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Sex Differences in Trauma and Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of Research

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Abstract

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.

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... Women seem to be more likely to develop PTSD than men after a traumatic experience (Tolin & Foa 2006), as was also observed in populations exposed to war trauma (Ai et al. 2002, Ekblad et al. 2002). Women's higher risk of certain types of trauma (e.g., rape, loss of spouse) has been suggested as the cause of the higher tendency to develop PTSD (Ekblad et al. 2002). ...
... Although some studies have suggested that PTSD symptom expression was similar in women and men (Chung et al. 2018), others have suggested that PTSD symptoms differ between genders (Ibrahim & Hassan 2017). There is no consensus about the role of the heightened prevalence of certain trauma types on the increased tendency of developing PTSD among women (Tolin & Foa 2006). Social and gender roles, cognitive factors, biological determinants and social factors, have been proposed as dimensions of multifactorial etiology (Breslau 2002). ...
... Although the lifelong prevalence of PTSD is estimated to be two times higher in women than in men, it has been reported that men experience more frequent traumatic experiences than women during their lifetime (Frans et al. 2005). In a quantitative review of 25 years of research, Tolin & Foa reported that female participants had a higher PTSD prevalence, although adult male participants were more likely to report traumatic experiences among all trauma types, including 'Combat, war, or terrorism' (Tolin & Foa 2006). When we focus on the studies on PTSD among Syrian refugees, we are able to summarize the differences below. ...
Article
Background: This study firstly described gender differences in traumatic experiences and the symptomatology and posttraumatic stress disorder (PTSD), among Syrian refugees settled in a camp in Turkey. Secondly, we aimed to discuss the reasons for gender differences, by comparing with the studies conducted on these Syrian refugees of the same culture who are the victims of the same war in their new settlement where they had been forced to migrate. Subjects and methods: This cross-sectional study was carried out on 352 refugees, randomly selected from a single settlement. The diagnosis of PTSD was performed using face-to-face psychiatric interviews according to the DSM-IV-TR criteria. The Stressful Life Events Screening Questionnaire and a sociodemographic history form were administered to all participants. We compared our results with other PTSD studies on Syrian Refugees. Results: Men were exposed to traumatic events 1.29 times more frequently than women. However, the prevalence of PTSD was significantly higher in women (44.1%) than in men (18.1%), with a prevalence of 30.7% in the overall sample. While symptoms of intrusion and avoidance/numbing were more prevalent in women with PTSD, there was no difference in symptoms of hypervigilance between genders. However, women reported a higher prevalence of fear response to traumatic events. Conclusions: Female refugees may be more prone than men to develop PTSD, although both genders shared the same traumatic environment in the early post-traumatic periods. The higher frequency of intrusion and avoidance/numbing may originate from an increased tendency of anxiety structural dissociation among women, alongside possibly higher peritraumatic dissociation, which may be also boosted by the higher ongoing perception of threat among female refugees. The possible role of peritraumatic and ongoing dissociation in PTSD should be taken into consideration for further research, particularly among populations under ongoing threat.
... The preponderance of trauma research concurs regarding the presence of a gendered "distress" gap after exposure to PTEs, where women experience PTSD at higher rates than men (Gavranidou and Rosner 2003;Laufer and Solomon 2009;Olff et al. 2007;Tolin and Foa 2006). Scholars ascribe these differences to three sources: (1) differential exposure to PTEs; (2) differential roles and resilience; and (3) gender differences in perceived threat. ...
... While widely observed in the literature, women's greater tendency to develop PTSD after trauma exposure compared with men warrants critical analysis (Laufer and Solomon 2009;Olff et al. 2007;Tolin and Foa 2006). Research on PTSD has historically emphasized male soldiers' (especially Americans') experiences (Brewin, Andrews, and Valentine 2000). ...
... Others suggest that military service and combat exposure are stronger precursors for depression and PTSD in women than men (Lehavot et al. 2018;Luxton, Skopp, and Maguen 2010). These mixed results across studies may result from divergent methodologies, study populations, or approaches to measuring specific PTEs, such as sexual trauma, that predominate among women in the military (Tolin and Foa 2006). ...
Article
Growing numbers of women in militaries worldwide, coupled with vast segments of women within war-affected populations globally, raise questions about gender as it structures trauma exposure, posttraumatic stress disorder (PTSD), and other mental health consequences of war. In this study, we investigate the gendered associations between early-life wartime stress exposures and PTSD symptoms in older adulthood using data from the 2018 Vietnam Health and Aging Study, a unique data set documenting multiple dimensions of health and wartime stress exposures within a sample of older adults who occupied diverse roles during the American war in Vietnam. Our results indicate that the severity of recent PTSD symptoms is significantly and positively associated with the severity of wartime stress exposure among both men and women. Vietnamese men’s social positions, particularly their predominance in combat, exposed them to more numerous war-related stressors. However, Vietnamese women experience a greater PTSD penalty associated with some wartime stress exposures, likely due to the burden of protecting family in wartime and incorporation into military and paramilitary roles with lesser preparation, training, and support than men. We conclude that women who survive major wars, both as soldiers and civilians, bear a significant burden of armed conflict’s lasting toll upon mental health.
... Following exposure to traumatic events, including sexual abuse, males are known to be less likely to experience threshold post-traumatic stress disorder (PTSD) compared with females, but report comparatively higher rates of externalising symptoms, including alcohol and drug use, irritability, anger and violent behaviour. 13 Of note, DSM-5-TR acknowledges that this constellation of externalising symptoms are particularly likely to co-occur with major depressive disorder in men. 14 Traumatic events may exacerbate underlying socially influenced gender differences in response to distress, resulting in alternative constellations of post-traumatic symptom patterns among boys and men. ...
... 14 Traumatic events may exacerbate underlying socially influenced gender differences in response to distress, resulting in alternative constellations of post-traumatic symptom patterns among boys and men. 13 Clinicians reticent to ask about men's sexual abuse experiences may inadvertently add to the harms experienced by men seeking care. Poor treatment experiences among male sexual abuse populations can reinforce a sense of shame and secrecy, perpetuate rejection and prohibit the development of therapeutic trust, acceptance, connection and honest disclosure with treating therapists. 2 Future research should examine differential outcomes for boys and men based on whether disclosure (and treatment access) is provided proximally to exposure, and the types of supportive approaches and interventions that boys and men experience as acceptable, engaging and safe. ...
Article
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The spectrum of adverse mental health trajectories caused by sexual abuse, broadly defined as exposure to rape and unwanted physical sexual contact, is well-known. Few studies have systematically appraised the epidemiology and impact of sexual abuse among boys and men. New meta-analytic insights (k = 44; n = 45 172) reported by Zarchev and colleagues challenge assumptions that men experiencing mental ill health rarely report sexual abuse exposure. Adult-onset sexual abuse rates of 1–7% are observed in the general population, but for men experiencing mental ill health, adult lifetime prevalence was 14.1% (95% CI 7.3–22.4%), with past-year exposure 5.3% (95% CI 1.6–12.8%). We note that these rates are certainly underestimates, as childhood sexual abuse exposures were excluded. Boys and men with a sexual abuse history experience substantial disclosure and treatment barriers. We draw attention to population health gains that could be achieved via implementation of gender-sensitive assessment and intervention approaches for this at-risk population.
... This lower treatment effect for girls can be explained by the fact that girls are more likely to experience interpersonal trauma (i.e. sexual assault and abuse) than boys, whereby girls tend to develop more post-traumatic cognitions when they experience low social support after a traumatic event [58,59], which may particularly have a negative effect on their wellbeing [60]. The presence of these post-traumatic cognitions may lead to higher levels of shame and self-blame [59], causing more persistent symptoms before treatment, and smaller treatment effects in girls than boys. ...
... sexual assault and abuse) than boys, whereby girls tend to develop more post-traumatic cognitions when they experience low social support after a traumatic event [58,59], which may particularly have a negative effect on their wellbeing [60]. The presence of these post-traumatic cognitions may lead to higher levels of shame and self-blame [59], causing more persistent symptoms before treatment, and smaller treatment effects in girls than boys. ...
Article
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Children can develop post-traumatic stress disorder (PTSD) and mental health symptoms after traumatic events. This meta-analysis evaluated the influence of moderators of cognitive behavioural trauma treatment (CBTT) with caregiver involvement in traumatized children. A total of 28 studies were included, with 23 independent samples and 332 effect sizes, representing the data of 1931 children (M age = 11.10 years, SD = 2.36). Results showed a significant medium overall effect (d = 0.55, t = 2.478, p = 0.014), indicating CBTT with caregiver involvement was effective in treating PTSD (d = 0.70), with somewhat smaller effect sizes for internalizing, externalizing, social, cognitive and total problems (0.35 < d > 0.48). The positive treatment effect was robust; we found somewhat smaller effect sizes at follow-up (d = 0.49) compared to post-test (d = 0.57) assessments. Furthermore, several sample (i.e. child’s age, gender, and trauma event), programme (i.e. the duration of treatment, number of sessions), study (i.e. control condition, type of instrument, informant, type of sample), and publication (i.e. publication year and impact factor) characteristics moderated the treatment outcomes of the child. In sum, the results of our meta-analysis might help to improve the effectiveness of cognitive behavioural trauma treatment for youth with PTSD, and guide the development of innovative trauma interventions that involve caregivers. Implications for theory and practice are discussed.
... Sex differences in experience of PTSD however must control for the nature of the precipitating stimulus. A detailed metaanalysis (290 studies) of types of trauma producing PTSD in primarily WEIRD societies showed that for every type of trauma except childhood sexual abuse, more females than males developed PTSD (OR = 1.98) (Tolin & Foa, 2006). Further detail came from a Nordic study (n > 5,200) in which approximately twice as many women (25.6%) as men (13.2%) were categorized as having PTSD (Ditlevsen & Elklit, 2012). ...
... While the female preponderance of PTSD could be due to more females than males experiencing severe trauma, current evidence disputed this. In the meta-analysis in WEIRD countries, fewer females than males confronted severe traumas (OR = 0.77) (Tolin & Foa, 2006). Likewise, globally, females were less likely than males to die from fatal injuries (WHO, 2014a) or become disabled due to injuries (Haagsma et al., 2016). ...
Article
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We extend Benenson et al.'s hypothesis from the individual level to the societal level. Because women have highly limited reproductive rates, societies have generally prioritized female survival and regarded males as expendable. We describe various lines of evidence that are consistent with this hypothesis, and we offer additional predictions about differential attitudes toward male versus female endangerment.
... While PTSD is caused by a preceding traumatic event, traumatic exposure does not necessarily lead to PTSD, indicating a multifactorial etiology [4]. Meta-analyses have identified several risk factors, differentiating between factors before, during, and after the trauma [5][6][7]. Among the most important risk factors were specific characteristics during the traumatic situation, such as perceived life-threat or dissociation and general life stress or lack of social support in the aftermath of experiencing trauma. ...
... Overall, most of the causes mentioned by the participants resembled causes and risk factors for PTSD that have been identified by meta-analyses, e.g., certain characteristics of the traumatic event, general life stress, lack of social support, lower socio-economic status, prior trauma, childhood adversities, and being female [5][6][7]. The results thus indicate that clinicians' etiological models for PTSD might be plausible for, and shared by, laypersons. ...
Article
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Abstract: Laypersons’ causal beliefs about mental disorders can differ considerably from medical or psychosocial clinicians’ models as they are shaped by social and cultural context and by personal experiences. This study aimed at identifying differences in causal beliefs about post-traumatic stress disorder (PTSD) by country and gender. A cross-sectional, vignette-based online survey was conducted with 737 participants from Germany, Greece, Ecuador, Mexico, and Russia. Participants were presented with a short unlabeled case vignette describing a person with symptoms of PTSD. Causal beliefs were assessed using an open-ended question asking for the three most likely causes. Answers were analyzed using thematic analysis. Afterwards, themes were transformed into categorical variables to analyze differences by country and by gender. Qualitative analyses revealed a wide range of different causal beliefs. Themes differed by gender, with women tending to mention more external causal beliefs. Themes also differed between the five countries but the differences between countries were more pronounced for women than for men. In conclusion, causal beliefs were multifaceted among laypersons and shared basic characteristics with empirically derived risk factors. The more pronounced differences for women suggest that potential gender effects should be considered in cross-cultural research.
