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Men's mental health: fatherhood and psychotherapy.

The average father's participation in his child's birth and subsequent caretaking is a rather recent phenomenon. In fact, the current increase in men's active participation in the delivery room and in subsequent infant care can be thought of as a revolution in contemporary men's behavior, in gender relations, and in men's relations with their children. Currently, fathers attend 95% of all births in Denmark (Madsen & Munck, 2001). Danish men take an average of three-and-a-half weeks of paternity leave. Among other Nordic countries the average is even higher, with fathers in Iceland taking an average of 12 weeks and in Sweden and Norway an average of six weeks (Dansk Ingeniorforening, 2006). In the report, "Can Men Do It?", prepared for the Nordic Council of Ministers, Oystein Holter (2003) states about Nordic men today, that
 most men want an extended care period for fathers, and there is
 gradual movement toward that goal ... the majority of men want a
 caring and family-friendly development both in the workplace and at
 home, where men and women cooperate more, are less segregated, and
 interact on a more balanced basis. (p. 62)

Fatherhood has been central to changes in masculine perceptions in Denmark and throughout the Nordic region. The aim of this article is to discuss two aspects of fatherhood in the Nordic countries--men's experiences of fatherhood and, specifically, men's depression related to fatherhood--and to illustrate how this "new fatherhood" is an important element in the study of masculinity. This is accomplished through a presentation of three Danish psychological studies investigating the subjective aspects of this transition from three different perspectives of the modern father. The first study focuses on changes in fatherhood from generation to generation by analyzing the relationship between contemporary men's images of their child-rearing with their experiences of their own fathers' parenting. The second examines men's reaction to becoming fathers through a study of postpartum depression in Danish men. Finally, some preliminary results of a third study will focus specifically on psychotherapy with men suffering from postpartum depression.

Men's Images of Themselves as Fathers and Their Images of Their Own Fathers

The fact that so many Danish fathers today are present at the birth of their children is the result of an evolution that started in the early 1970s when hospital births first became common. While at first these fathers were present mostly to support their partners, studies show that today they also participate to a large degree in order to specifically bond with the babies--i.e., to meet their children as fathers, not merely as "partners" or "relatives" (Madsen, Munck, & Tolstrup, 1999). There are several indications that recent decades have seen more new fathers engaging with their newborn and infant children. This evolution is connected to a general development in fatherhood, from the authoritarian father of the tail end of the last century, through the breadwinner and the "dad," to the "new father" of the present day (Lamb, 1995; Madsen, 2003; Madsen, Lind, & Munck, 2002). Many aspects of this evolution have been elucidated, for example, the questions of what fathers mean to their children (Belsky, 1999; Lamb & Oppenheim, 1989; Trowell & Etchegoyen, 2002) and how fathers interact with their children (Lamb & Oppenheim). The Danish research program Fathers' Relations with Their Infants (1) (Madsen, Munck, & Lind 1997) focused on the subjective aspects of becoming a father and how men experience their child and how they relate with him or her.

One approach to examining what it means to become a father and which changes a man undergoes, is to study men's images of what kind of fathers they want to be and can become. We assume that the men's wishes and images are determined in part by their own experiences of care and attachment, for example, with their fathers and mothers, as well as by cultural norms, their partners' attitudes and the collaborative development of the couple's image of themselves as parents, and the influence of friends and acquaintances. By studying men's narratives of this ideal at the very time when they become fathers, we gain access to special aspects of the man as father. The image of what constitutes a good father can be described as the men's consciously (and partly unconsciously) formed ideals for their parenthood during the months when their fatherhood is becoming a reality. As part of the research project, 41 men and ten women were interviewed before and after the birth of their child, concerning their thoughts about being fathers and mothers. They were asked, "In your opinion, what is a good father/mother? Name five words that characterize a good father/mother." There were no differences between the men's answers before and after the birth. Some of the answers were as follows: "being attentive," "intimacy," "being sympathetic and loving," "being present," "you have to be together," "it'll be difficult to be as present as I would actually like to be," "first of all intimacy," "he has to be loving ... um, interested and ... caring," "that he is sympathetic ... that he takes his time with his child," "that the child feels loved," and "whatchamacallit, attentive and interested."

