Women are at higher risk than men for developing posttraumatic stress disorder (PTSD), but underlying mechanisms are still unclear. Comprehensive knowledge about these mechanisms is necessary to develop tailored, sex- and gender-sensitive preventive interventions. This systematic review and meta-analysis examined sex-/gender-dependent risk factors, that is, risk factors with sex/gender differences in (a) vulnerability or (b) prevalence/severity, as well as sex-/gender-specific risk factors, that is, and (c) risk factors present in one sex/gender only. We searched PubMed, Web of Science, PsycINFO, PsycArticles, and PSYNDEX for articles published until October 16, 2022. We included prospective studies that assessed risk factors to predict subsequent PTSD symptom severity, as measured with the Clinician-Administered PTSD scale. The primary outcomes were sex/gender stratified pooled for sex-/gender-dependent vulnerability and sex-/gender-specific risk factors and pooled odds ratio (OR) or standardized mean difference (SMD) for sex-/gender-dependent risk factor prevalence/severity. We screened 17,270 records and included 117 reports from 45 studies (N = 13,752) in the systematic review. Seventeen studies (N = 4,257; 1,827 women, 2,430 men) were included in the meta-analysis. Regarding risk factor vulnerability, analyses revealed no significant sex/gender differences except for acute stress symptoms, with stronger associations for men (b = 0.11, SE = 0.06, p < .05). Regarding risk factor prevalence/severity, women reported more severe immediate psychological stress responses (range SMD = 0.23-0.56) and more commonly had a history of mental illness (OR = 1.81, 1.27-2.58). Men showed higher trauma load (SMD = -0.15, -0.29 to 0.01). Few women-specific and no men-specific factors were identified. Results suggest that women's heightened immediate psychological stress response drives sex/gender disparities in PTSD symptom severity. Preventive interventions should thus target women early after trauma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

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创伤后应激障碍危险因素的性别和性别差异：前瞻性研究的系统评价和荟萃分析。


女性患创伤后应激障碍 （PTSD） 的风险高于男性，但其潜在机制仍不清楚。关于这些机制的全面了解对于开发有针对性的、对性别和性别敏感的预防干预措施是必要的。本系统评价和荟萃分析检查了性别/性别依赖性风险因素，即在 （a） 脆弱性或 （b） 患病率/严重程度方面存在性别/性别差异的风险因素，以及性别/性别特异性风险因素，即 （c） 仅存在于一种性别/性别中的风险因素。我们在 PubMed、Web of Science、PsycINFO、PsycArticles 和 PSYNDEX 中检索了截至 2022 年 10 月 16 日发表的文章。我们纳入了前瞻性研究，这些研究评估了风险因素以预测后续 PTSD 症状的严重程度，如临床医生管理的 PTSD 量表所测量的那样。主要结局是性别/性别依赖性脆弱性和性别/性别特异性风险因素的性别/性别分层汇总，以及性别/性别依赖性风险因素发生率/严重程度的合并比值比 （OR） 或标准化均数差 （SMD）。我们筛选了 17,270 条记录，并在系统评价中纳入了来自 45 项研究的 117 份报告 （N = 13,752）。荟萃分析纳入了 17 项研究 （N = 4,257;1,827 名女性，2,430 名男性）。关于风险因素脆弱性，分析显示除急性应激症状外没有显着的性别/性别差异，男性的相关性更强 （b = 0.11，SE = 0.06，p < .05）。关于危险因素发生率/严重程度，女性报告了更严重的即时心理应激反应 （范围 SMD = 0.23-0.56），并且更常见的是有精神疾病史 （OR = 1.81， 1.27-2.58）。男性表现出更高的创伤负荷 （SMD = -0.15， -0.29 至 0.01）。 很少发现女性特异性因素，也没有发现男性特异性因素。结果表明，女性增强的即时心理压力反应导致了 PTSD 症状严重程度的性别/性别差异。因此，预防性干预措施应针对创伤后的早期女性。（PsycInfo 数据库记录 （c） 2024 APA，保留所有权利）。