... Sex differences in experience of PTSD however must control for the nature of the precipitating stimulus. A detailed metaanalysis (290 studies) of types of trauma producing PTSD in primarily WEIRD societies showed that for every type of trauma except childhood sexual abuse, more females than males developed PTSD (OR = 1.98) (Tolin & Foa, 2006). Further detail came from a Nordic study (n > 5,200) in which approximately twice as many women (25.6%) as men (13.2%) were categorized as having PTSD (Ditlevsen & Elklit, 2012). ...
... While the female preponderance of PTSD could be due to more females than males experiencing severe trauma, current evidence disputed this. In the meta-analysis in WEIRD countries, fewer females than males confronted severe traumas (OR = 0.77) (Tolin & Foa, 2006). Likewise, globally, females were less likely than males to die from fatal injuries (WHO, 2014a) or become disabled due to injuries (Haagsma et al., 2016). ...
Article
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The target article presented a plausible argument that females' susceptibility to threats might be self-protection for staying alive, but some evidence requires scrutiny. We need to consider (1) the biases of narrative reviews, (2) subjective life quality, and (3) the shadow side of extreme reactions to threats before concluding that females' threat-based response is a self-protection mechanism that promotes survival.
... Sociodemographic factors were collected because such variables may confound the relationship between personality traits and PTSD. 18,31,32 The Big Five personality traits can be measured using a variety of instruments, including the Neuroticism/Extraversion/Openness Personality Inventory, 25 Trait Descriptive Adjectives survey, and the BFI, which come in a variety of lengths. 33 Our survey used the 44-item BFI because of its brevity. ...
... Inconsistent with prior reports that showed that female participants were more likely than male participants to meet diagnostic criteria for PTSD 31 and that military service significantly increased the risk of developing PTSD, 32 we found that the sociodemographic characteristics of dental residents did not significantly contribute to PTSD scores. However, our analysis included a small sample of residents (n = 11) with military backgrounds. ...
Article
Purpose/objectives: The coronavirus disease 2019 (COVID-19) pandemic has presented mental health challenges among healthcare professionals, including posttraumatic stress disorder (PTSD). Few studies have examined PTSD predictors in dental settings. This cross-sectional study aimed to describe the relationship between personality traits and PTSD symptoms among US dental residents engaged in patient care during the pandemic. Methods: An online survey was administered to residents in advanced education in general dentistry, dental anesthesia, general practice residency, oral and maxillofacial surgery, and pediatric dentistry programs between September 2020 and April 2021. The survey included a sociodemographic questionnaire, the Big Five Inventory, and the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Logistic regression models, analysis of variance, and Tukey tests were used to examine the association between variables and PTSD scores and assess differences in personality traits and PTSD by specialty. Results: Among 149 respondents (mean age = 29.9 ± 4.9 years; 57.0% female), 53.7% reported experiencing stress during the pandemic. Many residents (38.9%) were not aware of available mental health resources. A total of 17.4% of residents met the diagnostic criteria for PTSD, but only 1.3% reported a previous PTSD diagnosis. The most significant predictors of PTSD were neuroticism (odds ratio = 2.90, p = 0.046) and stress unrelated to the resident's program role during the pandemic (odds ratio = 5.88, p = 0.02). Conclusions: PTSD symptoms were highly prevalent among dental residents, with stress and neuroticism being the most significant predictors.
... On the basis of a number of studies, being female appeared to be the most commonly indicated risk factor for PTSD during the pandemic. 9,19,20,24 A meta-analysis reported that females were more likely to meet PTSD criteria despite a lower likelihood of experiencing traumatic events, 25 with the higher rate of PTSD related to the higher rate of fear-and anxiety-based disorders in females. 25 It has also been suggested that females have higher rates of peritraumatic fear, horror, panic, helplessness, physical anxiety sensitivity, and dissociation, increasing the risk of PTSD. ...
... 9,19,20,24 A meta-analysis reported that females were more likely to meet PTSD criteria despite a lower likelihood of experiencing traumatic events, 25 with the higher rate of PTSD related to the higher rate of fear-and anxiety-based disorders in females. 25 It has also been suggested that females have higher rates of peritraumatic fear, horror, panic, helplessness, physical anxiety sensitivity, and dissociation, increasing the risk of PTSD. 26 Our study also found that nonphysician HCWs were at significantly higher risk than physicians for developing PTSD. ...
Article
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Background: Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19. Methods: This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD. Results: The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19. Conclusions: HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.
... These statistics differ from clinical reports in which women appear to be more sensitive to the consequences of ELS and more susceptible to the development of stress-related and anxiety disorders (Daskalakis et al., 2013;Kessler, 2003;Schöner et al., 2017). Moreover, women are far more exposed to adversity than men (Robles-García et al., 2020), especially to some type of traumatic experiences such as sexual assault, child sexual abuse, domestic violence, and lack of social and family protection (Kilpatrick et al., 2013;Robles-García et al., 2020;Tolin and Foa, 2006). ...
Article
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The neurobiology and development of treatments for stress-related neuropsychiatric disorders rely heavily on animal models. However, the complexity of these disorders makes it difficult to model them entirely, so only specific features of human psychopathology are emulated and these models should be used with great caution. Importantly, the effects of stress depend on multiple factors, like duration, context of exposure, and individual variability. Here we present a review on pre-clinical studies of stress-related disorders, especially those developed to model posttraumatic stress disorder, major depression, and anxiety. Animal models provide relevant evidence of the underpinnings of these disorders, as long as face, construct, and predictive validities are fulfilled. The translational challenges faced by scholars include reductionism and anthropomorphic/anthropocentric interpretation of the results instead of a more naturalistic and evolutionary understanding of animal behavior that must be overcome to offer a meaningful model. Other limitations are low statistical power of analysis, poor evaluation of individual variability, sex differences, and possible conflicting effects of stressors depending on specific windows in the lifespan.
... Many individual factors, including demographic factors (e.g., biological sex), clinical factors such as the presence of an internalizing disorder (e.g., anxiety, depression) or attention-deficit/hyperactivity disorder (ADHD), and the impact of the trauma (e.g., duration, proximity, severity) have been previously identified as predictors of psychological trauma development following traumatic events. Regarding sex, females develop PTSD at a higher rate than males even when trauma type is controlled for (e.g., Garza & Jovanovic, 2017;Tolin & Foa, 2006) and score higher on reexperiencing, avoidance, and arousal subscales of PTSD (Ditlevsen & Elklit, 2010). Internalizing disorders contribute to the pretraumatic risk for PTSD in females, since these disorders are more prevalent in females than males postpuberty (e.g., Christiansen & Hansen, 2015). ...
Article
Objective: This longitudinal study investigated the predictors of and changes in psychological trauma during the COVID-19 pandemic. Method: Participants included 236 adolescents (130 males; Mage = 16.74 years in spring 2020; 49.6% diagnosed with attention-deficit hyperactivity disorder; 16.1% diagnosed with an anxiety or depressive disorder) in the United States who completed online questionnaires at four timepoints (spring 2020, summer 2020, fall 2020, spring 2021). Results: Repeated measures ANOVA showed that psychological trauma was highest during stay-at-home orders in spring 2020, and decreased for a majority of adolescents by the summer of 2020. However, ~20% of adolescents exhibited moderate-to-clinical levels of psychological trauma at each timepoint. Four groups were identified based on the presence of psychological trauma symptoms: (a) resilient group (normal range across all timepoints; 60.6%); (b) moderate fluctuating group (moderate range at 1 or more timepoints; 18.2%); (c) severe fluctuating group (clinical range at 1 or more timepoints; 14.0%); and (d) chronic psychological trauma group (moderate or clinical range across all timepoints; 7.2%). Females, adolescents with preexisting internalizing disorders, and participants whose families were most impacted by the pandemic were more susceptible to experiencing psychological trauma symptoms. Conclusions: Findings highlight at-risk populations and suggest that the COVID-19 pandemic resulted in psychological trauma symptoms for approximately 20% of adolescents at some point during the first year of the pandemic. There is critical need to provide mental health services to adolescents, such as through school-based services, to reduce the negative long-term psychological impact of the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Based on the support for our hypotheses, we conducted a supplemental analysis to explore sex and race differences in the effectiveness of the CTHP given previous findings about the differences in trauma and its consequences (e.g., American Psychiatric Association, 2013; Baranyi et al., 2018;Tolin & Foa, 2006). Specifically, we conducted a multigroup analysis, using equality constraint, to see whether the effect of the CTHP participation significantly differed between males and females and between whites and blacks. ...
Article
This paper assesses a faith-based, short-term program for trauma healing among incarcerated individuals, “Correctional Trauma Healing Program” (CTHP). We hypothesized that participation in the CTHP would reduce negative consequences of lifetime trauma: symptoms of PTSD, state depression, state anger, suicidal ideation, and the risk of interpersonal aggression. We also hypothesized that the reduction, if found, would be partly attributable to anticipated program outcomes (a decrease in vengefulness and an increase in religiosity, forgiveness, perceived forgiveness of God, gratitude to God, and perceived positive impact of the Bible). To test our hypotheses, we conducted a quasi-experimental study of 349 jail inmates in Virginia. Manifest-variable structural equation modeling was applied to analyze data from pretest and posttest surveys. As hypothesized, the CTHP reduced the negative consequences of trauma by increasing religiosity and other positive attributes and decreasing vengefulness directly and/or indirectly via increased religiosity. Implications and limitations of our study are discussed.
... The psycho-emotional differences on the way to interpret and reveal childhood events between females and males may account for this gender difference (Kim, 2017). Although girls are usually more susceptible and vulnerable to traumatic events (Tolin & Foa, 2008), compared with girls, boys are less willing to reveal or disclose their past adverse experiences in childhood (Bynum et al., 2010). Instead of seeking help from teachers and social workers, they usually hide their emotions and try to face the adverse events themselves, which may lead to higher level of depression. ...
Article
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The negative effect of adverse childhood experiences (ACEs) on children’s mental health is widely explored. However, the mediating and moderating mechanisms underlying this relationship among children in mainland China are rarely investigated. This study examines the indirect link from ACEs to children’s depressive symptoms and self-esteem through peer victimization and positive identity. Gender differences in the pathways are also discussed. A total of 775 primary and middle school students (mean age = 12.43, 9–16 years old, 46.3% males) in Dali city of Yunnan province voluntarily participated in a questionnaire survey. The ACEs, depressive symptoms, self-esteem, peer victimization, and positive identity were assessed via questionnaire survey using validated measurement tools. Structural equation model with Amos 24.0 was used to test the hypothesized theoretical model. The results showed that ACEs had a direct effect on children’s depressive symptoms and self-esteem. Meanwhile, peer victimization and positive identity partially mediated the main effect. Moreover, four paths in the model showed significant gender differences, namely, from ACEs to depressive symptoms, from ACEs to peer victimization, from positive identity to depressive symptoms, and from positive identity to self-esteem. All of these paths showed that the moderating effect was stronger for males than for females. This study contributes to the current understanding of the mechanisms of ACEs on children’s depressive symptoms and self-esteem. Findings also highlight that future intervention programs and social services for enhancing children’s mental health must be more targeted to male victims of ACEs.
... In addition, girls tend to internalize their trauma, whereas boys tend to externalize these experiences (Dulmus et al., 2004;Gauthier-Duchense et al., 2017;Shufelt & Cocozza, 2006). These differences in internalization/externalization and differential neuropsychological alternation in response to trauma has differential implications on mental health; the American Psychiatric Association (APA; 2017) estimates that women are twice as likely to experience anxiety-related disorders, post-traumatic stress disorder, or depression, whereas men are more likely to commit suicide, have a substance use disorder, or have impulse control disorders (see also Cauffman et al., 1998;Tolin & Foa, 2006;World Health Organization [WHO], 2002). ...
