| [objectives]China has been in high sex ratio at birth Since the1980s, with the arrival of the marriageable age of these people, there has been a surplus of men. This trend would be more and more obvious in the next few decades, which may cause health problems among unmarried men and result in other social problems. In recognizing this important issue, the quantitative component of this paper investigated the psychological health, aggression and risky sexual behaviors among unmarried men aging from22to39years, who are in the legitimate age to get married, but still be unmarried. It aims to understand these three dimensions from the point of the overall group, the rural group and urban group, the elder age group and younger age group, and to explore the correlation between psychological health and aggression, as well as the correlation between the psychological health and risk sexual behaviors. Upon the findings of the quantitative research, this study further investigated the elderly unmarried men in poor area by qualitative interview. The qualitative part of the study aims to further understand the cause of remaining unmarried, the problems embedding in their psychological and daily life and reasons, which is to provide suggestion for intervention in terms of health promotion, social support and policy promotion.[Methods]This study used the quantitative and qualitative mixed research paradigm:In the quantitative study, with the consideration of the economic status, the accessibility of field for investigation, the quality control, and other related factors, Zhejiang, Guizhou and Yunnan province were selected as the participating areas. In these three provinces, multi-stage stratified cluster sampling method was used to select the sample, which was composed of1052unmarried men who aged22-39,1629married men and936unmarried women. The instruments used in the survey include the demographic questionnaire, sexual concept and behavior questionnaire, Beck depression inventory, Rosenberg self-esteem scale and Aggression scale, which were self-administered by participants. All data was entered into the database, which was set up by the Epidata3.0. statistical methods such as%tests, non-parameter tests, logistic regressions, and structural equation models were used to analyze the data by SPSS16.0and SPSS AMOS7.0software. The qualitative research enrolled30elderly unmarried men by purposive sampling from the Chishui area in Guizhou province. Semi-structured interview were conducted to explore the cause of remaining unmarried, other people's attitude about their unmarried status, self-evaluation of being unmarried, mental health and deep reasons behind the problems, the degree of dissatisfaction toward the society, and the status of sexual behavior, et al. All interviews were audiotaped with the consent of participants, which were transcribed into words and analyzed with the theme analysis approach.[Results]The mental health of unmarried men: The unmarried men have higher level of depression than the married men (p<0.05), the self-esteem differences between unmarried men and married men are not significant, but in the men older than27yeas, the single men have lower level of self-esteem than the men with partners(including wife or girlfriend)(p<0.05). The unmarried men have lower level of depression than unmarried women (p<0.05), but there is no significant difference of self-esteem between unmarried men and unmarried women. In addition, by the comparison of different characteristics of the unmarried men, we found that:(1) Compared to the urban unmarried men, the rural unmarried men have higher level of depression, and lower level of self-esteem (p<0.05).(2) There is no significant differences in depression and self-esteem between different age groups(<27and≥27).(3) Those unmarried men with higher education, higher income, have lower level of depression and higher level of self-esteem.(4) The unmarried men with fewer siblings especially fewer brothers, get lower level of depression; the elderly unmarried group with more brothers have lower lever of self-esteem.(5) The men who were single for lower economic status or not good appearance have higher level of depression and lower level of self-esteem; but those are unmarried for the much higher expectation of the spouse have higher level of self-esteem.(6) If the unmarried men live in a community with the cultural environment like these:there are other elderly unmarried men in the community, the community concern about the elderly unmarried men, or other elderly unmarried men around show positive psychological and behavioral change, the self-esteem of the unmarried men investigated would be higher; but if the unmarried men live in the communities where look down upon the elderly unmarried men, or the other elderly unmarried men around show negative psychological change, or the son preference culture is obvious, these unmarried men investigated would show higher depression and lower self-esteem. Multivariate analysis shows that higher education, higher income, with other elderly unmarried men in the community, and the concern attitude toward elderly unmarried men in community, may positively influence the psychological health of unmarried men investigated; however, the unwanted single status, the son-preference culture in community, the negative psychological change of other elderly unmarried men may negatively influence the psychological health of unmarried men investigated.With the interview, we found that most obvious psychological problem bothering these elderly unmarried men in poor area is the loneliness. Poverty is the most fundamental reason for their negative problems; and being consistent with the result from the quantitative research, the qualitative research indicates that the cultural environment of the community can influence the person's psychology. In addition, the weaker social network, the more negative copying style and poorer mental life are other reasons contributing to the negative psychological health of these elderly unmarried men in poor area.The aggression of unmarried men:There is no significant difference in the overall aggressive level between the unmarried and married men. Although the unmarried women have higher level of overall aggressive level than the unmarried men, as well as the verbal aggression, hostility and anger (p<0.05), the unmarried men do have higher level of physical aggression than the unmarried women (p<0.05). By comparing different groups within the unmarried men, we found:(1) The unmarried men live in rural area, have more obvious overall aggression than those living in the urban area (p<0.05) furthermore, the unmarried men younger than27living in rural area have more obvious physical aggression than those living in urban area (p<0.05), for the unmarried men over27years old, the anger is more obvious in those from rural area than those from urban area(p<0.05).