När kvinnor och män får barn : Ett psykologiskt och könsspecifikt betraktande av psykisk hälsa och ohälsa

Sammanfattning: The central issue is to increase knowledge of women's and men's mental wellbeing when their child is about to be born, as seen from four aspects relevant to maternity and child health care centres. Major psychological theories are the attachment theory and the affect theory, health psychology with theories on nervous tension, vulnerability, coping and individual resources, clinical psychology to understand mental divergencies, crisis theory to understand reactions, taking the individual's subjective experience and personal definitions of reactions and needs into consideration. Major concepts are the reflective function, RF, empowerment, positioning and intersubjectivity. Study I: Epistemological approach. Gender similarities are: Mental condition post-partum, practical arrangements, organizing the first days at home after delivery, pregnancy issues in the last trimester, existential issues to come to an understanding of what is happening. Gender differences: women ask about pains at giving birth and about breastfeeding, men ask about the child and its development, the role of the man at delivery and as father, the pair relationship and parenthood. Study II: Professional support. Fifteen percent took advantage of an offered home visit after delivery, by a midwife familiar from pregnancy. The study demonstrates a model for individualized healthcare. The experiment group differed from the control group in that more individuals had a mother tongue other than Swedish, more dysfunctional pair relationships, more women with somatic difficulties and a tendency to more mental problems. The visit revealed a need for positive confirmation, traumatic experiences of giving birth, crises in the pair relationship, social isolation and distress caused by death of a close relative or friend. Study III: Mental crisis and incidence of emergency visits to psychiatric clinics. The incidence group (women and men expecting a child or with a child aged 0-17 months) constituted 1.23% of all emergency visits to psychiatric clinics and 1.1% of the total parents expecting or with a child 0-17 months. More women than men and more people with Swedish as their mother tongue received planned psychotherapy. More men were given pharmacological treatment. Study IV: Psychotherapy. Short-term psychotherapy results were studied, 6 women and 6 men, before and after childbirth. The percept-genetic tests PORT and DMT were used as control instruments for diagnostic purposes. The psychotherapy narratives were analysed from a gender perspective. Dominant themes for women were first the pair relationship, secondly their own identity. With the men their own identity came first, the pair relationship second. All participants showed an insecure attachment, confirmed by the percept-genetic results; 3 women and 3 men showed disorganized patterns. Attachment experiences differed between women and men. Shame and humiliation were dominant in therapies with both women and men. Significantly less negative expressions of affect were found in the later period of the therapies and an increased consciousness of affective expressions and ability to express emotions in a constructive way.