Thesis
Justice-involved youth are exposed to adverse childhood experiences (ACEs) at higher rates than youth in the general public, highlighting the importance of addressing childhood trauma and adversity in juvenile justice settings. A majority of ACEs research has focused on the general population and has demonstrated the long lasting negative impact of ACEs, on mental health, physical health, and engagement in health risk behaviors. Both gender and racial/ethnic differences have been identified in ACEs literature, suggesting that not all groups in society have the same likelihood of experiencing ACEs. Additionally, ACEs may also impact individuals from racial/ethnic or gender groups differently, resulting in variable outcomes. In comparison to the ACEs literature among the general public, little research has examined ACEs among justice involved youth, and even fewer studies have examined gender and racial/ethnic differences in these settings. A historical account of gender and racial/ethnic discrimination within the juvenile justice system, coupled with the feminist pathways perspective within an intersectional context, illustrates gendered racial/ethnic differences regarding pathways into the system and ongoing discrimination. To advance the ACEs literature, this dissertation explores the prevalence of ACEs as well as the relationship between ACEs, behavioral factors associated with delinquency, and recidivism within gendered racial/ethnic groups of justice-involved youth. The findings of the current study demonstrate the importance of accounting for both gender and race/ethnicity, as few studies have done so. Overall, the findings were mixed in relation to the prior literature and highlight the need for more research in this area, as few conclusions can be drawn from the current study’s findings. While more research is needed, broad policy implications are drawn from this study to help guide equitable assessment and treatment/services of trauma among justice-involved youth.
... Trauma related to motor-vehicle accidents yielded the smallest association. Research suggests that women display both a higher prevalence of PTSD (Olff, Langeland, Draijer, & Gersons, 2007;Tolin & Foa, 2006) as well as higher guilt scores relative to men (Cohen, Panter, & Turan, 2012). Yet, we did not detect a significant gender effect with respect to the relationship between guilt and PTSD symptoms. ...
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Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35-0.42, p < 0.001, I 2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13-0.29, p < 0.001, I 2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36-0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02-0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.
... For those few researchers who have explored ethnoracial differences in other common mental health disorders within Black American subgroups, within-group differences in prevalence and presentation have been noted [e.g., major depressive disorder (51), substance use disorder (52), obsessive compulsive disorder (53), anxiety disorders (32) Similarly, the experiences of men and women in terms of potential traumatic event-type exposure, PTSD development, and resultant treatment outcomes can be very different between the sexes. Absent consideration of ethnicity, a landmark metaanalysis by Tolin and Foa considering sex-specific risk to traumatic events and PTSD, found men were more likely than women to report having experienced a potentially traumatic lifeevent (54). Nevertheless, the authors of said review also noted women were more likely than their male counterparts to meet diagnostic criteria for PTSD and to report a greater severity of PTSD-related symptoms. ...
Article
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Objective: Posttraumatic stress disorder (PTSD) is a debilitating disorder requiring timely diagnosis and treatment, with special attention needed for Black populations in the U.S. Yet, stakeholders often fail to recognize Black communities' heterogeneous ethnic composition, thus not allowing diverse sociocultural realities to inform PTSD interventions. This study aims to characterize sex and ethnic differences in lifetime trauma exposure, lifetime PTSD diagnosis and symptoms, and help-seeking among the African Americans and Black Caribbeans in the U.S. Method: This study relied on data from the National Survey of American Life 2001-2003 (NSAL) to investigate the lifetime exposure to traumatic events and prevalence of a clinical PTSD diagnosis based on the DSM-IV among African American (n = 3,570) and Black Caribbean (n = 1,623) adults. 44.5% of respondents were men and 55.5% were women. Logistic regression was utilized to investigate the impact of traumatic events on PTSD. Results: Several ethnic and sex differences in exposure to potentially traumatic events were identified. African American respondents were more likely to experience spousal abuse and toxin exposure than their Black Caribbean counterparts. Black Caribbeans reported higher lifetime exposure to muggings, natural disasters, harsh parental discipline, being a civilian living in terror and/or being a refugee than African American respondents. Specific to sex, Black men reported more events of combat, a peacekeeper/relief worker, being mugged, toxin exposure, seeing atrocities, and/or injuring someone. Black women were more likely to have been rape/sexual assault and/or intimate partner violence victims. The assaultive violence trauma type was most predictive of lifetime PTSD diagnosis among Black Americans. African American women were more likely to report PTSD symptoms than men, with almost no significant differences in Black Caribbean men and women. Approximately half of Black Americans sought help for their worst traumatic event, commonly engaging family/friends, psychiatrists, and mental health professionals. Further, there were almost no ethnic and sex differences related to professional and non-professional help sought. Conclusion: Future PTSD-related research should aim to characterize the heterogenous experiences of potentially traumatic events within different Black communities. Clinicians working with Black clients should strive to understand the limitations within their tools/interventions in meeting the needs of diverse groups.
... As well, we recognize the enormous value of reviving pre-war agricultural lifestyle to help the Acholi people restore communal work and cultural connectedness (McElroy et al., 2012). Our study indicates a higher prevalence of probable PTSD and depression among conflict-affected women than men, affirming what has been widely demonstrated in the literature (Ditlevsen and Elklit, 2012;Tolin and Foa, 2008). Some suggest that higher rates among women may be explained by greater exposure to high-impact trauma such as war-related sexual assault, a tendency toward internalizing symptoms, emotion-focused versus problem-focused coping, and sex-differentiated neurobiological mechanisms involving oxytocin (Ainamani et al., 2020;Olff, 2017). ...
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Background From 1986 to 2006, Northern Uganda experienced an atrocious civil war between the Lord's Resistance Army (LRA) and the Ugandan government. Acholi people living in the region continue to be impacted by trauma sequelae of the war and a wide range of daily stressors including poverty, hunger, and high rates of HIV infection. To date, there is a dearth of gender-differentiated mental health research in this post-conflict setting. The current study aimed to estimate the prevalence of probable post-traumatic stress disorder (PTSD) and depression in three districts most affected by the Northern Ugandan conflict and examine socio-structural, war-related, and sexual vulnerability factors associated with mental health. Methods Cango Lyec (Healing the Elephant) is an open cohort study involving participants from eight randomly selected communities in Amuru, Gulu, and Nwoya districts of Northern Uganda. Between November 2011 and July 2012, the baseline cohort (N = 2,458) completed the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptom Checklist-25 (HSCL-25) for screening PTSD and depression, in addition to a detailed questionnaire assessing socio-demographic-behavioral characteristics. Baseline categorical variables were compared between males and females using Fisher's exact test. Multivariate logistic regression was used to model correlates of probable PTSD and depression. All analyses were stratified by gender. Results The overall prevalence of probable PTSD and depression was 11.7% and 15.2% respectively. Among former abductees, the prevalence was 23.2% for probable PTSD and 26.6% for probable depression. Women were significantly more likely to experience mental distress than men. Factors associated with mental distress included wartime trauma (adjusted odds ratios ranging from 2.80 to 7.19), experiences of abduction (adjusted odds ratios ranging from 1.97 to 3.03), and lack of housing stability and safety (adjusted odds ratios ranging from 1.95 to 4.59). Additional risk factors for women included HIV infection (AOR=1.90; 95% CI: 1.29–2.80), sexual abuse in the context of war (AOR=1.58; 95% CI: 1.02–2.45), and intimate partner violence (AOR=2.45; 95% CI: 1.07–5.63). Conclusion Cango Lyec participants displayed lower than previously reported yet significant levels of probable PTSD and depression. Based on findings from this study, providing trauma-informed care, ensuring food and housing security, eliminating gender-based violence, and reintegrating former abductees remain important tasks to facilitate post-conflict rehabilitation in Northern Uganda.
... Concerning gender, sexually abused boys and girls seemed to suffer by PTSD at comparable rates; metaregression analysis confirmed this finding. To the same conclusion came a meta-analysis conducted by Tolin and Foa [48], which did not detect gender differences examining the overall lifetime risk of PTSD, among sexually abused children. Moreover, gender differences were not found in the study by Maikovich et al. [49], showing that boys and girls, victims of sexual abuse, had the same chances in developing lifetime PTSD. ...
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Child sexual abuse (CSA) has been associated with mental health disorders throughout life during childhood, adolescence and adulthood; one of the most prevalent mental health conditions after CSA is post-traumatic stress disorder (PTSD). The present systematic review and meta-analysis aims to examine the association between CSA and PTSD in children and adolescents, evaluating also the role of potential effect modifiers, such as gender and geographic region. Participants were sexually abused (vs. CSA-free) children, adolescents and young adults, up to 21 years of age, with or without a PTSD diagnosis. Settings of eligible studies spanned school, college, university, community, hospital and non-hospital mental health facilities. Eligible studies were sought in PUBMED, ΕΜΒΑSE, PSYCINFO and GOOGLE SCHOLAR databases; end-of-search was set at August 31, 2020. Random-effects (DerSimonian-Laird) models were used for the pooling of studies. Results were reported as pooled odds ratios (OR) and 95% confidence intervals (95% CIs). Twenty-eight studies were identified, including a total cohort of 28,693 subjects. CSA was strongly associated with PTSD, at a similar extent in boys (pooled OR = 2.86, 95% CI 2.09–3.91) and girls (pooled OR = 2.38, 95% CI 1.76–3.23); meta-regression with gender confirmed the non-significant effect of gender. The association was present in all examined geographic regions. CSA is strongly associated with PTSD in childhood, adolescence and young adulthood, irrespectively of gender. Future studies should opt for thorough assessment of confounders and examine regions with paucity of studies, such as East Asia and Latin America.
... The orexigenic stomach-produced hormone, ghrelin, wellestablished for its role in feeding behavior control, has been recently indicated as a mediator of stress-related and anxiety disorders (12,13), and is explored as a potential therapeutic target. The prevalence of anxiety disorders in humans differs by sex (27,28), yet, sex differences in ghrelin axis and how any potential differences may affect the functional outcome of ghrelin for example on feeding or especially anxiety remain largely unexplored. Here, we evaluated key molecular and behavioral aspects of the ghrelin system in male and female rats, with a particular focus on ghrelin's role in feeding and anxiety-like behavior. ...
Article
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Ghrelin, a stomach-produced hormone, is well-recognized for its role in promoting feeding, controlling energy homeostasis, and glucoregulation. Ghrelin's function to ensure survival extends beyond that: its release parallels that of corticosterone, and ghrelin administration and fasting have an anxiolytic and antidepressant effect. This clearly suggests a role in stress and anxiety. However, most studies of ghrelin's effects on anxiety have been conducted exclusively on male rodents. Here, we hypothesize that female rats are wired for higher ghrelin sensitivity compared to males. To test this, we systematically compared components of the ghrelin axis between male and female Sprague Dawley rats. Next, we evaluated whether anxiety-like behavior and feeding response to endogenous or exogenous ghrelin are sex divergent. In line with our hypothesis, we show that female rats have higher serum levels of ghrelin and lower levels of the endogenous antagonist LEAP-2, compared to males. Furthermore, circulating ghrelin levels were partly dependent on estradiol; ovariectomy drastically reduced circulating ghrelin levels, which were partly restored by estradiol replacement. In contrast, orchiectomy did not affect circulating plasma ghrelin. Additionally, females expressed higher levels of the endogenous ghrelin receptor GHSR 1A in brain areas involved in feeding and anxiety: the lateral hypothalamus, hippocampus, and amygdala. Moreover, overnight fasting increased GHSR 1A expression in the amygdala of females, but not males. To evaluate the behavioral consequences of these molecular differences, male and female rats were tested in the elevated plus maze (EPM), open field (OF), and acoustic startle response (ASR) after three complementary ghrelin manipulations: increased endogenous ghrelin levels through overnight fasting, systemic administration of ghrelin, or blockade of fasting-induced ghrelin signaling with a GHSR 1A antagonist. Here, females exhibited a stronger anxiolytic response to fasting and ghrelin in the ASR, in line with our findings of sex differences in the ghrelin axis. Most importantly, after GHSR 1A antagonist treatment, females but not males displayed an anxiogenic response in the ASR, and a more pronounced anxiogenesis in the EPM and OF compared to males. Collectively, female rats are wired for higher sensitivity to fasting-induced anxiolytic ghrelin signaling. Further, the sex differences in the ghrelin axis are modulated, at least partly, by gonadal steroids, specifically estradiol. Overall, ghrelin plays a more prominent role in the regulation of anxiety-like behavior of female rats.
