Gender

Gender differences in PTSD as the main topic. Gender is an important variable in most of our studies.

Completed: 2018

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Publications:
Murphy, S., Elklit, A., Chen, Y. Y., Ghazali, S. R., & Shevlin, M. (2018). Sex Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy. Doi: 10.1037/tra0000355

Christiansen, D. M. (2017). Mediation and moderation effects of sex and gender in PTSD. Department of Psychology and Behavioural Sciences, Aarhus University.

Christiansen, D. M. (2017). Sex and gender differences in trauma victims presenting for treatment. In M. J. Legato (red.), Principles of gender-specific medicine: Gender in the Genomic Era (3. udg., s. 497-511). Academic Press. Doi: 10.1016/B978-0-12-803506-1.00043-7

Murphy, S. & Elklit, A. (2017). Gender Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263-385. Doi: 10.1037/tra0000355

Christiansen, D. M., & Hansen, M. (2015) Accounting for sex differences in PTSD: A multi-variable mediation model. European Journal of Psychotraumatology, 6. Doi: 10.3402/ejpt.v6.26068

Ditlevsen, D. N. & Elklit, A.(2012) Gender, Trauma Type and PTSD Prevalence: A Re-analysis of 18 Nordic Convenience Samples. Annals of General Psychiatry, 11(26). Doi: 10.1186/1744-859X-11-26

Christiansen, D. & Elklit, A.(2011) Sex differences in PTSD. In E. Ovuga (Ed.): Post Traumatic Stress Disorders in a Global Context. (pp 113-142). ISBN 978-953-307-825-0. Rijeka, Croatia: Intech.

Spindler, H., Elklit, A. & Christiansen, D. (2010). Risk factors for post-traumatic stress disorder following a technological disaster in a residential area: A note on the origin of gender differences in post-traumatic stress disorder. Gender Medicine, 7(2), 156-165.

Ditlevsen, D. N. & Elklit, A.(2010) The Combined Effect of Gender and Age on Post-tramatic Stress Disorder: Do Men and Women Show Differences in the Lifespan Distribution of PTSD? Annals of General Psychiatry, 9(32). Doi: 10.1186/1744-859X-9-32.

Every year, 1500-2000 people are seriously injured in traffic accidents in Denmark. Post-traumatic stress disorder (PTSD) is common after such serious traffic accidents and similar serious accidents with prevalence rates of 20-45%. Unfortunately, our current knowledge on how best to identify individuals at risk of developing PTSD is extremely limited. In particular, it is unclear whether the same factors can be used to identify and prevent PTSD in men and women.

Approximately twice as many women as men develop PTSD after suffering a serious accident. We believe that a large part of the explanation for these gender differences can be found in men's and women's acute reactions to the accident. This includes psychological, physiological and endocrinological (hormonal) reactions. Understanding these factors may therefore be crucial to improving early identification, prevention and treatment of PTSD and other trauma-related disorders among accident victims.

The current project is a prospective pilot study of patients who have been involved in a traffic accident or similar serious accident. The focus area of the study can be divided into three parts:

1. The interplay between acute physiological, endocrinological and psychological responses to major accidents.
2. The influence of these acute reactions on the development of PTSD symptoms 3 and 6 months later.
3. Gender differences in the two items above, with a special focus on how both biological and socio-cultural gender-related factors affect trauma reactions.

The study will be the first of its kind to examine the complex interplay between the physical and psychological aspects of both gender and trauma response from multiple angles, which are often examined separately.  The absence of similar previous research is also the reason why the current study is being conducted as a pilot study as the first part of a research project that is expected to be conducted on a larger scale.

The aim of the study was to examine the combined effect of gender and age on post-traumatic stress disorder (PTSD) in order to describe a possible gender difference in the lifespan distribution of PTSD. Data were collected from previous Danish and Nordic studies of PTSD or trauma. The final sample was composed of 6,548 participants, 2,768 (42.3%) men and 3,780 (57.7%) women. PTSD was measured based on the Harvard Trauma Questionnaire, part IV (HTQ-IV). Men and women differed in lifespan distribution of PTSD. The highest prevalence of PTSD was seen in the early 40s for men and in the early 50s for women, while the lowest prevalence for both genders was in the early 70s. Women had an overall twofold higher PTSD prevalence than men. However, at some ages the female to male ratio was nearly 3:1. The highest female to male ratio was found for the 21 to 25 year-olds. The lifespan gender differences indicate the importance of including reproductive factors and social responsibilities in the understanding of the development of PTSD.

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Publications:
Ditlevsen, D. N. & Elklit, A. (2010). The Combined Effect of Gender and Age on Posttramatic Stress Disorder: Do Men and Women Show Differences in the Lifespan Distribution of PTSD? Annals of General Psychiatry, 9:32. Doi:10.1186/1744-859X-9-32.

