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

Importance: Knowledge of sex-differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Objective: To examine sex-dependent vulnerability to PTSD risk factors. Design: The Advancing Understanding of Recovery After TraumA (AURORA) study was a prospective cohort study that followed participants for 12 months after acute trauma exposure. Data for this report was collected from September 2017 through June 2021 and includes self-report information from baseline, 2-week, 8-week, and 3-month follow-up. Data analysis was performed from October 19, 2022 to January 31, 2023. Setting: Multicenter study conducted in 29 US emergency departments (ED).Participants: Adult patients presenting to EDs within 72 hours of acute trauma.Exposure: Acute trauma Main Outcome and Measures: Self-reported PTSD severity 3 months post-trauma as assessed with the PTSD Checklist for DSM-5. Results: A total of 2942 participants (62% women; mean age 35.9 (SD 13.3) years) were included. Women reported higher PTSD severity at 3-months post-trauma (d = .24, p<.001). 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 (ß = -0.11, p<.005), and acute dissociative symptoms (ß = -0.10, p<.005); both showed stronger associations with PTSD in men than in women.Conclusions and Relevance: We conducted a comprehensive analysis of sex-dependent vulnerability to early PTSD risk factors in a large cohort of acutely traumatized individuals. Despite women’s higher PTSD severity at 3-month post-trauma, analyses did not identify any risk factors to which women were more vulnerable than men. This points towards the consideration of further mechanisms to explain women’s higher PTSD risk. Our findings further indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. 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.