What is it about?

Men, influenced by societal norms of "masculinity," often find it challenging to seek help when facing psychological crises related to depression. They may struggle to communicate or report internalizing form of depressive symptoms (IFDS), such as feelings of sadness, helplessness, and loss of interest. As a result, the presentation of depressive symptoms in men may differ from the commonly recognized IFDS. When men experience depression, they are more likely to exhibit externalizing internalizing form of depressive symptoms (EFDS) involving emotional suppression, angry, engaging in high-risk behaviors, and alcohol or substance use. It is becoming evident that male depression is not solely linked to everyday life stress and adaptation issues. Research conducted by Sung-Hsien Sun, Sung-Chun Tsai, and Ming-Fang Tsai suggest that the underlying causes of adult male depression may be connected to enduring adverse childhood experiences (ACEs) and, in some cases, a complex post-traumatic stress disorder (CPTSD). These findings emphasize the importance of not underestimating the psychological health crisis that underlies male depression.

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Why is it important?

We have started to notice that the causes of EFDS in men may differ from IFDS. We believe that EFDS in men may be more closely related to ACEs and could be an extension of CPTSD resulting from ACEs. Therefore, in this study, we attempt to compare the differences in IFDS and EFDS among adult male populations and their ACEs and complex trauma. This study suggests that, influenced by traditional masculine norms, when men exhibit EFDS during a mental health crisis, these symptoms are more likely to be an extension of childhood trauma.


Our research findings confirm the previously mentioned ideas and suggest that male depression may be a form of CPTSD. However, when men exhibit EFDS, it is more likely to have a direct connection to ACEs. In other words, ACEs in men can significantly correlate with their mental health, leading to more severe symptoms of CPTSD. Alternatively, these ACEs may still affect men, and as adults, they may manifest the damage they endured during childhood through EFDS. In counseling and clinical practice, it is crucial to expand the perspective on male depression. Besides the typical depressive symptoms like sadness and hopelessness, men may also exhibit externalizing forms of depressive symptoms like increased irritability. When men show EFDS, it's important to focus on how their ACEs might affect them, rather than just reducing their depressive symptoms. Men may find it more acceptable to report EFDS, which aligns with cultural expectations of masculinity. However, disclosing the underlying childhood trauma and even CPTSD can be more challenging. Proactively identifying these hidden psychological health threats is an essential practical principle When conducting our research, we discovered that there is very little attention given to the field of men's psychology, both internationally and in Taiwan. Even fewer people focus on the impact of childhood trauma experiences on men's mental health. When men say, "I don't care, I've forgotten about my childhood, the past is in the past," it doesn't mean that these ACEs have no effect on them. In our research, we found that these impacts can be significant and even harmful. In the future, we need more research to explore the effects of childhood adversity experiences and childhood trauma on men. In the field of counseling and clinical practice in Taiwan, there is a scarcity of organizations or agencies that primarily serve male populations. Many men are less proactive in addressing their mental health concerns and may find it challenging to seek help or express their difficulties. In a culture influenced by traditional masculinity, many people do not recognize the external form of male depression as a psychological crisis. These symptoms and behaviors are often considered normal male conduct and are not linked to childhood trauma. Therefore, there is a need for more research to explore the impact of ACEs or childhood trauma on men. The authors of this study are all counseling psychologists in Taiwan, and they have observed the unique aspects of male mental health in their clinical work. Therefore, there is a desire to focus more on male-specific issues and develop strategies and methods for assisting men in addressing their mental health concerns effectively.

Dr. Love Neo Sun Sung-Hsien Sun
National Taipei University of Education

Read the Original

This page is a summary of: Beyond tears: The predictive role of adverse childhood experiences and complex trauma in male depression within the Chinese cultural context., Psychology of Men & Masculinity, December 2023, American Psychological Association (APA),
DOI: 10.1037/men0000459.
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