Posttraumatic Stress More
Common in Women Than Men
Excerpt By Stephanie Riesenman, Reuters Health

Women are more likely than men to suffer long-term posttraumatic stress disorder (PTSD) after a traumatic injury, according to researchers from the University of California at San Diego. But the reasons for the difference remain unclear.

In the study, symptoms of anxiety following a traumatic event were more common among women regardless of the severity or mechanism of injury. And women's quality of life after 18 months was worse than that of men who also suffered a traumatic event.

Dr. Troy Holbrook, lead investigator of the study, said that traumas such as sexual assault or domestic violence, which are often associated with symptoms of PTSD in women, were not common reasons for the hospital admissions in the study. So whatever is causing women to develop PTSD at higher rates then men needs to be investigated, he said.

The study involved more than 1,000 trauma patients admitted to four San Diego County hospitals from December 1993 to September 1996. All patients were 18 or older and were admitted for at least 24 hours before discharge. Study participants had suffered injuries due to vehicle and motorcycle accidents, stabbings, shootings, assaults or other causes. Patients with severe head injuries were excluded from the study.

Patient anxiety levels were assessed at discharge, then six months, 12 months and 18 months later. Sufficient follow-up results were available for 627 participants. The results are published in a recent issue of the Journal of Trauma Injury, Infection, and Critical Care.

Dr. Jonathan Davidson, director of the Anxiety and Traumatic Stress Program at Duke University, who was not involved with the study, said that a PTSD assessment lumps symptoms into three clusters of 17 possible symptoms. The first cluster contains "intrusive symptoms," which include flashbacks to the traumatic event that occur during the day or while a person is sleeping, or may be triggered by a stimulus such as a television program.

Next are "avoidance and numbing symptoms" brought on by fear. Davidson said a person with PTSD might avoid contact with anything that reminds them of the traumatic event, be it a person or a location. They become emotionally numb and withdraw from human contact.

Finally, people with "hyperarousal symptoms," said Davidson, always have their guard up. They believe the world is dangerous, and they can no longer concentrate because they are preoccupied with fear.

Davidson said one must have at least six symptoms to be diagnosed with PTSD. In the UCSD study, a patient was considered to have prolonged stress only if symptoms persisted beyond the six-month interview. Overall, 35% of the 627 patients had both full and partial symptoms of PTSD, and full symptoms alone were present in 32% of patients.

Women were 2.8 times more likely to develop full symptoms of PTSD than men. They were also 2.4 times more likely to have full and partial symptoms of PTSD than were men in the study.

The UCSD researchers also looked at the patients' quality of life in the 18 months following the trauma, evaluating their mobility, physical activity and social activity compared to that of an average healthy individual. Quality of life scores for both genders were significantly lower when symptoms of PTSD were present, but women had consistently lower scores than men at each interview point.

Treatment for PTSD can include counseling and antidepressants called selective serotonin reuptake inhibitors, which include Zoloft and Paxil.

"It's important to have a professionally trained person who's willing to listen and validate what happened and provide support and understanding and encourage the survivor to talk as much as they want to," said Davidson.

Understanding gender differences in regard to PTSD is important because "more and more women are in professional roles, such as the armed forces and emergency medical technicians, that put them at higher risk for serious injury," said Holbrook. Understanding why women are at higher risk for PTSD, he said, "will help us to better treat those who do develop posttraumatic stress disorder."

SOURCE: Journal of Trauma Injury, Infection and Critical Care 2002;53:882-887.

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