(2) There is no significant difference in the level of aggression between two age groups; but the older unmarried men have lower level of physical aggression than younger ones (p<0.05).(3) The unmarried men who got higher education have lower level of overall aggression.(4) If the unmarried men live in the community with a cultural environment like these:the community look down upon the elderly unmarried men, other elderly unmarried men in community show negative psychological and behavioral change, or son preference culture in community is obvious, the aggression of unmarried men investigated would be relatively more obvious; but if the unmarried men live in the community with a cultural environment like these:the communities concern the elderly unmarried men or other elderly unmarried men in community show positive behavior change, the aggression of unmarried men investigated would be relatively less obvious. Multivariate analysis shows that education may reduce the level of aggression among unmarried men, the son-preference culture in community may enhance the aggression of unmarried men.Being consistent with quantitative research, the qualitative research shows the aggression of elderly unmarried men hasn't been enhanced, and they wouldn't cause obvious social security problems.The risky sexual behavior of unmarried men:The self-report rate and future participate rate estimated of the risky sexual behavior among unmarried men, especially the elderly unmarried men, are significantly higher than the married men and unmarried women(p<0.05), and the potential health risk shouldn't be neglected. By doing the group comparison within the unmarried men, we found:(1) Compared to the elderly unmarried men in urban area and the unmarried men who are younger than27, the self-report rate of the risky sexual behavior among elderly unmarried men live in rural area is higher (p<0.05);(2) The unmarried men who were less educated, had siblings, have higher self-report rate and future participate rate of risky sexual behavior;(3) The unmarried men who take more open sexual concept, have common out-marriage love or commercial sex around, have relatively higher self-report rate and future participate rate of risky sexual behavior. Multivariate analysis shows that less education, self-indulgence in sexual concept and the persons around participating in prostitution or extra marriage affair frequently may be the risk factors which promote the unmarried men to participate in risky sexual behavior; the elderly age, and the status of having siblings, are additional risk factors promoting the unmarried men to participate in commercial sex.The qualitative research shows that some elderly unmarried men interviewed had participated in the extramarital or commercial sex, and being consistent with quantitative research, the qualitative research shows that the peer influence is one of important reasons for their commercial sex behavior.The structure equation analysis shows that:The depression may impact aggression directly, in other words, the depression may enhance the unmarried men's aggression directly; the self-esteem can't impact the aggression directly, however, the self-esteem may impact the unmarried men's aggression indirectly by the mediating effect of depression. The risky sexual behavior history may increase the level of depression and reduce the level of self-esteem among unmarried men; and the risky sexual behavior history also may induce the unmarried men to continue participating in the risky sexual behavior in future.In addition, by qualitative research, we also found that:The reasons for men unmarried in the poor area include these:(1) The traditional concept and customs in local place:it causes more and more expensive wedding expense resulting from the unnecessary comparison, the matchmaking dominated style, rules in the extended family and some feudal traditional thoughts and so on reduced the approaches to find a partner;(2) The poor and hard life in local area:The economy is less developed in local area, the communities are too poor and remote, the transport conditions are also too poor, these limits communication opportunity between men and women at marriageable age and life together with women;(3) The sex ratio in local area:the sex ratio at birth has been high for so many years that the women in marriageable age are relatively less than the men, then the outmigration of women for marriage or work worsens the imbalance in the local sex ratio;(4) Personal and family related factors:such as personal health status, appearance, income status, personality traits, bad habits and family economic burden, etc.Most of elderly unmarried men in poor area are lack of effective coping methods for the future life, especially the endowment.[Conclusions]The level of depression in unmarried men is relatively higher, however, the overall self-esteem level is relatively stable (the negative psychology is more obvious among elderly unmarried men); the aggression of unmarried men hasn't increased significantly, they won't bring obvious social security problems; the participant rate of risky sexual behavior among unmarried men is relatively higher, they are high-risk in sexually transmitted disease.Besides the social and demographic characteristics (including education level), the social culture environment also can influence the psychological and behavioral health among unmarried men.The negative psychology may increase the aggression of unmarried men, the risky sexual behavior may increase the negative psychology of unmarried men.Poverty is the important economic reason for unmarried status in the elderly unmarried men; the imbalance sex ratio in marriageable age population is the important social reason for their unmarried status.[Suggestions]Combing the results and discussion of this paper, we suggest:From the angle of health promotion:implementing the health education on risky sexual behavior, guiding the protective sexual behavior or masturbation among high-risk health group.From the angle of social support: constructing the working and living environment where the interpersonal relation is harmony, spirit life is rich and each person has his proper place; providing social interaction opportunity and psychological intervention services.From the angle of social policy:modifying the high sex ratio and improving the security system to protect the single disadvantaged people.
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