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      Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females Translated title: Diferencias según sexo para el riesgo de desarrollar el TEPT: La evidencia en poblaciones post-conflicto desafía la hipótesis general de un incremento de la vulnerabilidad en mujeres Translated title: PTSD风险的性别差异:来自冲突后人群的证据挑战了女性易感性增加的一般假设


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          Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations.

          Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load.

          Method: In civilian post-conflict samples from Northern Uganda ( N = 1665), Rwanda ( N = 433), Syria ( N = 974) and Sri Lanka ( N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load.

          Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample.

          Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.


          • In four samples of civilian conflict survivors, sex did not influence PTSD risk as strongly as commonly reported in the literature.

          • If males and females experience similar trauma event types and a high amount of traumatic stress, sex differences in PTSD risk seem to decrease.

          Translated abstract

          Antecedentes: Junto al efecto dosis-dependiente de la carga traumática, el sexo femenino representa un factor de riesgo bien establecido para el desarrollo del trastorno de estrés postraumático (TEPT). La exposición a tipos de eventos particularmente tóxicos, diferentes estilos de afrontamiento y factores de riesgo biológicos se enumeran con frecuencia como causas potenciales del aumento de la vulnerabilidad al TEPT en las mujeres. Sin embargo, no se ha observado de manera consistente la diferencia según sexo en todas las poblaciones estudiadas.

          Objetivo: Investigar las diferencias según sexo para el desarrollo del TEPT en poblaciones post-conflicto de diferentes países teniendo en consideración la carga traumática.

          Métodos: Se investigaron diferencias en el TEPT según sexo tomando en consideración la carga traumática a partir de muestras post-conflicto de población civil en el norte de Uganda ( N = 1665), Ruanda ( N = 433), Siria ( N = 947) y Sri Lanka ( N = 165). El TEPT y la carga traumática se evaluaron empleando entrevistas diagnósticas. Se analizaron las potenciales diferencias según sexo para el riesgo de desarrollar el TEPT empleando un análisis de regresión logística y considerando la carga traumática.

          Resultados: En todas las muestras, los varones reportaron mayor número de eventos traumáticos que las mujeres. Ambos sexos reportaron predominantemente eventos traumáticos relacionados a la guerra. Dejando de lado la carga traumática, los efectos del sexo para el riesgo de desarrollar el TEPT solo se encontraron en la muestra siria. Cuando se toma en consideración la carga traumática, se encontró un incremento en la vulnerabilidad para el desarrollo del TEPT en mujeres dentro de la muestra siria y, en menor medida, en la del norte de Uganda.

          Conclusión: En contraste con la literatura, no se encontró evidencia de un incremento generalizado de la vulnerabilidad para el desarrollo del TEPT en mujeres. El efecto dosis-respuesta de la carga traumática fue un predictor mucho más fuerte para el riesgo del desarrollo del TEPT que el sexo en todas las muestras.

          Translated abstract

          背景: 除了创伤负荷的剂量依赖性效应之外, 女性代表了一个确定的PTSD风险因素。暴露于特别有毒的创伤事件类型, 不同的应对方式以及生物学风险因素经常被列为女性PTSD易感性增加的潜在原因。然而, 并非在所有研究人群中都一致观察到了性别差异。

          目的: 在考虑创伤负荷的同时, 考查来自不同国家的冲突后人群在PTSD风险中的性别差异。

          方法: 在来自乌干达北部 ( N = 1665), 卢旺达 ( N = 433), 叙利亚 ( N = 974) 和斯里兰卡 ( N = 165) 的冲突后平民样本中, 我们在将创伤负荷考虑在内的同时, 考查了PTSD风险的性别差异。PTSD和创伤负荷使用标准化诊断访谈进行评估。PTSD风险中潜在的性别差异通过考虑创伤负荷的逻辑回归分析进行分析。

          结果: 在所有样本中, 男性报告了比女性更多的创伤事件。两性都主要报告战争相关的创伤事件。在不考虑创伤负荷的情况下, 仅在叙利亚样本中检测到了PTSD风险的性别效应。考虑到创伤负荷, 在叙利亚样本中发现了女性PTSD易感性增加的证据, 而在乌干达北部样本中则发现了降低的证据。

          结论: 与文献相反, 我们没有发现女性PTSD易感性普遍升高的证据。在所有样本中, 创伤负荷的剂量反应效应是一个比性别更强的PTSD风险预测因素。

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          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. (c) 2006 APA, All Rights Reserved.
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                Author and article information

                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                9 September 2021
                9 September 2021
                : 12
                : 1
                [a ]Clinical Psychology and Psychotherapy, Bielefeld University; , Bielefeld, Germany
                [b ]vivo International e.V; , Konstanz, Germany
                [c ]Clinical & Biological Psychology, Ulm University; , Ulm, Germany
                [d ]SAP S/4HANA CIC & Q2C, SAP Switzerland AG; , Tägerwilen, Switzerland
                [e ]Department of Clinical Psychology, Koya University; , Koya, Iraq
                Author notes
                CONTACT Sarah Wilker sarah.wilker@ 123456uni-bielefeld.de Clinical Psychology and Psychotherapy, Bielefeld University; , Universitätsstraße 25, Bielefeld 33615, Germany

                These authors contributed equally to this work

                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 2, References: 62, Pages: 13
                Research Article
                Basic Research Article

                Clinical Psychology & Psychiatry
                posttraumatic stress disorder,prevalence,sex differences,trauma load,conflict,war,trastorno de estrés postraumático,prevalencia,diferencias según sexo,carga traumática,conflicto,guerra,创伤后应激障碍,患病率,性别差异,创伤负荷,冲突,战争


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