Toward Understanding Sex Differences in the Prevalence of Posttraumatic Stress Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Toward Understanding Sex Differences in the Prevalence of Posttraumatic Stress Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
复制标题
DOI：
10.4088/jcp.16m11364
复制
发表时间：
2018-03-01
影响因子：
5.3
通讯作者：
Limosin, Frederic
中科院分区：
文献类型：
--
作者：
Blanco, Carlos;Hoertel, Nicolas;Limosin, Frederic
背景：创伤后应激障碍(PTSD)在女性中的患病率高于男性，目前尚不清楚是因为暴露于创伤事件的患病率存在性别差异，还是由于暴露于创伤事件的人对创伤事件的易感性存在差异。方法：我们应用调解和调节调解模型对来自全国具有代表性的大样本(N=34,653)的美国成年人(N=34,653)进行调查，这些样本来自全国酒精及相关疾病流行病学调查第二波(2004-2005)。结果：该模型假设19种创伤事件的影响在性别之间是相同的，并检验了DSM患病率的性别差异-IV创伤后应激障碍完全是由于暴露在创伤事件中的性别差异，预计男性和女性创伤后应激障碍的患病率相似(间接影响标准化β=0.04，P=.61)，与经验研究结果相反。相比之下，一个模型允许19个创伤事件对创伤后应激障碍风险的影响因性别而异，同时考虑到暴露流行率的性别差异，该模型表明，对于13个创伤事件，女性的影响明显大于男性(标准化贝塔系数范围=0.02-0.12，P<；0.05)。在该模型中，性别对创伤后应激障碍的总间接效应和直接效应分别为β=0.42(P<；.01)和β=-0.03(P=.76)，说明性别对创伤后应激障碍的所有影响都可以用这个调节模型来解释。结论：女性创伤后应激障碍的患病率较高，主要是因为她们更容易受到创伤事件的影响。
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 beta = 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 beta coefficients = 0.02-0.12, P < .05). The total indirect and direct effects of sex on PTSD in this model were, respectively, beta = 0.42 (P < .01) and beta = -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.