... Women's mental health is particularly important to examine in current times. Women are more likely to develop post-traumatic stress disorder in their lifetime than men [5][6][7][8]. In light of this past year's events in Lebanon, including the critical economic situation, due to both political turmoil and the COVID-19 pandemic, and a recently devastating atomic equivalent blast in the capital, resilience can no longer be avoided as an outcome when studying trauma in women. ...
Article
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Purpose: Resilience is defined as the ability to face adversities with positive outcomes. Various scales have been utilized, including 25-item Connor-Davidson Resilience Scale (CD-RISC), to evaluate resilience among populations. Resilience research is scarce, particularly in Lebanon as no such scales have been validated. Thus, in the present work, we aimed to assess the psychometric properties of the Arabic version of CD-RISC. Patients and methods: The study was conducted at the Women's Health Center at the American University of Beirut Medical Center among Lebanese women presenting to the obstetrics and gynecology clinics. Internal validity of the Arabic CD-RISC was examined. Pearson's correlation coefficients between the scores of the Arabic version of CD-RISC and the other related constructs (Rosenberg Self-Esteem Scale, Dispositional Hope Scale, Life Orientation Test, and Positive and Negative Affect Schedule) were assessed to evaluate its divergent and convergent validity. We collected responses from a total of 63 Lebanese women. Results: The studied scale displayed a high internal consistency. Adequate correlation coefficients were manifested by the significant positive moderate to strong and negative moderate correlations between the Arabic CD-RISC and the other related constructs. Conclusion: This is the first study to validate the Arabic version of the CD-RISC in a sample of Lebanese women. The findings of this study provide evidence that the Arabic version of CD-RISC is a reliable and valid tool for the evaluation of resilience among Lebanese women.
... A consistent finding in PTSD is that its prevalence is approximately two times greater in women compared to men (Kilpatrick et al., 2013;Tolin & Foa, 2006); however, few studies have examined mechanisms underlying sex differences in PTSD (for reviews, see Fonkoue et al., 2020;Seligowski et al., 2020). The most robust findings are that women exhibit heightened skin conductance responses to conditioned stimuli compared to men (Inslicht et al., 2013) and that gonadal hormones moderate these responses (e.g., higher progesterone in women with PTSD confers worse extinction retention; Pineles et al., 2016). ...
Article
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Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain–heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD–CVD link. The brain–heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain–heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain–heart axis. Finally, we discuss sex considerations in the PTSD–CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain–heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.
... Nearly 90% of adults in the U.S. report lifetime exposure to at least one potentially traumatizing event, while only 8.3% go on to develop posttraumatic stress disorder (1). Females report slightly lower rates of overall trauma exposure as compared to males, but are twice as likely to meet diagnostic criteria for PTSD (2). Females' proclivity to develop PTSD more frequently than males may be partially explained by greater exposure to specific types of trauma relative to males (e.g., intimate partner violence). ...
Article
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Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
... Future studies should consider the type of stressor used when studying sex differences. In humans, traumatic stress secondary to interpersonal violence or sexual abuse has a large pathogenic potential and is one of the most common sources of trauma in the population [93][94][95] . In sum, our results shed light on the role of PACAP-PAC1R in VMH for acute stress processing in female mice and show that the MeA to VMHdm circuit regulates PACAP short-term dynamics after an intense acute stressor and the appearance of a FE-deficient posttraumatic behavioral phenotype. ...
Article
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Exposure to traumatic stress can lead to fear dysregulation, which has been associated with posttraumatic stress disorder (PTSD). Previous work showed that a polymorphism in the PACAP-PAC1R (pituitary adenylate cyclase-activating polypeptide) system is associated with PTSD risk in women, and PACAP ( ADCYAP1 )-PAC1R ( ADCYAP1R1 ) are highly expressed in the hypothalamus. Here, we show that female mice subjected to acute stress immobilization (IMO) have fear extinction impairments related to Adcyap1 and Adcyap1r1 mRNA upregulation in the hypothalamus, PACAP-c-Fos downregulation in the Medial Amygdala (MeA), and PACAP-FosB/ΔFosB upregulation in the Ventromedial Hypothalamus dorsomedial part (VMHdm). DREADD-mediated inhibition of MeA neurons projecting to the VMHdm during IMO rescues both PACAP upregulation in VMHdm and the fear extinction impairment. We also found that women with the risk genotype of ADCYAP1R1 rs2267735 polymorphism have impaired fear extinction.
... This nonassociative difference in females also holds a great deal of translational significance. Women suffer from anxiety disorders at much greater rates than men (Tolin and Foa 2006;Bangasser et al. 2018). To our knowledge, there are no animal models of anxiety currently in use that replicate this, likely because most early work in anxiety modeling focused almost exclusively on males (Kokras and Dalla 2014). ...
Article
Inclusion of male and female subjects in behavioral neuroscience research requires a concerted effort to characterize sex differences in standardized behavioral assays. Sex differences in hippocampus-dependent assays have been widely reported but are still poorly characterized. In the present study, we conducted a parametric analysis of spontaneous alternation, object recognition, and fear conditioning in a commonly used control strain, C57BL/6NTac. Our findings show largely similar performance between males and females across the majority of behavioral end points. However, we identified an important difference in nonassociative fear sensitization, whereby females showed an enhanced fear response to the 75-dB tone that is used as the conditional stimulus. In addition, we observed an impairment in object location performance in females that was ameliorated by more extensive habituation to handling. Together, these findings argue that sex differences in nonassociative fear responses to both novel auditory cues and novel objects need to be considered when designing and interpreting cognitive assays in C57BL/6 mice. Furthermore, this elevated fear sensitization could serve as a novel approach to model the increased incidence of anxiety disorders in women.
... In detail, the lifetime and 12-month male to female prevalence ratios of anxiety disorders were 1:1.7 and 1:1.79, respectively (McLean et al. 2011). The disparity in prevalence between the two genders is seen in stress, anxietyrelated, and fear-based disorders, such as generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, and posttraumatic stress disorder (PTSD) (Tolin and Foa 2006;Kessler et al. 2009). This sex bias is mainly attributed to women's greater sensitivity to stressful experiences, and studies have shown that women exhibit more severe, frequent, and persistent symptoms, while experiencing more intense emotions of fear and panic than men (Holbrook et al. 2002;Donner and Lowry 2013;Altemus et al. 2014). ...
Chapter
Depression and anxiety disorders carry a tremendous worldwide burden and emerge as a significant cause of disability among western societies. Both disorders are known to disproportionally affect women, as they are twice more likely to be diagnosed and moreover, they are also prone to suffer from female-specific mood disorders. Importantly, the prevalence of these affective disorders has notably risen after the COVID pandemic, especially in women. In this chapter, we describe factors that are possibly contributing to the expression of such sex differences in depression and anxiety. For this, we overview the effect of transcriptomic and genetic factors, the immune system, neuroendocrine aspects, and cognition. Furthermore, we also provide evidence of sex differences in antidepressant response and their causes. Finally, we emphasize the importance to consider sex as a biological variable in preclinical and clinical research, which may facilitate the discovery and development of new and more efficacious antidepressant and anxiolytic pharmacotherapies for both women and men.
... Yet, findings suggested a significant association with a medium effect size for PTSD and depression in male participants. This association was smaller than what was found for female victims; however, this is not surprising seeing that women are more likely to develop PTSD in general, compared to men [92,96]. Moreover, researchers have previously argued that psychological violence targeting men might be different from psychological violence targeting women [97,98], and McHugh and colleagues [24] have argued that most validated measured used to screen for psychological violence have been developed based on female experiences with this type of abuse. ...
Article
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Purpose The present study examines the association between psychological violence and posttraumatic stress disorder (PTSD), depression, and anxiety, while comparing the specific subtypes of psychological violence and simultaneously focusing on methodological shortcomings. Method A systematic review and random-effects meta-analyses were applied on the three main outcomes: PTSD, depression, and anxiety. Four electronic databases were searched (PsycINFO, PubMed, EMBASE, and Web of Science), and a total of 194 studies were included ( k = 149 for meta-analyses). GRADEpro was used to evaluate the certainty of the evidence from the meta-analyses. Results Psychological violence had strong associations with the three main outcomes, with the strongest association for PTSD in both female and male victims. Coercive control was particularly associated with PTSD for female victims, while emotional/verbal and dominance/isolation had the strongest association with depression. Although the identified studies were characterized by gender bias, psychological violence appear to affect male mental health too. Discussion Findings from the meta-analyses support the notion that psychological violence is a traumatic experience, which is strongly association with PTSD and other common mental health problems linked to trauma. GRADEpro rated the certainty of evince to be low, and thus, our confidence in the estimated effect is limited. Gender bias, the applied terminology, and other methodological shortcomings are discussed. Despite the substantial amount of research on this topic, more research is needed before we can draw any final conclusions on the effect of psychological violence on mental health.
... Males were significantly more likely than females to be on a delayed-onset trajectory. Women are more vulnerable to posttraumatic distress after disaster (Norris et al., 2002;Tolin & Foa, 2006), though the lower rate of posttraumatic distress in men may reflect masculine norms impeding men acknowledging symptoms and seeking help (Street & Dardis, 2018). Accordingly, lower-level posttraumatic distress may be more likely to linger unresolved among men, making them on average more susceptible to exacerbation and delayed-onset posttraumatic distress. ...
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In 2014, the coalmine adjacent to the Hazelwood power station in the Latrobe Valley, Australia caught fire and distributed a large volume of toxic smoke into the surrounding community over 45 days. This study investigated risk and protective factors associated with four trajectories of posttraumatic distress (resilience; in-recovery; delayed-onset; chronic) in the affected community. A sample comprising 709 adults participated in two survey rounds, conducted in 2016-2017 and 2019-2020. Participants’ exposure to mine fire-related particulate matter (PM2.5) during the event, sociodemographic circumstances, physical and mental health histories, prior trauma, and exposure to recent stressful events were assessed. Mine fire-related posttraumatic distress was measured using the Impact of Events Scale – Revised and trajectories determined by categorising scores at each survey according to a threshold prescribed for identifying symptoms warranting clinical concern. Responses were analysed with univariate and multivariate multinomial regressions. Socioeconomic advantage and social support were associated with the resilient trajectory, which was the most common posttraumatic distress trajectory among participants. Prior trauma and recent stressful life-events, physical and mental health diagnoses, and loneliness were associated with chronic and delayed-onset trajectories. PM2.5 exposure during the mine fire was not a strong determinant of posttraumatic distress trajectory. Socioeconomic status, social connection, health and life experiences are among the most important factors shaping posttraumatic distress trajectories. These findings contribute to better understanding longer-term psychological resilience and vulnerability following disasters and can inform mental health initiatives within at-risk communities.
... There were slightly more males than females in the trauma population, in line with our knowledge that males are more likely to experience physical trauma (12). In 208 hospitals in the United States, over 60% of trauma patients received treatment in Med-Surg ICU. ...
