Sex Differences in Psychopathology Following Potentially Traumatic Experiences

Abstract

ImportanceVarious psychopathology may follow trauma; however, sex differences in these ranging manifestations of posttraumatic psychopathology remain understudied.ObjectiveTo investigate sex-specific incidence of posttraumatic psychopathology.Design, Setting, and ParticipantsThis population-based cohort study of Danish national health registries included a cohort of individuals who experienced a potentially traumatic event (PTE) from 1994 to 2016. Individuals were further categorized by presence of any pretrauma psychopathology. A comparison group of individuals who experienced a nontraumatic stressor (nonsuicide death of a first-degree relative) was examined as a reference cohort.ExposuresAt least 1 of 8 PTEs (eg, physical assault, transportation accident) derived through health registry International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, with additional qualifiers to improve classification accuracy.Main Outcomes and MeasuresIncidence of 9 categories of ICD-10 psychiatric disorders recorded in registries within 5 years of PTEs. The standardized morbidity ratios (SMRs) for psychopathology outcomes were also calculated to compare individuals experiencing PTEs with those experiencing a nontraumatic stressor.ResultsThis study included 1 398 026 individuals who had been exposed to trauma (475 280 males [34.0%]; 922 750 females [66.0%]). The group of males who had been exposed to trauma were evenly distributed across age, while most females in the trauma-exposed group were aged 16 to 39 years (592 385 [64.2%]). Males and females were equally distributed across income quartiles and predominantly single. Following PTEs, the most common diagnosis was substance use disorders for males (35 160 [7.4%]) and depressive disorders for females (29 255 [3.2%]); incidence proportions for these and other disorders were higher among males and females with any pretrauma psychopathology. Certain PTEs had elevated onset of various psychiatric disorders and some sex differences emerged. Following physical assault, associations were found with schizophrenia or psychotic disorders for males (SMR, 17.5; 95% CI, 15.9-19.3) and adult personality disorders for females (SMR, 16.3; 95% CI, 14.6-18.3). For noninterpersonal PTEs, males had larger SMRs for substance use, schizophrenia or psychotic disorders, and adult personality disorders (SMR, 43.4; 95% CI, 41.9-45.0), and females had larger SMRs for depressive disorders (SMR, 19.0; 95% CI, 18.6-19.4). Sex differences were also observed, particularly when considering pretrauma psychopathology. For example, among interpersonal PTEs, males were most likely to develop substance use disorders after physical assault, whereas females were more likely to develop various disorders, with stronger associations seen for females without pretrauma psychiatric diagnoses. Among noninterpersonal PTEs, exposure to toxic substance showed robust associations with psychopathology, particularly in those without pretrauma psychopathology, with sex-specific differences across psychiatric categories.Conclusions and RelevanceMental disorders after trauma were wide-ranging for males and females, and sex differences in patterns of posttraumatic psychopathology were more pronounced when accounting for pretrauma psychopathology. Findings provide new insights for sex-relevant PTEs and their mental health consequences. It also outlines future directions for advancing understanding of a constellation of posttraumatic psychopathology in males and females.

Sources of Social Support and Trauma Recovery: Evidence for Bidirectional Associations from a Recently Trauma-Exposed Community Sample

“…Although our study addressed previous criticisms of longitudinal studies of social support and PTSD symptoms by including four waves and using RI-CLPM [31,35], our statistical models were complex and statistical power was not adequate to go beyond our key questions to test moderators of this association (e.g., trauma type, gender), add covariates to the model (e.g., time since trauma, other forms of psychopathology that may contribute to perception of social support like depression), or directly compare sources of social support. Gender differences in the PTSD-social support association may be particularly interesting to examine given that women are at double the risk of PTSD than men [3], that patterns of trauma exposure and post-trauma psychopathology differ for men and women (e.g., with depression more common among women and substance use disorders more common among men [52]), and that women have been found to exhibit affiliative responses to stress [53], suggesting that women may be especially likely to benefit from social support after trauma. Future research could also examine the interplay between sex and gender differences and different types of trauma in relation to social support, as well as sex and gender differences in the likelihood of providing support to trauma-exposed family and friends.…”