Background: The factor structure of posttraumatic stress disorder (PTSD) has been extensively studied in Western countries. Some studies have assessed its factor structure in Asia (China, Sri Lanka, and Malaysia), but few have directly assessed the factor structure of PTSD in an Indian adult sample. Furthermore, in a largely patriarchal society in India with strong gender roles, it becomes imperative to assess the association between the factors of PTSD and gender. Objective: The purpose of the present study was to assess the factor structure of PTSD in an Indian sample of trauma survivors based on prevailing models of PTSD defined in the DSM-IV-TR (APA, 2000), and to assess the relation between PTSD factors and gender. Method: The sample comprised of 313 participants (55.9% female) from Jammu and Kashmir, India, who had experienced a natural disaster (N=200) or displacement due to cross-border firing (N=113). Results: Three existing PTSD models--two four-factor models (Emotional Numbing and Dysphoria), and a five-factor model (Dysphoric Arousal)--were tested using Confirmatory Factor Analysis with addition of gender as a covariate. The three competing models had similar fit indices although the Dysphoric Arousal model fit significantly better than Emotional Numbing and Dysphoria models. Gender differences were found across the factors of Re-experiencing and Anxious arousal. Conclusions: Findings indicate that the Dysphoric Arousal model of PTSD was the best model; albeit the fit indices of all models were fairly similar. Compared to males, females scored higher on factors of Re-experiencing and Anxious arousal. Gender differences found across two factors of PTSD are discussed in light of the social milieu in India.

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Publications:
Charak, R., Armour, C., Elklit, A., Angmo, D., Elhai, J. D. & Koot, H. M.: (2014). Factor Structure of PTSD and Relationship with Gender in Trauma Survivors from India. European Journal of Psychotraumatology, 5:25547. Doi: 10.3402/ejpt.v5.25547.

Background: The aim of the study was to examine a possible trauma type related variance in the gender difference of posttraumatic stress disorder (PTSD) prevalence. Methods: An analysis was conducted on 18 convenience sample studies including data from a total of 5220 participants. The studies all applied the Harvard Trauma Questionnaire - part IV to assess PTSD. Cohen's d was used to measure variance in gender differences. Trauma types included disasters and accidents, violence, loss, chronic disease and non-malignant diseases. Results: The results showed an overall gender difference in PTSD prevalence similar to previous findings. Thus, women had a two-fold higher prevalence of PTSD than men. Besides categorical analyses, dimensional analyses of PTSD severity were also performed; the latter were associated with twice as large effect sizes. Females were more vulnerable to PTSD after disasters and accidents, followed by loss and non-malignant diseases. In violence and chronic disease, the gender differences were smallest. Conclusions: The findings support the existence of a trauma type related variance in gender differences in PTSD prevalence.

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Publications:
Ditlevsen, D. N. & Elklit, A. (2012). Gender, Trauma Type and PTSD Prevalence: A Re-analysis of 18 Nordic Convenience Samples. Annals of General Psychiatry, 11:26. Doi:10.1186/1744-859X-11-26

Objective: Evidence has suggested there are sex differences in posttraumatic stress disorder (PTSD) symptom expression; however, few studies have assessed whether these differences are due to measurement invariance. This study aimed to examine sex differences in PTSD symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) using differential item functioning (DIF). Method: Confirmatory factor analysis was conducted on the DSM-5 model of PTSD, followed by a multiple indicators multiple causes (MIMIC) model to examine possible DIF using the PTSD Checklist for DSM-5. Data were analyzed from a Malaysian adolescent sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. Results: The results indicated the presence of DIF for 2 of 20 PTSD criteria. Females scored significantly higher on emotional cue reactivity (B4), and males reported significantly higher rates of reckless or self-destructive behavior (E2) while statistically controlling for the latent variables in the model. However, the magnitude of these item-level differences was small. Conclusion: These findings indicate that despite the presence of DIF for 2 DSM-5 symptoms. this does not provide firm support for nonequivalence across sex.

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Publications: 
Murphy, S., Elklit, A., Chen, Y.Y., Ghazali, S.R., & Shevlin, M. (2018). Gender Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3) pp. 263-385. Doi: 10.1037/tra0000355

Gender is an important risk factor for both posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in adolescents; however, little is known about the influence of gender when considering their common co-occurrence. This study examined independent predictors of PTSD severity between genders in a Danish probability sample of 15- to 18-year-old males (n = 863) and females (n = 1,125). The results showed that drug abuse and avoidant attachment to best friends were significant predictors of PTSD severity in male adolescents, whereas alcohol abuse and the absence of posttraumatic social support from parents remained significant predictors for female adolescents. The results support the influence of gender-specific substance abuse patterns and dysfunctional interpersonal relationships on the PTSD severity of traumatized adolescents.