Article
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Purpose This study aimed to determine the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in critically ill trauma patients. Methods This retrospective study involved adult trauma patients from 335 intensive care units (ICUs) at 208 hospitals stored in the eICU database. The primary outcome was ICU mortality. The lengths of ICU and hospital stay were calculated as the secondary outcomes. The multivariable logistic regression model was used to identify independent predictors of mortality. To identify the effect of the NLR on survival, a 15-day survival curve was used. Results A total of 3,865 eligible subjects were enrolled in the study. Univariate analysis showed that patients in the group with a higher NLR were more likely to receive aggressive methods of care delivery: mechanical ventilation, vasopressor, and antibiotics ( P < 0.001 for all). The ICU, in-hospital, and 15-day mortality rates of the four groups increased in turn ( P < 0.001 for all). The multivariable logistic Cox regression model indicated that a higher NLR was an independent risk factor of ICU mortality in trauma patients. ROC analysis showed that the NLR had better predictive capacity on the mortality of patients with traumatic brain injury (TBI) than those with trauma (AUC 0.725 vs. 0.681). An NLR > 7.44 was an independent risk factor for ICU death in patients with TBI (OR: 1.837, 95% CI: 1.045–3.229) and TBI victims whose NLR > 7.44 had a 15-day survival disadvantage ( P = 0.005). Conclusion A high NLR is associated with a poor prognosis in trauma patients, even worse in patients with TBI. An NLR > 7.44 is an independent risk factor for death in patients with TBI.
... Two covariates, gender and income, were incorporated into the analyses to help control for confounding effects on the mental health outcomes. The covariates were selected based on research suggesting that PTS and depression are associated with gender and income demographic characteristics (Breslau & Anthony, 2007;Tolin & Foa, 2006). ...
Article
Prior research has found that the prevalence and severity of intimate partner violence (IPV) increase in communities experiencing a disaster. Less studied are the associations between IPV, disaster exposure, and mental health outcomes following disaster events. In the current study, authors examined the prevalence of IPV before and after Hurricane Harvey and the direct and indirect effects of risk (i.e., disaster exposure, IPV) and resilience on mental health outcomes using structural equation modeling with 382 adults. Results indicate that exposure to Hurricane Harvey was significantly associated with risk for IPV, posttraumatic stress (PTS) symptoms, and depression symptoms. In addition, IPV mediated the relationships between disaster exposure and PTS and depression symptoms. These findings support the need to incorporate IPV services and resources into disaster mental health services.
... Therefore, habituation is a fundamental aspect of the stress response that plays an important role in stress-related disorders. Compared to men, women are approximately twice as likely to be diagnosed with stress-related mood disorders, such as PTSD, depression, and anxiety in Western countries [14][15][16]. Understanding sex differences in the mechanisms underlying stress habituation may provide insight into the higher prevalence of these stress-related disorders in women. ...
Article
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Background Habituation to repeated stress refers to a progressive reduction in the stress response following multiple exposures to the same, predictable stressor. We previously demonstrated that the posterior division of the paraventricular thalamic nucleus (pPVT) nucleus regulates habituation to 5 days of repeated restraint stress in male rats. Compared to males, female rats display impaired habituation to 5 days of restraint. To better understand how activity of pPVT neurons is differentially impacted in stressed males and females, we examined the electrophysiological properties of pPVT neurons under baseline conditions or following restraint. Methods Adult male and female rats were exposed to no stress (handling only), a single period of 30 min restraint or 5 daily exposures to 30 min restraint. 24 h later, pPVT tissue was prepared for recordings. Results We report here that spontaneous excitatory post-synaptic current (sEPSC) amplitude was increased in males, but not females, following restraint. Furthermore, resting membrane potential of pPVT neurons was more depolarized in males. This may be partially due to reduced potassium leakage in restrained males as input resistance was increased in male, but not female, rats 24 h following 1 or 5 days of 30-min restraint. Reduced potassium efflux during action potential firing also occurred in males following a single restraint as action potential half-width was increased following a single restraint. Restraint had limited effects on electrophysiological properties in females, although the mRNA for 10 voltage-gated ion channel subunits was altered in the pPVT of female rats. Conclusions The results suggest that restraint-induced changes in pPVT activation promote habituation in males. These findings are the first to describe a sexual dimorphism in stress-induced electrophysiological properties and voltage-gated ion channel expression in the pPVT. These results may explain, at least in part, why habituation to 5 days of restraint is disrupted in female rats.
... This sex predilection for general anxiety might be attributed to biological susceptibilities, lower self-esteem or greater exposure to trauma [40]. In addition, females may be more likely to develop internalizing symptoms such as anxiety following exposure to stressors [41]. ...
Article
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(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA’s level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.
... A surprisingly large percentage of traumatized individuals meet the criteria for various mental and physical conditions, including mood and anxiety disorders, substance abuse and dependence disorders, eating disorders, somatoform disorders, and medically unexplained symptoms (Crowne et al., 2011;Pico-Alfonso et al., 2006). Women are more likely to experience interpersonal trauma (including sexual assault) than men (David & Foa, 2006;Kessler et al., 1995;Norris et al., 2002). The CDC National Intimate Partner and Sexual Violence Survey conducted in 2010 states that almost 20% of women in the US have been raped at one time in their lives (Black et al., 2011). ...
Article
This study investigated the reliability and predictive validity of the Sense of Coherence (SOC) scale for 299 American survivors of gender-based violence (GBV). First, confirmatory factor analysis examined the construct validity of the SOC-13. Then, relationships between SOC and clinical scales were examined. Confirmatory factor analysis supported the 3-factor solution, and Cronbach's alpha reliability values for comprehensibility, manageability, and meaningfulness subscales and total score of SOC-13 were: .62, .53, .65, and .81, respectively. Multiple regression revealed that age, posttraumatic growth, depression, and posttraumatic stress scores explained 53% of the variance of SOC scores. We interpret this to suggest that SOC is a protective factor in GBV, especially in younger women. Clinical implications are suggested.
... These differences could be due to greater exposure to stresses during the pandemic and/or heightened response to stress in females. As females in Nepal are usually the caregivers in a family and are involved in domestic works, infection could further traumatize them for not being able to perform their role Likewise, females are more prone to develop internalizing symptoms following exposure to stress and trauma, even accounting for the specific event [40]. ...
Article
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Home isolated patients infected with COVID-19 might be at increased risk of developing mental health problems. The study aimed to identify the prevalence and factors associated with anxiety and depression among COVID-19 home isolated patients in Province One, Nepal. This was a cross-sectional study conducted between February 17, 2021, to April 9, 2021. A total of 372 home isolated patients from Province One were phone interviewed in the study. Anxiety and depression were measured using a 14-items Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression analysis was done to determine the risk factors of anxiety and depression. Among home isolated COVID-19 infected participants, 74.2% and 79% had symptoms of anxiety (borderline: 48.7% and abnormal: 25.5%) and depression (borderline: 52.7% and abnormal: 26.3%), respectively. Watching television was significantly associated with lower odds of experiencing symptoms of anxiety and depression. Females had significantly higher odds of having depression symptoms compared to males while ever married, those with COVID-19 related complications, and those taking medicine for the treatment of COVID-19 symptoms had a higher likelihood of exhibiting symptoms of anxiety. A focus on improving the mental health well-being of COVID-19 infected patients in home settings with connection to the health services is warranted with timely psychological interventions.
... The DSM-V finds that the highest rates of PTSD are found among rape survivors, combat veterans and victims of captivity, and survivors of ethnically or politically motivated internment or genocide (APA, 2013). Women demonstrate a higher prevalence of PTSD symptomatology following trauma exposure, while less likely to report trauma exposure (Tolin & Foa, 2008). Studies have also demonstrated that controlling for experienced distress accounted for gender differences in fulfilling criteria for PTSD diagnoses (Frans et al., 2005;Lilly et al., 2009). ...
Article
The current understanding of domestic violence is largely nomothetic by design and does not adequately address the treatment and rehabilitation needs of survivors. This thesis aimed to gain a qualitative understanding of the culture-specific experiences of domestic violence in south Indian female survivors, with a focus on the treatment of posttraumatic stress disorder (PTSD), and comorbid psychopathology. An interpretative phenomenological analysis was undertaken with five south Indian women to investigate the in-depth, lived experiences of domestic violence and its mental health sequelae. Responses to, and appraisals of abuse were found to be heavily influenced by pre-abuse identity, interpersonal childhood experiences, societal perceptions of, and stigmatising attitudes towards survivors. These factors impact the experience of disclosure and help-seeking among survivors, with a clear preference for informal sources of support such as family and social care organisations. Further, the findings shed light on the experience of resisting and counteracting the abuse in this context, as well as the complex, non-linear and iterative process of leaving abusive relationships. This was found to be rooted in the sociocultural framework of Indian society, patriarchal ideologies of gender roles, and the systemic and structural disempowerment of women, perpetuating the perpetration and experience of abuse and violence. The treatment protocol examined in this thesis is Narrative Exposure Therapy (NET), which is a short-form psychotherapeutic technique originally developed for survivors of war and organised violence in low-resource contexts. The comprehensive and up-to-date meta-analysis of its current evidence base along with a quality appraisal of the trials included was conducted. The findings revealed low- to medium-quality evidence of NET efficacy for the alleviation of PTSD. High heterogeneity estimates and low powered trials significantly impact the interpretation of the pooled intervention effect estimates. This review also revealed an overreliance on randomised controlled trial findings and a paucity of idiographic research investigating change mechanisms through NET. In the final study, an inductive and deductive thematic analysis was undertaken to investigate the change mechanisms through NET for survivors of domestic violence. NET was administered to seven south Indian women and was well tolerated by the sample. Paired sample t-tests revealed a statistically significant improvement in PTSD and somatic symptoms at post-test. The raw testimony data was qualitative analysed, and a theoretically-informed framework of recovery was developed through thematic analysis to elucidate the specific processes that contribute to change and underlie improvement on symptom scores. There was evidence for several proposed mechanisms based on seminal PTSD theories, as well as some data-driven mechanisms such as positive memories and a focus on future aspirations that contributed to recovery in this sample. There are no published accounts of NET’s use or efficacy in India, and practice implications include culture-specific and stressor-specific applications of NET using the template from the recovery framework. These findings complement the limited RCT evidence of NET from an idiographic perspective. Importantly, the need to consider and explore culture- and context-specific change mechanisms is demonstrated through the framework, which found additional processes contributing to recovery in this sample. Recommendations for the adaptation of individual-focused, empirically supported treatments such as NET that are culturally sensitive and consider the complex socio-ecological milieu of the Indian context are discussed.
Article
Increasing attention has been focused on suicidal behavior among military personnel. Exposure to deployment‐related traumatic events (DRTEs) and child abuse (CA) both have been associated with mental disorders and suicidal behaviors among military personnel. Thus, the primary objectives of this study were to examine (a) sex differences in CA history and DRTEs, past‐year mental disorders, and past‐year suicide‐related outcomes and (b) independent, cumulative, and interactive effects of CA history and DRTEs on past‐year mental disorders and suicide outcomes among Canadian military personnel. Data were from the representative Canadian Forces Mental Health Survey collected in 2013 (N = 8,161; response rate = 79.8%). The results indicated a high prevalence of trauma exposure, with sex differences noted for specific trauma types. Both CA history and DRTEs were strongly associated with mental disorders, CA history: aORs = 1.60–2.44; DRTEs; aORs = 1.67–3.88. Cumulative, but not interactive, effects were noted for the effects of CA history and DRTEs on most mental disorders. Associations between CA history and DRTEs on suicide outcomes were largely indirect via their impact on mental disorders. Information regarding the role of specific types of predeployment trauma on mental disorders and suicidal behavior can be used to develop more targeted prevention and intervention strategies aimed at improving the mental health of military personnel.