It is characteristic that most of the men mention becoming and being attentive, caring, and present. We also see that for some of them, prioritizing time together with the child in relation to, for example, work is an important issue. Moreover, men describe (as do many women) the tension (potentially) entailed by closeness with the child versus work. Finally, there is some concern about how the child's presence will influence the couple's relationship and whether there will be enough time to nurture both. It bears mentioning that only one man brings up the issue of the family's financial and material situation; the descriptions seem to focus to a large extent on the personal and relational level.

These statements stand out markedly when we examine how the same men describe their own fathers. We asked the same 41 men, including both first-time and second-time fathers, the following questions taken from the "The Father Attachment Interview" (Lind, Madsen, & Munck, 1998): a) "How would you describe your father as a father?"; b) "Are there any elements of your father's way of fathering that you would like to use in your parenting?"; and c) "Do you feel that your father understood you and how you felt as a child?" The answers are distributed as follows (Madsen, Lind, & Munck, 2002):
 50% categorize their father as psychologically or physically absent

 40% express a downright negative attitude toward their father as

 60% state that their father did not understand them or that they
 don't know whether he did

 66% say that there isn't anything from their father that they can
 use in parenting their own infant.

Thus there is a marked difference between the men's images of a "good father" and their own ideals, on the one hand, and their perceptions of their own fathers, on the other. We have no knowledge about how these men's fathers actually behaved as caregivers or how they related with their sons. We have only the present experiences and memories of the 41 men. Their images of their own fathers might change over time when their children grow up and/or when their fathers are experienced in the role as grandfathers. However, the great changes that have taken place during the last decades from a socio-cultural perspective--gender equality, the rise of women in the labor force, men's participation at childbirth, men's growing use of parental leave, more and more equal sharing of family obligations, etc.--indicates important differences between contemporary men's experiences of fatherhood and their fathers' experiences a generation before.

From a psychological perspective the men's statements suggest that a reorienting emotional process has taken off, a psychological process that seems to touch many layers of these men's personality, identity, and existence in general. Which direction this reorientation can take becomes apparent when we compare these men's descriptions of a "good father" with the women's answers to what constitutes a "good mother." The women interviewed just prior to and just after birth typically gave the following answers:
 ... that you're caring of course--and that you spend lots of time
 with the child.
 ... of course she's a loving mother ... engaged ... lively, happy
 ... trusting.
 ... a loving mother, who dares to show her love for her child.
 ... caring and consoling.
 ... physical contact is also incredibly important.
 ... loving and present.
 ... that you can show your love for the child both through care and
 ... someone who responds to the child, who tries to create a sense
 of security.
 ... security, so the child knows you're there, intimacy.

There are no significant differences between the women's statements before and after birth. Most women mention intimacy and care, and largely point to the same characteristics as men did of a good mother or father, respectively.

Fathers' Images of Their Children

If we turn from men's and women's images of themselves as fathers and mothers to their inner representations of the children, we find marked differences over time and between the genders. Both future fathers and future mothers were asked the following questions during the pregnancy, two months before the due date:
 If you were to imagine a situation featuring yourself as a
 mother/father together with your future child, how do you see
 yourself? What are you doing?

If you were to imagine your future child in some situation or other, how old is it? What is your child doing?

Here are some typical answers from the fathers-to-be (N = 41):
 ... the first thing would be around the age of 12 to 14.
 ... biking, in a forest, where we can ride around and explore.
 ... running around on the lawn playing ball.
 ... some sort of game, playing football or building with LEGOs.
 ... he's about 4 or 5 years old and is running around playing on a
 ... going out into the garden and playing ball.
 ... he's out experiencing the world, getting a lot of
 explanations--it'll probably be some months.
 ... for some reason I always see the child as a boy ... in a
 garden, where we are playing together.

When it comes to images of the future child, a large majority of the interviewed fathers-to-be have an image of an older child, rather than an infant. They talk about children they can play with, talk to, and go on trips with.

