Disentangling sex differences in PTSD risk factors: a systematic overview and multiple mediation analysis in the AURORA study
Year: 2025
Type: preprint
Abstract: Despite extensive of research on sex differences in posttraumatic stress disorder (PTSD), underlying mechanisms are still not fully understood. Here we present a systematic overview of three sex-related risk pathways. We assessed 16 risk factors as well as 3-month PTSD severity in a prospective cohort (n=2924) of acutely traumatized individuals and investigated potential mediators in the pathway between sex and PTSD severity using multiple mediation analysis with regularization. Six risk factors were more prevalent/severe in women, and none was more pronounced in men. Analyses showed that acute stress disorder, neuroticism, lifetime sexual assault exposure, anxiety sensitivity, and pre-trauma anxiety symptoms fully mediated and uniquely contributed to the relationship between sex and PTSD severity. Our results demonstrate different risk mechanisms for women and men. Such knowledge can inform targeted interventions. Our systematic approach to differential risk pathways can be transferred to other mental disorders to guide sex-sensitive mental health research.
Authors: Stephanie Haering, Antonia V. Seligowski, Sarah D. Linnstaedt, Vasiliki Michopoulos, Stacey L. House, Francesca Beaudoin, Xinming An, Thomas C. Neylan, Gari D. Clifford, Laura T. Germine, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey, Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Brittany E. Punches, Robert A. Swor, Nina T. Gentile, Lauren A. Hudak, Jose L. Pascual, Mark S. Seamon, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Brian J. O'Neil, Leon D. Sanchez, Steven E. Bruce, Steven E. Harte, Samuel A. McLean, Ronald C Kessler, Karestan C. Koenen, Abigail Powers, Jennifer Stevens
Institution: Harvard University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
OpenAlex ID: W4406973868