Sex differences in the severity and natural recovery of child PTSD symptoms: a longitudinal analysis of children exposed to acute trauma

Abstract

Background Higher levels of PTSD symptoms are present among trauma-exposed females v. males in adulthood; however, much less is known about the emergence of this sex difference during development. Methods In a multi-study sample of 7–18-year-olds (n = 3397), we examined the effect of sex and age on the severity of PTSD symptoms after a single incident trauma at 1 month (T1), and on symptom change after a natural recovery period of 3 (T2) and 6 months (T3). PTSD scores were harmonised across measurement types, and linear regressions were used to determine sex and age effects, adjusting for study level variance and trauma type. Results A sex × age interaction was observed at T1 (p < 0.001) demonstrating that older age was associated with greater PTSD symptom severity in females (β = 0.008, p = 0.047), but less severe symptoms in males (β = −0.011, p = 0.014). The same pattern was observed at T2 and T3, with sex differences beginning to emerge by age 12 years. PTSD symptoms decreased naturally by ~25% at T2 with little further improvement by T3. Further, females showed a greater reduction in symptoms at T3 than males, although the same effect was not observed at T2. Conclusions Sex differences in PTSD symptoms become apparent during adolescence, due to opposing changes in susceptibility occurring in females and males with age. Understanding the factors contributing to these findings is likely to provide wider insight into sex-specific psychological vulnerability to trauma-related psychopathology.

Change in prevalence of post-traumatic stress disorder in the two years following trauma: a meta-analytic study

“…In children, a meta-analysis investigating PTSD prevalence and symptom severity in the first 12 months post-trauma concluded that there was a period of spontaneous recovery in the initial 3–6 months post-trauma, with only small improvements seen after this point (Hiller et al, 2017 ). These findings are similar to results from a multi-study sample of 7–18-year-olds, in which a natural 25% decline in child PTSD symptoms was observed at 3 months, with little improvement thereafter (Hiscox et al, 2022 ). In the adult literature, a systematic review of longitudinal studies between 1998 and 2010 found the median prevalence of PTSD in adults exposed to trauma to be 28.8% at 1 month, declining to 17% at 12 months, with most evidence of changes in median prevalence within the first 6 months (Santiago et al, 2013 ).…”

“…Several theories have been proposed to explain the higher prevalence of PTSD following intentional trauma, including higher levels of distress during the trauma (Ozer, Best, Lipsey, & Weiss, 2003 ), increased negative beliefs (Christiansen & Hansen, 2015 ), and loss of social support (Jiang, Webster, Robinson, Kassam-Adams, & Richmond, 2018 ). There is also evidence that the type of exposure can lead to different symptom manifestations (Birkeland et al, 2021 ) and influence the course of PTSD, with some studies reporting that intentional trauma is associated with poorer recovery (Hiscox et al, 2022 ; Santiago et al, 2013 ).…”

Somatic and Posttraumatic Stress Symptoms in Children and Adolescents in France

“…39,40 With regard to the effect of sex assigned at birth on the increase and maintenance of PTSD symptoms, some studies suggest that these differences begin to appear after the age of 12 years. 41 In particular, children and adolescents experiencing a sexual violence event, hostage situation, or terrorist attack are at risk of PTSD in more than 50% of cases, 30,34,42 whereas the ones experiencing natural disasters are approximately 30%. 43 Moreover, a growing literature is examining age-specific clinical features and the necessity of developing child-focused interventions.…”

“…However, other studies found no effect of sex assigned at birth in the development of PTSD . With regard to the effect of sex assigned at birth on the increase and maintenance of PTSD symptoms, some studies suggest that these differences begin to appear after the age of 12 years . In particular, children and adolescents experiencing a sexual violence event, hostage situation, or terrorist attack are at risk of PTSD in more than 50% of cases, whereas the ones experiencing natural disasters are approximately 30% .…”

Sex and gender in psychotrauma research

“…Christiansen & Hansen, 2015 ; Olff, 2017 ; Olff et al, 2007 ) across the life span (e.g. Grenier et al, 2019 ; Hiscox, Bray, et al, 2023 ; Rezayat et al, 2020 ). PTSD, for instance, is typically two to three times more common in women than in men (Tortella-Feliu et al, 2019 ).…”