Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.

980

720

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’ Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Section: Resultssupporting

confidence: 85%

Trauma and PTSD in the WHO World Mental Health Surveys

Kessler

Aguilar‐Gaxiola

Alonso

et al. 2017

980

720

“…Furthermore, they seem less likely to seek help for mental health problems after trauma (Möller-Leimkühler, 2002), which may leave untreated symptoms more likely to develop to suicidality. Thirdly, following trauma, women are more likely than men to meet criteria for PTSD (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Tolin & Foa, 2006). PTSD has frequently been reported to be associated with suicidality and may be an important mediator in further development of suicidality after trauma (Ford & Gomez, 2015; Panagioti et al, 2015; Wilcox, Storr, & Breslau, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge on how various types of traumatic event may predict suicidality (Yoo et al, 2018) is, however, still scarce, especially with regard to gender. Studies have shown that men are more likely than women to experience various types of trauma, except for sexual and violent trauma (de Vries & Olff, 2009; Tolin & Foa, 2006). Women are, however, more likely to engage in self-harm and suicide attempts than men (Nock et al, 2008; World Health Organization, 2014).…”

mentioning

confidence: 99%

The association between different traumatic life events and suicidality

Ásgeirsdóttir

Valdimarsdóttir

Thorsteinsdottir

et al. 2018

Background: Traumatic life events have been associated with increased risk of various psychiatric disorders, even suicidality. Our aim was to investigate the association between different traumatic life events and suicidality, by type of event and gender. Methods: Women attending a cancer screening programme in Iceland (n = 689) and a random sample of men from the general population (n = 709) were invited to participate. In a web-based questionnaire, life events were assessed with the Life Stressor Checklist – Revised, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criterion was used to identify traumatic life events. Reports of lifetime suicidal thoughts, self-harm with suicidal intent and suicide attempt were considered as lifetime suicidality. We used Poisson regression, adjusted for demographic factors, to express relative risks (RRs) as a measure of the associations between traumatic events and suicidality. Results: Response rate was 66% (922/1398). The prevalence of lifetime traumatic events was 76% among women and 77% among men. Lifetime suicidality was 11% among women and 16% among men. An overall association of having experienced traumatic life events with suicidality was observed [RR 2.05, 95% confidence interval (CI) 1.21–3.75], with a stronger association for men (RR 3.14, 95% CI 1.25–7.89) than for women (RR 1.45, 95% CI 0.70–2.99). Increased likelihood for suicidality was observed among those who had experienced interpersonal trauma (RR 2.97, 95% CI 1.67–5.67), childhood trauma (RR 4.09, 95% CI 2.27–7.36) and sexual trauma (RR 3.44, 95% CI 1.85–6.37), with a higher likelihood for men. In addition, an association between non-interpersonal trauma and suicidality was noted among men (RR 3.27, 95% CI 1.30–8.25) but not women (RR 1.27, 95% CI 0.59–2.70). Conclusion: Findings indicate that traumatic life events are associated with suicidality, especially among men, with the strongest association for interpersonal trauma.

“…Research has consistently found that females are more vulnerable to the development of PTSD than males (Breslau, 2009; Tolin & Foa, 2006). The present study found no gender differences in clinical post-traumatic stress symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…First, the method of retrospective self-report could lack validity, as self-reports may be influenced by forgetting, lack of awareness, or reporting bias related to emotional states or gender roles (Tolin & Foa, 2006). However, false negatives appear to be more common than false positives in the general population, and possible biased associations between retrospective reports of CMT and psychopathology may be the result of the rehearsal of memories, rather than bias related to current emotional states (Hardt & Rutter, 2004).…”

Section: Discussionmentioning

confidence: 99%

Childhood maltreatment trauma: a comparison between patients in treatment for substance use disorders and patients in mental health treatment

Rasmussen¹,

Arefjord

Winje

et al. 2018

Background: While previous research has found strong associations between childhood maltreatment trauma and substance use disorders (SUDs), the role of possible moderating effects of gender and mediating effects of psychopathology and SUD is unclear.Objective: The objective of this study was to investigate differences in self-reported childhood maltreatment trauma, general psychological distress, and post-traumatic stress symptoms between 112 patients in treatment for substance use disorders (SUD group) and 112 matched controls with mild to moderate mental health disorders (comparison group).Methods: Childhood maltreatment trauma was measured by the Childhood Trauma Questionnaire – Short Form (CTQ-SF). General psychological distress was measured by the Symptom Checklist-90 – Revised (SCL-90-R), and post-traumatic stress symptoms were measured by the Impact of Event Scale – Revised (IES-R).Results: The SUD group reported more severe childhood maltreatment trauma than the comparison group. Females in the SUD group reported more severe and various forms of trauma compared to males. The SUD group reported higher mean scores on the SCL-90-R, but the proportions of people with caseness scores on the IES-R and the SCL-90-R were similar in the two samples. The SUD group reported more avoidance symptoms than the comparison group.Conclusion: This study adds further evidence to the repeatedly found strong associations between childhood maltreatment trauma and SUD, implying that the prevention of childhood maltreatment trauma may reduce the occurrence of SUD. Furthermore, patients with SUD should be screened for childhood maltreatment trauma, and the results should be applied in trauma-informed as well as trauma-focused interventions aimed to help this population. The association appears to be particularly strong for female substance users.