The statements of the mothers-to-be at the same point in the pregnancy (two months before the due date) were typically as follows (N = 10):
 ... something like sitting with the child.
 ... keeping the child close.
 I see images of breastfeeding her.
 ... when changing her diaper.
 She's lying there babbling or smiling or laughing.
 The image I get is an intimate situation with eye contact.
 Most thoughts are of an infant where you're being caring and
 We're just sitting there, looking at each other.
 I see myself with the baby in my arms.
 ... changing the diaper.

As opposed to the future fathers, almost all the women interviewed talk about the child as an infant. Additionally, all the men talk about the child as a boy, where the women talk about a girl.

In the study we see the following distribution (Table 1) between future fathers' and mothers' answers.

It turns out, however, that these fathers' responses to the same question four months after the birth of their child are markedly different. At that time, the fathers were interviewed at our clinic without their children present. They were asked the following questions:
 If you were to imagine a situation featuring yourself as a father
 together with your child, how do you see yourself? What are you

 If you were to imagine your child in some situation or other, how
 old is it? What is your child doing?

The statements from the same fathers four months after birth typically sounded like this:
 ... then I carry her around in my arms and she's laughing and we're
 I am lying down and playing with him.
 I'm lying on my back and he's crawling on top of me, that's
 something that happens almost every day.
 ... where she's sitting in her bouncy chair being fed.
 I'm changing diapers and feeding him his bottle.
 ... he's sitting there eating mashed potatoes and he's got mashed
 potatoes all over and he is laughing.
 ... and now I can't imagine her being able to walk and talk, even
 though she'll be able to soon.
 ... when I imagine a situation now, I'm changing his diaper, or
 perhaps we just took a bath together.

We see that now almost all fathers describe an infant. The images of the older child have largely disappeared and there are both boys and girls in the picture. The majority of the men are quite able to give an empathetic and age-appropriate description of a four-month-old infant. The distribution of the fathers' answers compared to the answers before birth can be seen in Table 2.

Thus, a marked change in the fathers' representations of the child takes place once the infant is actually present.

Changes in Images of Masculinity

The first noteworthy element of this insight into men and masculinity via the process of becoming a father is that the fathers interviewed--both before and after birth--define a good father as being engaged and present. Here they do not differ from the mothers. The question arises whether this is an expression of something new and different in relation to their own fathers in the same situation. We have no materials to directly elucidate this. We do know, however, as mentioned above, that Danish men today are present at their children's birth. We also know that these men's fathers were not present to the same extent at the births of their children. In the research program Fathers' Relations with Their Infants we asked 165 men about their knowledge concerning their own fathers' presence at their births. Twenty percent of those asked knew that their fathers were present, while slightly above 30% did not know whether or not he was present. Sixty percent knew that he was not (Madsen, Munck, & Tolstrup, 1999).

In the study, only 10% of the men had learned anything about their own fathers' participation at birth. We do not know what these men's fathers would have answered to the question about what constitutes a good father, but we know that, as a rule, they did not consider being present at the birth to be part of it. Meanwhile, we can also tell that, while the interviewees talk about themselves as intimate and engaged on a caring level with their newborns, these are not the kind of qualifiers they use to describe their own fathers' way of parenting (Madsen, Lind, & Munck, 2002). It was exceptional if one of the interviewees described his father as caring. Those who described their fathers positively spoke of them as helpers, role models, and as friends and playmates. Most of the men said that they did not think that their fathers understood them. The answers indicate that these fathers do not use their own fathers as role models. On the contrary, their statements about how they themselves wish to parent seem to contrast sharply with their descriptions of their own upbringings. They have another agenda than their fathers. This is consistent with Daly's find that men's fathers--when it comes to raising infants--are primarily represented as negative role models (Daly, 1995).

The second insight of this study is that there is a strong similarity between the perceptions of the men and women interviewed of what constitutes a good parent. To the extent that we are dealing with representative trends, an equalization has taken place between the genders' perceptions of parenting infants. (2) In the case of the fathers interviewed, we are dealing with a clear break with the fathering of the previous generation.

