
Conclusions:
People with schizophrenia have greater opportunities to use their capacities for productive work in rural than urban settings in China. Contextual mechanisms that may explain this result offer a useful focus for future research.
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