Article
The impact of physical activity on mental health outcomes is well-established. Researchers have suggested that engagement in physical activity may have benefits for people with post-traumatic stress disorder (PTSD). In particular, moderate to vigorous physical activity (MVPA) is theorized to reduce PTSD symptomology and improve treatment outcomes. While there are evident sex and gender differences in the biology and etiology of PTSD, significant gaps remain in the analysis of sex- and gender-based factors in physical activity interventions. The purpose of this scoping review was to: (1) explore the study parameters (i.e. research design, intervention, measures, and sex and gender considerations), (2) present the types of outcomes found in studies investigating MVPA as an adjunctive strategy to support women with PTSD, and (3) assess researcher engagement with trauma-informed approaches. Guided by Arksey and O'Malley's scoping review framework, we systematically searched four databases, yielding 615 results that underwent through two levels of screening: title and abstract, and full text. Twelve papers met the specified criteria, which included a focus on, or inclusion and analysis, of female participant data in studies investigating the therapeutic potential of PA as an adjunctive strategy to address PTSD. Analysis of selected articles revealed commonly employed study characteristics and parameters; the diversity of PTSD and PA measures used for inclusion and outcome measurement, respectively; the biological and psychological outcomes and identified limitations; and, how and if the impacts of trauma on the accessibility of research participation were considered. Overall, we found that MVPA should be further investigated as a potential intervention for women with PTSD and careful consideration of the study measures employed is critical when designing population- and gender-tailored interventions. Based on the findings, we highlight the need for a trauma- and violence-informed approach to address the acceptability and feasibility of physical activity interventions.
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Background: Although childbirth is considered a natural process, a high percentage of postpartum women consider it traumatic. Any previous traumatic event in a woman's life can be revived through a traumatic birth experience, especially after a complicated vaginal delivery or cesarean delivery. The purpose of this study was to clarify the relationship between previous traumatic life events and posttraumatic stress disorder (PTSD) in postpartum women after cesarean section and which specific events exerted the greatest influence. Methods: A sample of 469 women who had undergone cesarean sections at a Greek university hospital consented to participate in this prospective study. Data from a medical/demographic questionnaire, life events checklist, perinatal stressor criterion A, and posttraumatic stress checklist were used to evaluate past traumatic life events and diagnose postpartum posttraumatic stress. Results: Out of 469 women, 25.97% had PTSD and 11.5% a PTSD profile, while 2.7% had PTSD and 2.7% a PTSD profile. Also, it appeared that only specific direct exposure to a traumatic event and/or witnessing one were predictors of postpartum PTSD. Conclusions: This survey identified specific traumatic life events, psychiatric history, stressor perinatal criterion A, preterm birth, and emergency cesarean section as risk factors for the development of PTSD or a PTSD profile in women after cesarean delivery.
Article
Background Nearly half of the refugee and asylum seeking population in Europe is under the age of 18, and many of these individuals are unaccompanied children and adolescents. Objective The aim of this systematic review is both to summarize findings regarding the prevalence of mental health disorders among unaccompanied refugee minors (URM) in European countries since the last available systematic review (October 2017), and to describe associated risk factors. Methods Five databases were systematically searched for articles published between October 1, 2017 and May 1, 2022. Results The findings from 23 studies conducted in 9 countries which examined 80,651 child and adolescent URM are explained. Afghanistan was the most common country of origin in the majority of studies and >75 % of the subjects were boys. Most of the studies (N = 13, 56.5 %) assessed posttraumatic stress disorder (PTSD) prevalence. We found a high prevalence of mental health disorders among URM children and adolescents, which varied considerably between studies, ranging from 4.6 % to 43 % for (PTSD), 2.9 % to 61.6 % for depression, 32.6 % to 38.2 % for anxiety and 4 to14.3 % for behavioral problems. Two studies looking at suicide attempts and deaths, also observed higher rates in URM compared to the host population of the same age. The studies looking at mental health risk factors suggest that levels of social support in the host country, rearing environment, and other factors are associated with psychopathology. Moreover, a meta-analysis of four studies regarding PTSD in URM and accompanied refugee minors (ARM) showed a lower prevalence among ARM: -1.14 (95%CI:-1.56—0.72). Conclusions PTSD, depression and anxiety are the most prevalent problems among the URM population in Europe. Early intervention in host countries is needed in order to improve mental health outcomes for this vulnerable population and avoid possible neglect.
Article
The following article reviews the existing data on autonomic nervous system status in posttraumatic stress disorder. This review is embedded in a framework that considers the comparative ethology of sleep under threat. In sum, the current literature, though still quite limited, supports a role for impaired parasympathetic drive but not for increased sympathetic drive in the periphery during sleep in PTSD. Understanding this domain better can be expected to provide insights into the elevated prevalence of cardiovascular disease in posttraumatic stress disorder (PTSD) and may help to identify as-yet unrecognized medical comorbidities. Measurement issues and future opportunities are considered.
Article
Objectives This survey was conducted to evaluate the prevalence of post-traumatic stress disorder (PTSD) and the sleep quality in victims and rescue team of the third deadliest nightclub fire in the world. Study design A cross-sectional study. Methods Participants were victims and rescue workers exposed to a fire at a nightclub, which occurred in January 2013 in Southern Brazil. The Pittsburgh Sleep Quality Index (PSQI), composed of seven subjective sleep variables (including daytime dysfunction), and PTSD Checklist – Civilian version (PCL-C) were applied to all people who sought medical attention at the local reference center in the first year after the event. Comprehensive information was obtained concerning sociodemographic factors, health status, and sleep complaints. Results A total of 370 individuals, 190 victims and 180 rescue workers, were included. Participants were 70% male, with an average age of 29 years. The prevalence of PTSD was 31.9%, ranging from 24.4% for rescue workers to 38.9% for victims. The prevalence of poor sleep quality was 65.9%, ranging from 56.1% for rescue workers to 75.3% for victims. Most of the participants with PTSD (91.5%) had PSQI scores >5 (poor sleepers), against 54.0% of the non-PTSD individuals. All seven PSQI subscores showed significant differences between PTSD and non-PTSD individuals, especially daytime dysfunction. Sex, shift work, previous psychiatric disease, and sleep quality remained associated with PTSD in adjusted models, with a prevalence ratio (95% CI) of 1.76 (1.28–2.43) in females, 1.73 (1.17–2.55) in shift workers, 1.36 (1.03–1.80) in individuals with psychiatric disease history, and 5.42 (2.55–11.52) in poor sleepers. Conclusions The presence of daytime dysfunction increased by at least tenfold the prevalence of PTSD in this sample. Considering that daytime dysfunction was shown to be strongly associated with PTSD, sleep-related issues should be addressed in the assessment of individuals exposed to traumatic events, both victims and rescuers. Factors like shift work and female sex were also associated with PTSD, especially among victims.
Article
Stress-linked disorders are more prevalent in women than in men and differ in their clinical presentation. Thus, investigating sex differences in factors that promote susceptibility or resilience to stress outcomes, and the circuit elements that mediate their effects, is important. In male rats, instrumental control over stressors engages a corticostriatal system involving the prelimbic cortex (PL) and dorsomedial striatum (DMS) that prevent many of the sequelae of stress exposure. Interestingly, control does not buffer against stress outcomes in females, and here, we provide evidence that the instrumental controlling response in females is supported instead by the dorsolateral striatum (DLS). Additionally, we used in vivo microdialysis, fluorescent in situ hybridization, and receptor subtype pharmacology to examine the contribution of prefrontal dopamine (DA) to the differential impact of behavioral control. Although both sexes preferentially expressed D1 receptor mRNA in PL GABAergic neurons, there were robust sex differences in the dynamic properties of prefrontal DA during controllable stress. Behavioral control potently attenuated stress-induced DA efflux in males, but not females, who showed a sustained DA increase throughout the entire stress session. Importantly, PL D1 receptor blockade (SCH 23390) shifted the proportion of striatal activity from the DLS to the DMS in females and produced the protective effects of behavioral control. These findings suggest a sex-selective mechanism in which elevated DA in the PL biases instrumental responding towards prefrontal-independent striatal circuitry, thereby eliminating the protective impact of coping with stress.
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Propranolol, a non-cardioselective β1,2 blocker, is most commonly recognised for its application in the therapy of various cardiovascular conditions, such as hypertension, coronary artery disease, and tachyarrhythmias. However, due to its ability to cross the blood–brain barrier and affinity towards multiple macromolecules, not only adrenoreceptors, it has also found application in other fields. For example, it is one of the very few medications successfully applied in the treatment of stage fright. This review focuses on the application of propranolol in the treatment of various types of anxiety and stress, with particular reference to stage fright and post-traumatic stress disorder (PTSD). Both mechanisms of action as well as comparison with other therapies are presented. As those indications for propranolol are, in most countries, considered off-label, this review aims to gather information that can be useful while making a decision about the choice of propranolol as a drug in the treatment of those mental conditions.
Article
Women veterans with posttraumatic stress disorder (PTSD) have historically received more psychiatric medications than men. The current analysis identified prescribing trends of medications recommended for (i.e., select antidepressants) and against (i.e., benzodiazepines, select antidepressants, antipsychotics, and select anticonvulsants) use in PTSD treatment among women and men in 2010–2019. All veterans receiving care for PTSD in 2019 were identified using national U.S. Department of Veterans Affairs (VA) administrative data. Multivariable logistic regression analyses, adjusted for demographic characteristics and psychiatric comorbidities, were used to contrast the likelihood of receiving a medication class across genders. Sensitivity analyses using identical selection methods were conducted for the calendar years 2010, 2013, and 2016. In 2019, 877,785 veterans received treatment for PTSD within the VA, 13.5% of whom were women. Across medication classes and years, women were more likely to receive all psychiatric medications of interest. Relative to men, women were slightly more likely to receive antidepressants recommended for PTSD in 2019, adjusted odds ratio (aOR) = 1.07, 95% CI [1.06, 1.09]. However, gender differences for medications recommended against use for PTSD were notably larger, including benzodiazepines, aOR = 1.62, 95% CI [1.59, 1.65]; anticonvulsants. aOR = 1.41, 95% CI [1.38, 1.44]; and antidepressants recommended against use for PTSD, aOR = 1.26, 95% CI [1.19, 1.33]. To inform tailored intervention strategies, future work is needed to fully understand why women receive more medications recommended against use for PTSD.
Article
Background Prior evidence links posttraumatic stress disorder (PTSD) and depression, separately, with chronic inflammation. However, whether effects are similar across each independently or potentiated when both are present is understudied. We evaluated combined measures of PTSD and depression in relation to inflammatory biomarker concentrations. Methods Data are from women (n’s ranging 628-2,797) in the Nurses’ Health Study II. Trauma exposure, PTSD, and depression symptoms were ascertained using validated questionnaires. We examined (a) a continuous combined psychological distress score summing symptoms for PTSD and depression, and (b) a categorical cross-classified measure of trauma/PTSD symptoms/depressed mood status (reference group: no trauma or depressed mood). Three inflammatory biomarkers (C-reactive protein [CRP], interleukin-6 [IL-6], tumor necrosis factor alpha receptor 2 [TNFR2]) were assayed from at least one of two blood samples collected 10-16 years apart. We examined associations of our exposures with levels of each biomarker concentration (log-transformed and batch-corrected) as available across the two time points (cross-sectional analyses; CRP, IL-6 and TNFR2) and with rate of change in biomarkers across time (longitudinal analyses; CRP and IL-6) using separate linear mixed effects models. Results In sociodemographic-adjusted models accounting for trauma exposure, a one standard deviation increase in the continuous combined psychological distress score was associated with 10.2% (95% confidence interval (CI): 5.2-15.4%) higher CRP and 1.5% (95% CI: 0.5-2.5%) higher TNFR2 concentrations cross-sectionally. For the categorical exposure, women with trauma/PTSD symptoms/ depressed mood versus those with no trauma or depressed mood had 29.5% (95% CI: 13.3-47.9%) higher CRP and 13.1% (95% CI: 5.1-21.7%) higher IL-6 cross-sectionally. In longitudinal analysis, trauma/PTSD symptoms/depressed mood was associated with increasing CRP levels over time. Conclusions High psychological distress levels with trauma exposure is associated with elevated inflammation and is a potential biologic pathway by which distress can impact development of inflammatory-related chronic diseases, such as cardiovascular disease. Considering multiple forms of distress in relation to these pathways may provide greater insight into who is at risk for biologic dysregulation and later susceptibility to chronic diseases.