Thirdly, we see that, although there are few gender differences in the answers to the question about the "good parent," there are clear gender differences in the fantasies of the future parents spending time with their children. Most of the fathers-to-be imagine an older child--one who can walk and talk--whereas most of the expectant mothers imagine an infant. However, when the majority of men are interviewed four months after the birth, they have adjusted to the infant. In relation to the men's adjustment to fatherhood there is no contradiction inherent in having images of an older child before birth and being able to relate to the child as an infant once it is born. In other words, the images the fathers have of their coming child are not an indication of their potential for relating to the infant or of their capacity to empathize and care for it. (3)

The gender difference observable prior to birth, however, is notable. It represents a phenomenon that seems significant in researching both parenting from a gender perspective as well as other gender differences, i.e., differences in the narratives of the two genders, especially concerning feelings, relationships, sexuality, and ways of being together. These gender differences can be understood in the light of differences in socialization and in processes of gender identification. Through socialization the boy develops his gender, psychologically speaking, via dis-identification and the creation of an identity that represents the opposite or "something different" in relation to the gender of the person, the mother, who has cared for him during early childhood (Chodorow, 1978), and the loss of close caring relations early in his childhood (Pollack, 1995, 2005). Through differing socialization with two different experiences of identification and different expectations of the management of feelings and relations, men and women acquire different foundations for parenting.

Given the evolution, however, that has taken place in masculinity, equality, and parenting, at least in the Nordic countries, and as the results of this research indicate, we observe a series of different and complex issues facing men:

An intergenerational break seems to be taking place, in which new fathers have developed very different images of the good father from the previous generation.

Over a short span of years, present-day fathers have developed different new behaviors in certain areas--e.g., their participation in births and, in general, being together with their infants. At the same time we still find differences between men and women regarding commitment, time, and responsibility in the care of infants. Still, the development towards greater equality continues.

We see that men and women today to a large extent have the same images and fantasies of what constitutes a good parent; however, there is still a gap when it comes to carrying out intimate, engaged, present parenting. The trend toward more engagement on the part of the fathers continues.

Before birth, men and women have markedly different ideas and images of the coming child. Most fathers-to-be do not have images of an infant but, once the child is born, this does not seem to influence the man's relationship with his newborn child.

Although men and women, fathers and mothers have differing narratives about many aspects of parenting and relating to children, there seem to be fewer differences in the ways in which they actually parent--at least in the potential they have. We know from studies of men and women's collaborative praxis with infants that there are no decisive differences in the ways they relate to the child--especially not when they are alone (Lamb, 1997). Men can take the primary responsibility for children from the beginning (Geiger, 1996), and attachment research indicates that men have just as great a potential for creating a secure base for a child as do women (Ijzendoorn & Bakermans-Kranenburg, 1997; Main & Weston, 1981).

Many of the changes and shifts taking place in perceptions of masculinity thus seem, to a large extent, to both revel in and be strongly influenced by the great changes in fatherhood. In the Nordic countries, where the trend toward equality in parenting is relatively strong, there are unique opportunities to study new elements of evolution of masculinity closely through studies of fatherhood.

Men with Mood Disorders Related to Becoming Fathers

Men's transition to parenthood has a great psychological and sometimes even psychiatric impact on men's lives, their identities, and their states of mind (Bartlett, 2004; Madsen, Lind, & Munck, 2002). The impact of women's transition to motherhood has been acknowledged for many years, and many psychiatric and psychological studies have focused on postpartum depression in women (Brockington, 2004; Madsen, 1996). Postpartum depression, as measured with the Edinburgh Postnatal Depression Scale (EPDS) (Cox & Holden, 2003), affects approximately 10 to 14% of women (Cox, Connor, & Kendeli, 1982).

A growing number of studies on postpartum depression in women also take note of the father's psychological well-being (Ballard & Davies, 1996; Matthey, Barnett, Ungerer, & Waters, 2000). The fact that men might also suffer from postpartum depression was demonstrated from the results of the Fatherhood Research Program and was first publicly announced in Denmark in 2002 (Madsen, Lind, & Munck, 2002). In the present work, pre- and postpartum mood disorders in both women and men are understood as psychological conditions emerging first and foremost out of the processes of being a parent, due to factors of individual experiences with disturbances of care-giving in one's own childhood in combination with difficulties in developing an attachment with a baby and socio-cultural gender norms and norms of parenthood. This model of this kind of mood disorder has been developed for women in Madsen (1996) and for men in Madsen, Lind, and Munck (2002). (4)

