Higher risk – less data: A systematic review and meta-analysis on the role of sex and gender in trauma research

Abstract

Sex- and gender-sensitive research can help to understand differences in prevalence, manifestation, and etiology of mental disorders. It is acknowledged that men and women are at different risks for traumatization as well as for the development of posttraumatic stress disorder (PTSD). In this systematic review and meta-analysis, we examine sex/gender differences in PTSD risk within five time-intervals ranging from 1 month to 5 years post-trauma, and analyze how sex and gender are considered in prospective studies on PTSD development (k=45). Women had higher PTSD burdens across timepoints but were underrepresented in research (68.5% male, 31.5% female participants). Only one study used sex as discovery variable. Sex and gender aspects in design, data, and discussion were considered by only one third of studies each. Trauma research falls short of its potential to adequately consider sex and gender. Sex- and gender-sensitive practices can advance rigor, innovation and fairness in clinical research.

Higher risk—less data: A systematic review and meta-analysis on the role of sex and gender in trauma research.

“…The data and an R-based html markup document which reproduces our analyses and results is available at https://osf.io/ng8ab (Haering et al, 2022).…”

Sex and gender differences in risk factors for post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

“…While men are at higher risk for experiencing traumatic events, women develop posttraumatic stress disorder (PTSD) more than twice as often. 1,2 As this disparity manifests early after trauma exposure 3 , effective prevention requires attention to the role of sex and gender in PTSD etiology. Not only is PTSD the mental disorder with the greatest potential for prevention, as it is the only disorder with a defined causethe traumatic eventand therefore, a clearly identifiable timepoint for intervention onset.…”

“…However, to date no meta-analysis has systematically summarized evidence on sex/gender differences in PTSD risk factors, most likely due to profound methodological challenges: Although sex or/and gender are assessed in nearly every study, sex-/gender-dependent mechanisms are hardly investigated. 3 1 We use the term "sex/gender" as an umbrella term to highlight that both, biological factors associated with sex as well as sociocultural factors associated with gender are related to mental health and disorders. As primary studies included in this systematic review inconsistently referred to the terms sex and gender, a nuanced differentiation between sex-related and gender-related factors was not possible.…”

Shame and Emotion Dysregulation as Pathways to Posttraumatic Stress Symptoms Among Women With a History of Interpersonal Trauma

“…However, individuals with a history of interpersonal trauma, which encompasses physical assault, sexual assault, and other unwanted sexual experiences, tend to experience worse PTSD symptomology than those who survive other types of trauma ( Jaffe et al, 2019 ; Kimerling et al, 2018 ). Despite women being more likely than men to experience interpersonal trauma, to develop PTSD (2:1 ratio) and more likely to experience more severe and chronic PTSD symptoms ( Kilpatrick et al, 2013 ; Kimerling et al, 2018 ; Tolin & Foa, 2008 ), women are underrepresented in PTSD research ( Haering et al, 2022 ). Indeed, “Trauma research falls short of its potential to adequately consider sex and gender” ( Haering et al, 2022 , p. 1); gender-sensitive investigations of PTSD etiology and treatment are needed.…”

“…Despite women being more likely than men to experience interpersonal trauma, to develop PTSD (2:1 ratio) and more likely to experience more severe and chronic PTSD symptoms ( Kilpatrick et al, 2013 ; Kimerling et al, 2018 ; Tolin & Foa, 2008 ), women are underrepresented in PTSD research ( Haering et al, 2022 ). Indeed, “Trauma research falls short of its potential to adequately consider sex and gender” ( Haering et al, 2022 , p. 1); gender-sensitive investigations of PTSD etiology and treatment are needed.…”