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

Stephanie Haering; Antonia V Seligowski; Sarah D Linnstaedt; Vasiliki Michopoulos; Stacey L House; Francesca L Beaudoin; Xinming An; Thomas C Neylan; Gari D Clifford; Laura T Germine; Scott L Rauch; John P Haran; Alan B Storrow; Christopher Lewandowski; Paul I Musey Jr; Phyllis L Hendry; Sophia Sheikh; Christopher W Jones; Brittany E Punches; Robert A Swor; Nina T Gentile; Lauren A Hudak; Jose L Pascual; Mark J Seamon; Claire Pearson; David A Peak; Roland C Merchant; Robert M Domeier; Niels K Rathlev; Brian J O'Neil; Leon D Sanchez; Steven E Bruce; Steven E Harte; Samuel A McLean; Ronald C Kessler; Karestan C Koenen; Jennifer S Stevens; Abigail Powers

doi:10.1017/S0033291724000941

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

Psychol Med. 2024 May 22:1-11. doi: 10.1017/S0033291724000941. Online ahead of print.

Authors

Stephanie Haering^{1

2}, Antonia V Seligowski³, Sarah D Linnstaedt⁴, Vasiliki Michopoulos⁵, Stacey L House⁶, Francesca L Beaudoin^{7

8}, Xinming An⁴, Thomas C Neylan⁹, Gari D Clifford^{10

11}, Laura T Germine^{12

13

14}, Scott L Rauch^{3

12

14}, John P Haran¹⁵, Alan B Storrow¹⁶, Christopher Lewandowski¹⁷, Paul I Musey Jr¹⁸, Phyllis L Hendry¹⁹, Sophia Sheikh¹⁹, Christopher W Jones²⁰, Brittany E Punches^{21

22}, Robert A Swor²³, Nina T Gentile²⁴, Lauren A Hudak²⁵, Jose L Pascual^{26

27}, Mark J Seamon^{27

28}, Claire Pearson²⁹, David A Peak³⁰, Roland C Merchant³¹, Robert M Domeier³², Niels K Rathlev³³, Brian J O'Neil³⁴, Leon D Sanchez^{31

35}, Steven E Bruce³⁶, Steven E Harte^{37

38}, Samuel A McLean^{39

40}, Ronald C Kessler⁴¹, Karestan C Koenen⁴², Jennifer S Stevens⁵, Abigail Powers⁵

Affiliations

¹ Department of Education and Psychology, Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.
² Charité Center for Health and Human Sciences, Gender in Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³ Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
⁴ Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁶ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁷ Department of Epidemiology, Brown University, Providence, RI, USA.
⁸ Department of Emergency Medicine, Brown University, Providence, RI, USA.
⁹ Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA.
¹⁰ Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
¹¹ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
¹² Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
¹³ The Many Brains Project, Belmont, MA, USA.
¹⁴ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹⁵ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
¹⁶ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁷ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁹ Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA.
²⁰ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²¹ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA.
²² Ohio State University College of Nursing, Columbus, OH, USA.
²³ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
²⁴ Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
²⁵ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
²⁶ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
²⁷ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
²⁸ Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
²⁹ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA.
³⁰ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
³¹ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
³² Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA.
³³ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
³⁴ Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA.
³⁵ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
³⁶ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
³⁷ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
³⁸ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
³⁹ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁰ Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴¹ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁴² Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.

PMID: 38775091
DOI: 10.1017/S0033291724000941

Abstract

Background: Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.

Methods: As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.

Results: Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.

Conclusions: Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.

Keywords: PTSD; risk factors; sex differences; trauma.