Only a few empirical studies have had their main focus on men's postpartum depression (Condon, Boyce, & Corkindale, 2004; Deater-Deckard, Pickering, Dunn, & Golding, 1998). The importance of raising the awareness of men's postpartum depression has been emphasized by research indicating that paternal depression has a specific and detrimental effect on their children's early behavioral and emotional development (Ramchandani, Stein, Evans, & O'Connor, 2005). On the basis of a study covering more than 5,000 families in the U.S., Paulson, Dauber, and Leiferman (2006) stressed the importance in this statement: "Postpartum depression is a significant problem in both mothers and fathers in the United States. It is associated with undesirable parent health behaviors and fewer positive parent-infant interactions" (p. 659).

When looking at depression in general, women have a two-fold higher prevalence for depressive disorder (Blazer, Kessler, McGonagle, & Swartz, 1994). In the last decade, more studies have focused on whether men show other symptoms of depression than women. Studies have shown that anger attacks, affective rigidity, self-criticism, and alcohol and drug abuse are symptoms that more often occur in men suffering from depression (Cochran & Rabinowitz, 2000; Piccinelli & Wilkinson, 2000; Winkler, Pjrek, & Heiden, 2004). In Europe, some authors refer to these symptoms as male depressive syndrome (Winkler, Pjrek, & Kasper, 2005; 2006). Rutz, von Knorring, Pihlgren, Rihmer, and Walinder (1995) suggested the existence of such a male-specific syndrome following their experiences of the Gotland Study showing that education of general practitioners about depressive illness resulted in a statistically significant reduction in the number of female suicides but left the rate of male suicides almost unaffected. These experiences led to the development of the Gotland Male Depression Scale. American authors in the field have used the term "masked depression" to designate the male symptoms (Cochran & Rabinowitz, 2000; Pollack, 2005).

The clinical work in our department at Copenhagen University Hospital (Madsen, Lind & Munck, 2002) with fathers suffering from mood disorders related to parenthood indicates--in accordance with studies on treatment of men with depressions in general (Cochran, 2005; Pollack, 1995)--the importance of identifying other symptoms than those used in traditional instruments for assessing depression, for example, the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Edinburgh Postnatal Depression Scale (EPDS). Therefore we conducted a study (Madsen & Juhl, 2007) with the purpose not only to find out the prevalence of postpartum depression in men as fathers in a Danish population but also to consider whether the so-called male depressive symptoms should be included when screening for men with mood disorders. Thus we integrated the Gotland Male Depression Scale (GMDS) into a questionnaire with the Edinburgh Postnatal Depression Scale (EPDS) (5), traditionally used to screen for postpartum depression, in order to make it possible to detect some fathers with possible depression who would not score above cut-off on the EPDS.

The two scales list the following conditions as possible indicators of depression as shown in Table 3.

The study, which received funding from the EU-Commission under 'Community Frame-work Strategy on Gender Equality 2001-2005,' involved 607 men recruited through antenatal classes and midwife consultations at the hospital. The response rate among the men who received the questionnaire was 91%.

The results indicate that 6.5% of fathers suffer from postpartum depression. When we utilized the questionnaire traditionally used to identify postpartum depression in women--EPDS--it was estimated that 5% of men examined suffer from postpartum depression. Using the specific scale for "male depression"--GMDS--an estimated 3.4% of men were found to be suffering from postpartum depression. The numbers in Table 4 show the following distribution among the 544 fathers who responded.

The current annual number of births in Denmark is around 65,000. Hence on a national level in Denmark the numbers indicate that roughly 4,000-4,500 men suffer from postpartum depression annually. Comparing postpartum depression with other forms of depression, recent Danish research shows that 3.5% of 20 to 50-year-old men suffer from depression of moderate to medium severity at any given time (Gerlach, 2006). As mentioned, twice as many women as men are diagnosed as suffering from depression. The study thus still indicates that men's problems are generally under-diagnosed and that they hence receive insufficient treatment in this area.