Article
Traumatic events have an important effect in human life and may lead to psychopathological disturbances by affecting the personal and social lives of individuals. Recently, various studies have been reported in the literature showing that the traumatic experiences may be associated with intergenerational psychopathologies. However, there is limited data regarding the neuroimaging studies investigating changes in brain structures in children of traumatized mothers. In this study, we aimed to investigate the potential changes in the hippocampus and amygdala volumes in the children of mothers exposed to mass trauma. The traumatic event experienced by the mothers was the two devastating earthquakes they experienced when they were teenagers. Hippocampus and amygdala volumes were evaluated in magnetic resonance imaging of 40 children whose mothers were exposed to earthquakes and 27 children in control group. Bilateral amygdala volumes were significantly smaller in the children of mothers exposed to earthquake compared to the control group. In addition, right amygdala and hippocampus volumes were smaller in children of mothers exposed to earthquakes than left. This is one of the pioneering neuroimaging studies on the intergenerational transmission of trauma. Our study shows that there may be a potential relationship between intergenerational trauma and various brain structures.
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Purpose: There is a lack of research on childhood sexual abuse (CSA) experienced by men, with even less research examin- ing long term neurophysiological repercussions. This study explored the neurophysiology of the brain at rest to examine the influence of CSA on resting state functional connectivity (RSFC) into adulthood. Methods: RSFC was examined with functional magnetic resonance imaging (fMRI) within the default mode, salience and limbic networks in men with CSA histories, with and without post-traumatic stress disorder (PTSD; CSA + PTSD n = 7, CSA-PTSD n = 9), and men without a CSA history nor PTSD (n = 13). Results: CSA + PTSD participants had increased functional connectivity (FC) in the medial prefrontal cortex (mPFC) from the default mode network seed compared to participants with CSA-PTSD. Both CSA groups showed significantly less FC in the striatal-thalamic circuits of the salience network than the control group. Similarly, the robust FC between the bilateral amygdalae and the mPFC that was notable in control participants, was not exhibited in participants who experienced CSA with or without PTSD histories. Conclusions: These findings demonstrate that intrinsic neurophysiological differences in limbic, salience and default mode network connectivity are apparent even during a resting state between the groups of participants. This is preliminary evidence of long-term neurophysiological effects of CSA in men with PTSD, and even in those without. Importantly, these findings can validate the lived experiences of males with CSA histories and guide researchers and clinicians to potential avenues to support their well-being.
Article
The bi‐directional relationship between sleep and stress has been actively researched as sleep disturbances and stress have become increasingly common in society. Interestingly, the brain and underlying neural circuits important for sleep regulation may respond uniquely to stress that leads to post‐traumatic stress disorder (PTSD) and stress that does not. In stress that does not lead to PTSD, the hypothalamic‐pituitary‐adrenal axis (HPA) pathway is activated normally that results in sympathetic nervous system activation that allows the brain and body to return to baseline functioning. However, exposure to stress that leads to PTSD, causes enhanced negative feedback of this same pathway and results in long‐term physiological and psychological changes. In this review, how stress regulates glucocorticoid signaling pathways in brain glial cells called astrocytes, and then mediates stress‐induced insomnia are examined. Astrocytes are critical sleep regulatory cells and their connections to sleep and stress due to disturbed glucocorticoid signaling provide a novel mechanism to explain how stress leads to insomnia. This review will examine the interactions of stress neurobiology, astrocytes, sleep, and glucocorticoid signaling pathways and will examine the how stress that leads to PTSD and stress that does not impacts sleep‐regulatory processes. The goal of this review is to examine the molecular regulation of the interactions between stress and the development of insomnia. Molecular and cellular mechanisms are additionally examined that may be responsible for the development of stress‐induced insomnia by differentiating the difference between stress that leads to post‐traumatic stress disorder and stress that does not.
Article
Current approaches to non-specialized help with stress are set out in this article and stress management tools are provided, which are developed by WHO in the stress management handbook “Doing What Matters in Times of Stress: An Illustrated Guide”. This knowledge is especially current in the giving of first aid in emergencies, and in giving psychosocial support to patients as well, by primary care physicians, who must have effective communication skills and mutual understanding, and have experience in supporting people in difficult situations too, as it is specified in numerous WHO recommendations on mental health, in such as : «mhGAP Intervention Guide for mental, neurological and substance use disorders in nonspecialized health settings», «IASC Guidelines for mental health and psychosocial support in emergency settings»,«mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies», «Support for Rehabilitation: Self-Management after COVID-19 Related Illness» and etc. Aim – to give the information for the distant self-learning of the primary care professionals to use the simple stress-management tools in difficult circumstances. Distance learning is built on the basis of the evidence based WHO documents and recommendations about low intensity psychological interventions. The WHO Guide has five sections, where five ideas and techniques for reducing stress are descibed, which are designed as the acquisition of five skills. The authors at the end of each section of the Guide developed algorithms of use the skills of such tools as: «Grounding», «Unhooking», «Acting according to own values», «Showing kindness», «Creating space». The psychosocial support provided by the primary care physician / facilitator / assistant lies in helping people to use guidance and apply strategies in their own lives, and it prevents the professional burnout of healthcare professionals as well. The short information about WHO guide and stress -management methods are described in sufficient details to enhance the awareness level of the primary care personnel about stress-management tools use. As the result of using the Guide will enhance the capacity of local helth care staff and non medical staff to provide the mental health services and psychosocial support during the current COVID-19 pandemic, and readiness for the future emergencies.
Article
The literature suggests that being subject to a stressful life and victimization may negatively affect mental health, and that women and men seem to differ in these variables. Nevertheless, neither the mediating role of victimization experiences in the relationship between stress and mental health, nor the moderated role of sex have been explored. A sample of 826 adults, aged from 18 to 77 years old, completed a set of self-reported questionnaires (69.4% women). Results revealed significant mediation effects of psychological violence on the relationship between stress, depression and anxiety. Participants who reported more stressful life events in the previous year, also reported higher psychological abuse, which in turn predicted higher depression and anxiety. Furthermore, the moderating effects of sex were found to be statistically significant. Results suggest that interventions should be tailored to individual needs in order to prevent secondary victimization derived from biased beliefs related to stress, violence and gender in professional practice.
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In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress.
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Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient. It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms. To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD. Two samples of 27 and 176 road traffic accident survivors were recruited. Patients were assessed shortly after the accident and followed at intervals over the next 6 months. Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms. All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months. Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters. Memory fragmentation and data-driven processing also predicted PTSD. Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms. Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions.
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Background: The traumatic events experienced by thousands of people in Bosnia and Herzegovina during the 1992-1995 conflict may have a lasting effect on the mental health of the country, characterized by high rates of post-traumatic stress disorder (PTSD). A diagnosis of PTSD among family physicians could affect their ability to diagnose and treat patients for depression, anxiety and PTSD. Objective: The aim of the present study was to determine the prevalence of PTSD among family medicine physicians in Bosnia and Herzegovina. Methods: A self-administered questionnaire, including the PTSD Checklist-Civilian Version (PCL-C) which is a validated scale for PTSD screening, was distributed to family medicine residents and specialists in Bosnia and Herzegovina. The prevalence of PTSD was determined, and factors related to PTSD were considered. Results: One hundred and thirty-three (90.5%) of the 147 physicians who were available to be surveyed completed the questionnaire. Of the 88% who had a traumatic experience during the war, 18% met the criteria for PTSD. The likelihood of meeting the criteria for PTSD was not affected by age, sex or whether the physician had worked in a field hospital during the war. However, a positive response to the question "Do you think the traumatic event you experienced during the war still affects you today?" was highly associated with the diagnosis of PTSD (odds ratio 7.26, 95% confidence interval: 1.57-33.60). Also, this question was shown to have a high degree of sensitivity and negative predictive value, and may be of use as a screening tool for ruling out the presence of PTSD after a traumatic war experience.
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Background Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient. It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms. Aims To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD. Method Two samples of 27 and 176 road traffic accident survivors were recruited. Patients were assessed shortly after the accident and followed at intervals over the next 6 months. Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms. Results All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months. Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters. Memory fragmentation and data-driven processing also predicted PTSD. Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms. Conclusions Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions.
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Few epidemiological studies of traumatic events amongst tertiary students have been conducted in South Africa. The aims of this study were to quantify the number of traumatic events experienced by Technikon Pretoria students in the preceeding year and to record the types of trauma symptoms experienced as a result of these traumatic events. The incidence of 10 traumatic event categories have been measured by means of the Traumatic Stress Schedule in a convenience sample (N = 245). The sample consisted of females (n = 183) and males (n = 61). It was found that more than two thirds (70,6%) of the sample reported one or more traumatic events during the preceeding year, with the most frequent traumatic event categories being the death of a loved one, negative change in life circumstances and witness to injury/death. The least frequent traumatic event categories were natural disasters and motor vehicle accidents. Females reported a significantly higher incidence of unwanted sexual activity than males. Intrusive thoughts, particularly amongst female students, was the most frequent symptom associated with 8 of the 10 traumatic event categories, while physical injuries was the least frequent symptom associated with all the traumatic event categories.
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This paper compares male and female rapereporting behavior. Participants from National Crime andVictimization Survey data (90% female, 10% male) aremuch like victims of other violent crimes (25%non-white, higher than average unemployment, young, andunmarried). The data indicate that the situationalcharacteristics of rape, and factors that influence arape reporting decision, differ by sex. Whereas men fail to report rape when it jeopardizes theirmasculine self-identity, women fail to report rape whenthe rape does not fit the classic stereotypical rapesituation. Women reported victimization more frequently than did men. It is asserted that furthercomparative research on rape reporting behaviorutilizing qualitative methods is needed in order tofully understand rape victimization for bothsexes.
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A sample of 222 African American, Mexican American, or European American undergraduate students completed questionnaires assessing lifetime exposure to interpersonal violence and current levels of psychological distress. The frequency of interpersonal violence was high: 39.2% of the students reported direct exposure to at least one violent, nonsexual life event and 43.7% reported at least one violent sexual experience. Fourteen percent of the participants had lifetime diagnoses of post-traumatic stress disorder, with the highest reported rate occurring for the African Americans, who also reported more violent sexual and nonsexual experiences and higher levels of psychological distress. Women reported more direct sexual experiences whereas men reported more nonsexual violent events. Covariance analyses suggested that degree of exposure to violence explained most, but not all of the ethnic and gender differences found in terms of posttraumatic symptomatology. Thus, exposure to life-threatening events, rather than ethnic or gender group per se was most directly related to psychological distress.
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Little is known about the impact of trauma in postconflict, low-income countries where people have survived multiple traumatic experiences. To establish the prevalence rates of and risk factors for posttraumatic stress disorder (PTSD) in 4 postconflict, low-income countries. Epidemiological survey conducted between 1997 and 1999 among survivors of war or mass violence (aged >/=16 years) who were randomly selected from community populations in Algeria (n = 653), Cambodia (n = 610), Ethiopia (n = 1200), and Gaza (n = 585). Prevalence rates of PTSD, assessed using the PTSD module of the Composite International Diagnostic Interview version 2.1 and evaluated in relation to traumatic events, assessed using an adapted version of the Life Events and Social History Questionnaire. The prevalence rate of assessed PTSD was 37.4% in Algeria, 28.4% in Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. Conflict-related trauma after age 12 years was the only risk factor for PTSD that was present in all 4 samples. Torture was a risk factor in all samples except Cambodia. Psychiatric history and current illness were risk factors in Cambodia (adjusted odds ratio [OR], 3.6; 95% confidence interval [CI], 2.3-5.4 and adjusted OR,1.6; 95% CI, 1.0-2.7, respectively) and Ethiopia (adjusted OR, 3.9; 95% CI, 2.0-7.4 and adjusted OR, 1.8; 95% CI, 1.1-2.7, respectively). Poor quality of camp was associated with PTSD in Algeria (adjusted OR, 1.8; 95% CI, 1.3-2.5) and in Gaza (adjusted OR, 1.7; 95% CI, 1.1-2.8). Daily hassles were associated with PTSD in Algeria (adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth domestic stress, death or separation in the family, and alcohol abuse in parents were associated with PTSD in Cambodia (adjusted OR, 1.7; 95% CI, 1.1-2.6; adjusted OR, 1.7; 95% CI, 1.0-2.8; and adjusted OR, 2.2; 95% CI, 1.1-4.4, respectively). Using the same assessment methods, a wide range of rates of symptoms of PTSD were found among 4 low-income populations who have experienced war, conflict, or mass violence. We identified specific patterns of risk factors per country. Our findings indicate the importance of contextual differences in the study of traumatic stress and human rights violations.
