Moving beyond gender: A systematic review of diversity data gaps in prospective trauma research

Background: To better understand heterogeneity in PTSD development and to ensure that knowledge of risk and intervention mechanisms is available for a diverse group of trauma exposed individuals, psychotraumatology needs to consider diversity in sample characteristics. Objective: In a comprehensive overview, we evaluated how nine diversity domains including age, socioeconomic status (SES), race/ethnicity, sexual orientation, care responsibilities, religion/worldview, mental health, physical health, and disability status were considered in prospective PTSD research. In in-depth analyses, we further investigated the assessment and representation of population groups with regard to age, SES and race/ethnicity. Method: Based on a systematic literature research in PubMed, Web of Science, PsycINFO, PsycArticles and PSYNDEX we included k=45 studies that prospectively assessed PTSD symptoms in trauma exposed individuals and that were previously analyzed with regard to sex and gender consideration. Information on diversity assessment and characteristics was systematically extracted and analyzed. Results: While age was assessed in all studies, consideration of the remaining diversity domains was insufficient, ranging from 57.8% of studies for SES to 0.0% regarding sexual orientation and care responsibilities. Our in-depth analyses showed that middle-aged, well-educated and racially non-marginalized individuals were overrepresented. Conclusions: Our study revealed diversity data gaps in reporting and representation, limiting the generalizability of research findings. It highlights the need to routinely assess diversity domains, whenever appropriate, as well as to further develop and establish existing instruments. Given this selection bias in naturalistic studies, strategies to attract and retain traditionally underrepresented groups in studies are necessary.