This Danish study points toward the necessity of raising awareness that men can suffer from mood disorders related to being a father, and that men with depression seem to show some symptoms more often than women. The study also points to the need for training health-care staff who come into contact with families during pregnancy, birth, and infancy to be aware of gender-related conditions and of the psychological state of fathers, in order to identify and help those suffering from postpartum depression. Furthermore, the method applied to men as fathers to identify postpartum depression might turn out to be useful in developing tools to improve general diagnosis of depression in men. Finally, the study underlines the need for research into developing treatment in general--especially the training of treatment providers of psychotherapy, in particular, psychotherapy for men suffering from postpartum depression.

Psychotherapy with Men Suffering from Psychological Problems Related to Fatherhood

The clinic at the Department of Psychology, Play Therapy & Social Counselling at Copenhagen University Hospital has long been the only place in Denmark offering specialized treatment for men with mood disorders related to being a father. As of the beginning of 2007, nearly 100 men have received this psychotherapeutic treatment for postpartum depression. This third section of the article presents reflections on preliminary results from an ongoing study on this psychotherapeutic work. The study is based on qualitative analysis of statements from the men in the psychotherapeutic dialogue.

Based on the results from the studies Fathers' relations with their infants (Madsen, Munck, & Lind, 2002) mentioned above, analysis of the therapies has focused on the following four areas of the participants' psychological accounts: 1) men's symptoms of depression; 2) images of fatherhood and masculinity; 3) relationship with the infant; and 4) experiences with caregiving in their own childhood. As regards the men's symptoms, we find both the traditional, more introverted symptoms of postpartum depression included in the EPDS scale, as well as aggression, anger, irritability, and low-impulse control as mentioned in GMDS. We also find withdrawal reaction as described by Cochran and Rabinowitz (2000). Aggression is often directed toward the child and reflected in the man's fear of not being able to control himself physically and thus of inadvertently harming the child physically. (6) This leads simultaneously to strong feelings of shame, and it is of course extremely difficult for the man to tell his partner--the child's mother--about thoughts of harming their child. Therefore, he must often handle his feelings alone unless he receives treatment.

Concerning the topic of men's images of fatherhood and masculinity, men characteristically describe the circumstances surrounding the beginning of their mood difficulties as a sequence or a situation, in which their role or position has appeared particularly fragile, vulnerable, or contradictory. The changes in life that fatherhood entails often become clear in the moment when they're arriving home from the hospital. Almost all fathers in therapy have had as their point of departure that they want to be present, caring, and engaged fathers. They are prepared to share responsibility and to participate in all aspects of parenting. At the same time it is difficult for these fathers, in particular, to figure out what it is they need and want to do with the child. For some, this leads to the feeling that the mother and child are excluding them or that they are powerless in the face of what a child needs, for example, when it cries. In that connection he often thinks that as a man, he is not able to do all the things that a woman can do for the child. This also often causes him to question his ability as a man to develop the attachment and achieve the closeness he wants with his child.

In relation to the child--the third focus of the analysis--the men often feel pain and despair at not being able to handle the relationship, shame at their aggressive thoughts, and feelings of being overwhelmed by the constraints and the heavy responsibility involved in parenting. For this reason, the relationship with the child itself becomes painful, contradictory, and ambivalent. Here many men experience their child as being fretful, demanding, fitful, and needy, and they feel that they have an especially hard time comforting it, putting it to sleep, feeding it, etc. This experience is often at variance with the assessments of the partner, the health nurse, and others who observe him with the child. In addition to this unhappy and unsatisfactory relation with the infant, the fathers in therapy express pain about complicated relations with their own parents when they are asked to describe their relationships to their father and/or mother, during childhood and in the present. Their answers focus on not being understood, not feeling comforted, not being able to depend on others' love, always having to comfort oneself, not being seen, feeling abandoned, and other similar statements.

The analysis of the psychotherapeutic dialogue in these four areas points to the use of such elements of psychotherapeutic treatment of men with this kind of problems as:
 Working with men's states of anger and withdrawal
 A two-pronged psychotherapy working with the man's past and present
 with caregivers alternating with his relations with the infant
 The man's ambivalence between attachment and independence
 The man's images of masculinity confronted with the child's need
 for care.

This approach to postpartum mood disorders in men and the abovementioned suggestions for elements to include in therapeutic work with these men serve as our point of departure for developing a treatment model for this type of problem.