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The Impact of Events Scale (IES) has been characterized as one of the most widely used measures of the subjective psychological distress associated with traumatic events. However, the scale may measure other aspects of events, such as the cognitive accessibility of an event, as well as emotional distress or symptoms of Posttraumatic Stress Disorder (PTSD). To explore this possibility, 58 Texas community college students (35 women, 23 men) completed the scale with the target “stressor” being the worst movie or television show they had seen recently. Analysis showed that participants' scores approximated IES ranges often associated with significant emotional distress or PTSD. Insofar as the IES measures the memorability, cognitive accessibility or other aspects of events instead of psychopathology associated with events, it may produce misleading results when used as a measure of PTSD or emotional distress.
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This research was conducted, as part of American Psychological Association Working Group on the Investigation of Memories of Childhood Abuse (see record 2000-13581-002), to address concerns about cases in which an individual has no memory for a traumatic experience, enters therapy, and emerges sometime later with an elaborate memory. The article summarizes research on human memory, focusing on the literature in cognitive and developmental psychology. The authors provide a broad overview of memory and its development by making use of a conceptual framework for thinking about the flow of information within the memory system. They then focus on 3 topics: (1) a developmental perspective and its relevance for considering questions of adults attempting to remember things from the distant past; (2) suggestibility, memory distortions, and the extent to which misleading information may degrade memory performance; and (3) distinguishing between reality and fantasy, and monitoring the sources of information. The report concludes with a treatment of the importance of determining boundary conditions for some of the effects that are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The prevalence of violence exposure and posttraumatic stress disorder (PTSD) symptomatology among a sample of incarcerated adolescents is compared with that among a matched sample of high school students. Adolescents who have come to the attention of the juvenile justice system have been exposed to significantly higher levels of sexual and community violence, and report significantly higher levels of PTSD symptomatology. Within the incarcerated group, adolescents who report higher levels of delinquent activity (in the form of gun possession and gang involvement) also report higher levels of some forms of violence exposure. Incarcerated youth with more serious delinquent histories displayed higher levels of PTSD symptomatology, as well. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This paper reports on the first national survey of adults concerning a history of childhood sexual abuse. Victimization was reported by 27% of the women and 16% of the men. Higher rates of abuse were found among men who grew up in unhappy families, lived for some period with only their mothers, who were currently residing in the West and who came from English or Scandinavian heritage. Higher rates of abuse were found among women who grew up in unhappy families, lived for some period without one of their natural parents, received inadequate sex education, were currently residing in the West or who were born after 1925.
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This research was conducted, as part of American Psychological Association Working Group on the Investigation of Memories of Childhood Abuse (see record 2000-13581-002), to address concerns about cases in which an individual has no memory for a traumatic experience, enters therapy, and emerges sometime later with an elaborate memory. The article summarizes research on human memory, focusing on the literature in cognitive and developmental psychology. The authors provide a broad overview of memory and its development by making use of a conceptual framework for thinking about the flow of information within the memory system. They then focus on 3 topics: (1) a developmental perspective and its relevance for considering questions of adults attempting to remember things from the distant past; (2) suggestibility, memory distortions, and the extent to which misleading information may degrade memory performance; and (3) distinguishing between reality and fantasy, and monitoring the sources of information. The report concludes with a treatment of the importance of determining boundary conditions for some of the effects that are discussed.
Chapter
The power of an index flows from its unity and simplicity. Researchers can choose to assess troublesome thoughts, moods, and behaviors using either indexes or diagnoses. Both forms of assessment represent syndromes, which are groups of signs and symptoms that collectively characterize a disorder; however, these forms embody two opposite views of proper representation. This chapter argues for the use of indexes in research on stress and mental, emotional, or behavioral problems. It begins by contrasting the concepts and procedures that distinguish indexes from diagnoses. Then it illustrates several ways that results based on indexes differ from those based on diagnoses. First, indexes reveal patterns of correlation that are obscured by the diagnostic discounting of symptoms in people with coincident traits. The case of depression in old age illustrates this point. Second, indexes help reduce the surface complexity of appearances to the most concise useful set of distinctions and assessments. Diagnostic categories proliferate because each factor taken into consideration varies in intensity and the factors coincide in an extremely large number of combinations, each of which appears distinctive. Third, indexes minimize the attenuation of correlations and significance tests, and they minimize bias from stereotypes and other sources of diagnostic preconception. By using indexes, stress researchers can distinguish effects on thoughts, feelings, and behaviors from effects on the likelihood of getting a diagnosis net of, or adjusting for, the symptoms. Indexes avoid the confounding of diagnostic preconception with empirical correlation.
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Objective: To examine the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in injured children and to evaluate the utility of ASD as a predictor of PTSD. Method: Children hospitalized for injuries sustained in a traffic crash were enrolled in a prospective study. ASD was assessed in 243 children within 1 month after injury, and PTSD was assessed in 177 of these children 3 or more months after injury. The relationship between ASD and PTSD was examined via correlations between symptom severity scores and calculation of sensitivity, specificity, and positive and negative predictive values for categorical prediction of PTSD from ASD or subsets of ASD symptoms. Results: Eight percent of children met the symptom criteria for ASD and another 14% had subsyndromal ASD; 6% met the symptom criteria for PTSD and another 11% had subsyndromal PTSD. ASD and PTSD symptom severity were associated. Sensitivity was low for prediction of child PTSD from child ASD. Subsyndromal ASD was a more effective predictor of PTSD. Conclusions: A substantial minority of injured children are affected by traumatic stress disorders. ASD in children may not be an optimal categorical predictor of PTSD. With increasing attention to early posttrauma services for children, empirically valid assessment/triage models deserve further study.
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Six months after September 11, 2001 (9/11), 124 New York City workers participated in a self-report study of symptoms of posttraumatic stress disorder (PTSD). Although direct exposure to the terrorist attacks of 9/11 was limited, estimates of the prevalence of current PTSD in this mostly ethnic minority population ranged from 7.8% to 21.2%, as measured by the PTSD Checklist (F. W. Weathers, B. I Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993). Consistent with the study hypotheses, direct exposure to the attacks of 9/11, worries about future terrorist attacks (threat appraisal), and reduced confidence in self after 9/11 each predicted symptoms of PTSD, even after controlling for symptoms of anxiety and depression. These results support the idea that a traumatic event's meaning is associated with PTSD symptoms. Gender was not a significant predictor of symptoms, once other demographic variables were controlled. Most respondents who met the criteria for current PTSD had not sought therapy or counseling.
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Heart rate, skin conductance, and left lateral frontalis and corrugator facial electromyogram responses were measured during script-driven imagery of personal childhood sexual abuse (CSA) and other life experiences among women with and without Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., American Psychiatric Association, 1987) -diagnosed posttraumatic stress disorder (PTSD) resulting from CSA. Women with current PTSD (n = 29) showed larger physiologic responses than those who never had PTSD (n = 18) during personal sexual abuse imagery but not during imagery of stressful, nonabuse-related life experiences. Responses of individuals with lifetime, but not current, PTSD (n = 24) fell between the other groups. An a priori discriminant function derived from physiologic responses of previously studied individuals, correctly classified 66% of women with current PTSD and 78% of women who never had PTSD.
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Objective: To investigate the severity of posttraumatic stress (PTS) and the prevalence of posttraumatic stress disorder (PTSD) in individuals with pediatric spinal cord injury (SCI) and their parents and to assess relationships among family members' degree of PTS and PTSD diagnoses. Study Design: Cross-sectional mail survey. Setting: A pediatric orthopedic surgical and rehabilitation hospital. Participants: A volunteer sample of 64 pediatric SCI patients (59% male and 41% female), 64 mothers, and 49 fathers. Main Outcome Measures: The Posttraumatic Diagnostic Scale was used for parents and for patients more than 18 years of age and the Child Posttraumatic Stress Scale was used for patients 18 years of age and under. Results: Sixteen (25.4%) patients, 25 (41%) mothers, and 16 (35.6%) fathers reported current PTSD. Mothers' total PTS scores statistically predicted patients' and fathers' PTS scores, and patients' PTS scores statistically predicted mothers' PTS scores. In addition, mothers' and patients' PTSD diagnoses related significantly. Conclusions: PTSD may be among the most prevalent psychological comorbidities in families experiencing pediatric SCI. Screening and treatment for PTSD appear warranted as part of standard psychosocial care for these families.
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Research on the assessment and diagnosis of posttraumatic stress disorder (PTSD) has rather quickly expanded from relatively small studies in clinical settings into the realm of community epidemiology, increasingly relying on population-based or "community" studies. This article highlights some of the key challenges and opportunities associated with assessing PTSD outside of treatment settings by reviewing the results of some recent efforts to develop, test, and use diagnostic measures of PTSD among samples of Vietnam veterans in the community, including in particular the recently completed National Vietnam Veterans Readjustment Study. Prevalence rates emanating from these different studies are compared, a comprehensive effort to account for some of the more major discrepancies is described, and a general strategy for assessing PTSD in the community-one based on comprehensive assessment of multimethod and multisource information-is suggested.
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Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
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One-hundred and thirty-two victims of motor vehicle accidents (MVAs), who sought medical attention as a result of the MVA, were assessed at three points in time: 1-4 months post-MVA, 6 months later, and 12 months later. Of the 48 who met the full criteria for Post-Traumatic Stress Disorder (PTSD) initially, half had remitted at least in part by the 6-month follow-up point and two-thirds had remitted by the 1-yr follow-up. Using logistic regression, 3 variables combined to correctly identify 79% of remitters and non-remitters at the 12-month follow-up point: initial scores on the irritability and foreshortened future symptoms of PTSD and the initial degree of vulnerability the subject felt in a motor vehicle after the MVA. Four variables combined to predict 64% of the variance in the degree of post-traumatic stress symptoms at 12 months: presence of alcohol abuse and/or an Axis-II disorder at the time of the initial assessment as well as the total scores on the hyperarousal and on avoidance symptoms of PTSD present at the initial post-MVA assessment.
Article
The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.
Article
Background There is a lack of comparative data on the prevalence and effects of exposure to violence in African youth. Aims We assessed trauma exposure, post-traumatic stress symptoms and gender differences in adolescents from two African countries. Method A sample of 2041 boys and girls from 18 schools in CapeTown and Nairobi completed anonymous self-report questionnaires. Results More than 80% reported exposure to severe trauma, either as victims or witnesses. Kenyan adolescents, compared with South African, had significantly higher rates of exposure to witnessing violence (69% v. 58%), physical assault by a family member (27% v. 14%) and sexual assault (18% v. 14%). But rates of current full-symptom post-traumatic stress disorder (PTSD) (22.2% v. 5%) and current partial-symptom PTSD (12% v. 8%) were significantly higher in the South African sample. Boys were as likely as girls to meet PTSD symptom criteria. Conclusions Although the lifetime exposure to trauma was comparable across both settings, Kenyan adolescents had much lower rates of PTSD. This difference may be attributable to cultural and other trauma-related variables. High rates of sexual assault and PTSD, traditionally documented in girls, may also occur in boys and warrant further study.
Article
The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.
Article
Context Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults.Objective To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score).Design, Setting, and Participants A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues.Main Outcome Measure Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce.Results The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience–suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively.Conclusions A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.