Background: It is unclear whether the higher prevalence of posttraumatic stress disorder (PTSD) in women than in men is due to sex differences in the prevalence of the exposure to traumatic events or to differences in vulnerability to traumatic events among those exposed to them. Methods: We applied mediation and moderated mediation models to a large nationally representative sample of US adults (N = 34,653) drawn from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Results: A model that assumed that the effect of 19 traumatic events was the same across sexes and examined whether sex differences in the prevalence of DSM-IV PTSD were due exclusively to sex differences in exposure to traumatic events predicted similar prevalence of PTSD among men and women (indirect effect standardized β = 0.04, P =.61), contrary to empirical findings. By contrast, a model that allowed the effect of 19 traumatic events on risk of PTSD to vary by gender, while taking into account sex differences in the prevalence of exposure, indicated that, for 13 of the traumatic events, the effect was significantly greater in women than in men (range of standardized β coefficients = 0.02-0.12, P <.05). The total indirect and direct effects of sex on PTSD in this model were, respectively, β = 0.42 (P <.01) and β =-0.03 (P =.76), indicating that all of the effect of sex on PTSD was explained by this moderated mediation model. Conclusions: The higher prevalence of PTSD among women appears to be due mainly to their greater vulnerability to the effects of traumatic events.
Bibliographical noteFunding Information:
Submitted: November 28, 2016; accepted July 18, 2017. Published online: March 27, 2018. Author contributions: Drs Blanco, Hoertel, and Wall designed the study. Drs Hoertel and Wall conducted the data analyses. Dr Blanco wrote the initial draft of the manuscript. All authors contributed to manuscript revision and approved the final version. Potential conflicts of interest: Dr Blanco holds stocks in Sanofi and Eli Lilly. Dr Limosin is a member of the speakers/advisory boards for Janssen, Euthérapie, Lundbeck, and Roche. The other authors report no conflicts of interest. Funding/support: The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded, in part, by the Intramural Program, NIAAA, National Institutes of Health (NIH). Work on this manuscript was supported by NIH grants DA019606, MH076051, and MH082773 (Dr Blanco) and T32MH096724 (Dr Helpman); the New York State Psychiatric Institute (Drs Blanco, Neria, and Wall); and a fellowship grant from Public Health Expertise (Dr Hoertel). Role of the sponsor: The sponsors had no additional role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Disclaimer: The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the US government. Additional information: Due to increasing concerns for confidentiality of individuals participating in US Government and other surveys, NIAAA has determined that Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) be designated as limited-access data files. Information on procedures for accessing the Waves 1 and 2 data are currently being developed. For more information, see this NIAAA website: www.niaaa. nih.gov. Supplementary material: See accompanying pages.
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ASJC Scopus subject areas
- Psychiatry and Mental health