Men's transition to parenthood has a great psychological and sometimes even psychiatric impact on their lives, their identities, and their states of mind. In this transition there are cultural and psychological contrasts between traditional and modern masculinities. We have seen a development of men as fathers--from the mythological fatherhood of Abraham, King Laios, and Oedipus to the absent fathers in folktales to contemporary men--who might get mood disorders related to being a parent. This is a transformation of men as fathers from psychological detachment and distance to attachment and closeness, which has been very apparent in the Nordic countries.

It is in the light of this change that we are able to study men's psychological transition to fatherhood and the complexity of this process. In studying men as fathers and discovering, understanding, and treating men with mood disorders related to fatherhood we look into one of the most dramatic changes over the last few decades. At the same time we contribute to the understanding of men's mental and physical health. The study of contemporary men as fathers is an important aspect of men's studies.


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(1) This research programme was carried out at Copenhagen University Hospital and Institute of Psychology at Copenhagen University and consists of the following projects: The main project "Fathers' attachment with their infants" and the sub-projects: a) "Fathers and delivery," b) "Fathers and prenatal classes," c) "Fathers of newborn infants and toddlers at hospital," d) "Fathers of overweight children," e) "Fathers and donor insemination/biological fatherhood," f) "Grandfathers and their sons as fathers," g) "Men with postnatal depression," and h) "Psychotherapy in the treatment of men suffering from postnatal depression."

(2) The interviewees are not representative of the population as a whole--there is a certain bias of the socio economic status of the fathers who participated in the study toward higher than average education and income.

(3) Further exploration of fathers' empathy and orientation toward care of the infant is presented in Madsen, Lind, and Munck (2002).

(4) Such a psychological and socio-cultural based understanding of the pre and postpartum mood disorders provides the basis for a discussion of whether such conditions ought to be given more appropriate names in order to differentiate from disturbance due to biological factors?

(5) Validated for men by Matthey, Barnett, Kavanagh, and Howie (2001).

(6) Aggression turned against the child is also seen in many women suffering from postpartum depression. Here, however, the feelings do not find expression in violent physical aggression, but in other ways (Madsen, 1996).


Copenhagen University Hospital, Rigshospitalet

Svend Aage Madsen, Department of Psychology, Play Therapy and Social Counselling, Copenhagen University Hospital, Rigshospitalet, Denmark.

Correspondence concerning this article should be addressed to Svend Aage Madsen, Copenhagen University Hospital, Rigshospitalet, Sec. 4073, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Electronic mail:
Table 1
Parents' Answers Two Months Prior to Birth (%)

 Fathers (N = 41) Mothers (N = 10)

Older child 70 10
Infant 30 90

Table 2
Fathers' Answers Four Months after Birth (%)

 Before birth (N = 41) After birth (N = 41)

Older child 70 15
Infant 30 85

Table 3
Items in the Two Depression Scale

EPDS ('Traditional' depression) GMDS ('Male' depression)

* Unable to laugh or * Lower stress threshold
 be humorous
* Unable to look forward * Aggressiveness, low impulse
 to things
* Blaming myself unnecessarily * Feeling of being burnt
 when things go wrong out and empty
 * Constant, inexplicable tiredness
* Feeling anxious or worried * Irritability, restlessness,
 for no good reason dissatisfaction
 * Difficulty making ordinary
* Feeling scared or panicky everyday decisions
 for no good reason * Sleep problems
* Things get on top of me * In the morning especially, feeling
* Have been so unhappy of disquiet/anxiety/displeasure
 that I have had * Abusive behaviour, hyperactive
* Feeling sad or miserable behaviour, under- or overeating
* Feeling so unhappy that * Antisocial behaviour
 I have been crying
* The thought of harming * Depressive thought content
 myself has occurred to me * Complaintiveness
 * Hereditary loading; depressive
 illness, alcoholism, suicide

Table 4
Percentages of Men Scoring above Cut-off on the Two Depression Scales

EPDS 5.0
Gotland 3.4
Depression including EPDS + Gotland * 6.5

* Cases included in both scales are only counted as one.
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Author:Madsen, Svend Aage
Publication:The Journal of Men's Studies
Article Type:Report
Geographic Code:4EUDE
Date:Jan 1, 2009
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