Sex and gender differences in risk factors for posttraumatic stress disorder: A systematic review and meta-analysis of prospective studies.

Abstract

Women are at higher risk than men for developing posttraumatic stress disorder (PTSD), but underlying mechanisms are still unclear. Comprehensive knowledge about these mechanisms is necessary to develop tailored, sex-and gender-sensitive preventive interventions. This systematic review and meta-analysis examined sex-/gender-dependent risk factors, that is, risk factors with sex/gender differences in (a) vulnerability or (b) prevalence/severity, as well as sex-/gender-specific risk factors, that is, and (c) risk factors present in one sex/gender only. We searched PubMed, Web of Science, PsycINFO, PsycArticles, and PSYNDEX for articles published until October 16, 2022. We included prospective studies that assessed risk factors to predict subsequent PTSD symptom severity, as measured with the Clinician-Administered PTSD scale. The primary outcomes were sex/gender stratified pooled for sex-/gender-dependent vulnerability and sex-/ gender-specific risk factors and pooled odds ratio (OR) or standardized mean difference (SMD) for sex-/ gender-dependent risk factor prevalence/severity. We screened 17,270 records and included 117 reports from 45 studies (N = 13,752) in the systematic review. Seventeen studies (N = 4,257; 1,827 women, 2,430 men) were included in the meta-analysis. Regarding risk factor vulnerability, analyses revealed no significant sex/gender differences except for acute stress symptoms, with stronger associations for men (b = 0.11, SE = 0.06, p , .05). Regarding risk factor prevalence/severity, women reported more severe immediate psychological stress responses (range SMD = 0.23-0.56) and more commonly had a history of mental illness (OR = 1.81, 1.27-2.58). Men showed higher trauma load (SMD = −0.15, −0.29 to 0.01). Few women-specific and no men-specific factors were identified. Results suggest that women's heightened immediate psychological stress response drives sex/gender disparities in PTSD symptom severity. Preventive interventions should thus target women early after trauma. This article was published Online First May 30, 2024. Christina Boisseau served as action editor.Stephanie Haering https://orcid.org/0000-0003-4831-8926 Stephanie Haering and Caroline Meyer have shared their first authorship. We highly value the time and efforts of all authors of the included studies who provided us with the requested data for the present meta-analysis. Furthermore, we would like to thank Jule Käselau for her support in the screening process. Since this was a systematic review and meta-analysis of published articles, no ethics approval was needed. A prior version of this article was posted as a preprint at https://osf.io/preprints/psyarxiv/hfqt2 (Haering, Meyer, et al., 2023b). This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The authors declare no competing interests.Lars Schulze served as lead for visualization and served in a supporting role for supervision and writing-review and editing.