Sex Differences in PTSD: Mediation and Moderation Effects

Christiansen, Dorte Mølgaard

doi:10.1007/978-3-319-08359-9_4

Cited by 7 publications

(11 citation statements)

References 45 publications

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“…The next step should be to move toward an explanatory level and increasingly investigate sex- and gender-related factors that underly these risk differences. This may include sex-/gender-differential risk factor prevalence or severity as well as sex-/gender-differential association of a risk factors with PTSD (for instance, certain risk factors might be associated with PTSD exclusively in women or men; might differ in the strength of the association for women relative to men, or might be positively associated with PTSD and men and negatively associated with PTSD in women or vice verca; Christiansen, 2016). Such research can help to understand whether the same factors may be equally or differentially important to the prediction (and treatment) of PTSD in women and men.…”

Section: Discussionmentioning

confidence: 99%

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

Haering,

Schulze,

Geiling

et al. 2024

Journal of Psychopathology and Clinical Science

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Women and men are at different risk for posttraumatic stress disorder (PTSD). It is unclear, however, how studies on PTSD risk factors integrate this knowledge into their research. Moreover, the temporal development of women's higher PTSD risk is unknown. In this systematic review and meta-analysis, we examine how prospective studies on PTSD development (k = 47) consider sex and gender across four domains (samples, terminology, analyses, and reporting). Further, we differentially analyze sex/gender differences within five time intervals from 1 month to 5 years posttrauma. PTSD prevalence (OR = 1.72 [1.27-2.34]) and severity (g = 0.31 [0.09, 0.53]) were increased for women relative to men at 1 month posttrauma already, that is, at the first timepoint of a possible PTSD diagnosis. PTSD severity was elevated for women compared to men across all time intervals, but evidence for increased PTSD prevalence for women relative to men was less stable with longer follow-ups. Despite women's higher PTSD burdens, they were clearly underrepresented in samples (68.3% male, 31.7% female participants). Only 5.0% of studies explained or described their understanding of sex and gender, and only 2.6% used sex as discovery variable, that is, investigating sex-dependent risk mechanisms. 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 gendersensitive practices can advance rigor, innovation, and equity in psychopathology research.

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Section: Discussionmentioning

confidence: 99%

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

Haering,

Schulze,

Geiling

et al. 2024

Journal of Psychopathology and Clinical Science

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“…The development and functioning of the HPA axis are influenced by one's genome, the prenatal environment, and by life experiences. HPA functioning is especially sensitive to repeated early life trauma ( 72 ). As a result, there are multiple ways in which both sex and gender can affect the HPA axis.…”

Section: Sex-based Theoriesmentioning

confidence: 99%

“…Furthermore, the sudden increase of sex/gender differences around the time of puberty in many mental disorders is often interpreted as support for the influence of gonadal hormones, but to what degree hormones directly contribute to this finding is unclear. Of probably equal importance is the increased exposure in adolescence to societal pressures to conform to gender-role expectations ( 72 ). Evidence for the impact of both sex and gender is present in almost all such attributions.…”

Section: The Coming Together Of Sex and Gendermentioning

confidence: 99%

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Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness

2022

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Sex differences are prevalent in multiple mental disorders. Internalizing disorders are more commonly diagnosed in women, whereas externalizing and neurodevelopmental disorders are more often diagnosed in men. Significant sex/gender differences are reported in prevalence, symptom profile, age of onset, comorbidities, functional impairment, prognosis, as well as in responses to various treatments. In this conceptual article, we discuss theories and empirical studies of sex- and gender-related influences in mental health, by focusing on three examples: autism spectrum disorder (ASD), acknowledged as a disorder whose roots are mainly biological; eating disorders, whose origins are considered to be mainly psychosocial, and posttraumatic stress disorder (PTSD), an environmentally caused disorder with both psychosocial and biological underpinnings. We examine the ways in which sex differences emerge, from conception through adulthood. We also examine how gender dichotomies in exposures, expectations, role assumptions, and cultural traditions impact the expression of our three selected mental illnesses. We are especially interested in how sex-based influences and gender-based influences interact with one another to affect mental illness. We suggest that sex and gender are multi-faceted and complex phenomena that result in variations, not only between men and women, but also within each sex and gender through alterations in genes, hormone levels, self-perceptions, trauma experiences, and interpersonal relationships. Finally, we propose a conceptual diatheses-stress model, depicting how sex and gender come together to result in multiple sex/gender differences across mental disorders. In our model, we categorize diatheses into several categories: biological, intrapersonal, interpersonal, and environmental. These diatheses interact with exposure to stressors, ranging from relatively minor to traumatic, which allows for the sometimes bidirectional influences of acute and long-term stress responses. Sex and gender are discussed at every level of the model, thereby providing a framework for understanding and predicting sex/gender differences in expression, prevalence and treatment response of mental disorders. We encourage more research into this important field of study.

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“…to examine whether sex moderates the association between a risk factor and PTSD in a way that the strength, significance and/or direction of the association differs between women and men. We selected our predictors of interest based on a literature review of sex differences in PTSD predictors (Christiansen, 2016). Predictors that are assumed to be associated with PTSD differently for men and women, and were assessed in the AURORA study, were included in this analysis.…”

Section: Introductionmentioning

confidence: 99%

Sex-dependent differences in vulnerability to early risk factors for posttraumatic stress disorder: results from the AURORA study

Haering,

Seligowski,

Linnstaedt

et al. 2024

Psychol. Med.

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Background Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD. Methods As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men. Results Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects. Conclusions Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.

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Sex Differences in PTSD: Mediation and Moderation Effects

Cited by 7 publications

References 45 publications

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

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

Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness

Sex-dependent differences in vulnerability to early risk factors for posttraumatic stress disorder: results from the AURORA study

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