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[Marital status and the first consultation at a psychiatric outpatient clinic. A 5-year follow-up study].

Incidence density ratios of first admission to an out-patient psychiatric clinic during a 5-year (1980-84) follow-up have been studied, the exposure of interest being marital status. The measured co-variates were sex, age and residence. A nearly 4-fold excess rate ratio of admission (age adjusted IDR = 3.8, 95% c.i. 3.3, 4.4) was detected for separated/divorced versus married persons, and an 80% excess rate ratio (aIDR = 1.8, 95% c.i. 1.6, 2.0) for unmarried. The aIDR for widowed persons approximated unity. Sex and residence modified the measures of effect. Men's aIDR was consistently above that of women for all categories of marital status: unmarried men's aIDR was 2.0 versus women's 1.6; widower's 1.8 versus widows' 0.9, and the aIDR of separated/divorced men was 4.0, versus 3.6 in women. In men, residence also modified the effect in the widowed and the separated/divorced. Rural widowers experience an excess rate ratio of 2.5, versus aIDRs of 1.5 and 1.0 in the urban and the coastal. The age-adjusted IDR in separated/divorced rural men was 10.4, versus 3.9 and 0.8 in urban and coastal men. The modification caused by gender has previously been observed, and has often been explained in terms of social support and networks. The residential effect needs to be explored further.