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Publications:
Donbaek, D. F. & Elklit, A. (2015). Gender-specific predictors of Posttraumatic Stress Disorder in Adolescence: The role of problematic substance use and interpersonal relationships. Journal of Child and Adolescent Trauma, 8, 161-172. Doi: 10.1007/s40653-015-0040-5

Adolescents who have multiple traumatic experiences may suffer from posttraumatic stress disorder (PTSD) or other mental health problems later in life. Study of trauma exposure and PTSD among adolescents is very limited in Malaysia. This study explored the prevalence of lifetime trauma, demographic risk factors, and PTSD symptoms among Malaysian adolescents. This cross-sectional study recruited 1,016 adolescents aged 13 to 17 (Mage = 14.9 years). Results showed that 83% participants had at least 1 traumatic exposure (TE), whereas prevalence of PTSD symptoms was 11.7%. Adolescents with multiple TEs and those with violent and self-inflicted TE were at significantly higher risk to develop PTSD symptoms. Findings suggest that a large proportion of Malaysian adolescents are exposed to a variety of traumatic events since childhood. Trauma exposure should be included as an important component in our adolescent mental health assessment, allowing early psychological intervention to be provided to those affected.

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Publications
Ghazali, S. R., Elklit, A., Sultan, M. A., Balang, R. V., & Chen, Y. Y.(2016): Lifetime trauma exposure, gender and DSM-V PTSD symptoms among adolescents in Malaysia. Traumatology, 23(3), 235-239. Doi: 10.1037/trm0000088

Background: Studies indicate that differences in trait anxiety and trauma-related distress may mediate the gender differences observed in posttraumatic stress disorder (PTSD). Objective: We examined the contributions of gender, trait anxiety, and trauma-related distress to the development of PTSD after an industrial disaster. Methods: Three months after a massive explosion in a fireworks factory in Kolding, Denmark, in November 2004, residents in the surrounding area were asked to complete the Harvard Trauma Questionnaire, the General Health Questionnaire, and a questionaire designed for the present study. Using multivariable logistic regression with PTSD as the dependent variable, we examined 4 explanatory models: (1) gender; (2) gender and trait anxiety; (3) gender, trait anxiety, and perceived danger; and (4) gender, trait anxiety, perceived danger, perceived hostility, feeling isolated, depersonalization, and behavioral self-blame. Results: Fifty-one percent (N = 516; 265 women and 251 men) of the area residents participated in the study. The female-to-male ratio of PTSD was 2.4:1. Women experienced significantly more trait anxiety (P < 0.001), feelings of isolation (P < 0.005), and behavioral self-blame (P = 0.018), and less perceived danger (P = 0.034) than did men. In multivariable logistic regression analysis, gender alone predicted 3.7% of the variance in PTSD status (odds ratio [OR] = 2.40; 95% CI, 1.35-4.27; P < 0.005); however, in all other models, gender was not significant. The final model comprised trait anxiety (OR = 1.20; 95% CI, 1.11-1.30; P < 0.001), perceived danger (OR = 4.62; 95% Cl, 2.24-9.50; P < 0.001), perceived hostility (OR = 5.21; 95% CI, 1.93-14.09; P < 0.001), feeling isolated (OR = 3.34; 95% CI, 1.55-7.16; P < 0.002), depersonalization (OR = 2.49; 95% CI, 1.42-4.37; P < 0.001), and behavioral self-blame (OR = 0.46; 95% CI, 0.24-0.86; P = 0.015), explaining 48.9% of the variance in PTSD severity. Conclusion: This cross-sectional study found that gender was no longer associated with PTSD status when trait anxiety, perceived danger and hostility, feeling isolated, depersonalization, and behavioral selfblame were taken into account.

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Publications:
Spindler, H., Elklit, A. & Christiansen, D. (2010). Risk factors for post-traumatic stress disorder following a technological disaster in a residential area: A note on the origin of gender differences in post-traumatic stress disorder. Gender Medicine, 7(2), 156-165. Doi: 10.1016/j.genm.2010.04.001

Objective: There is increasing evidence to suggest that anxiety is related more strongly to chronic pain experience in men relative to women. The aim of the present study was to examine for the first time gender-specific associations between anxiety and chronic pain experience in men and women exposed to whiplash trauma.

Results: Anxiety was found to be positively related to the level of general disability to a significantly stronger magnitude in men compared with women. A trend difference in correlation magnitude was also found between men and women when comparing anxiety with pain frequency, with the magnitude of correlation being higher in men.

Discussion: The stronger association between anxiety and symptoms of whiplash trauma in men compared with women may be due to gender differences in the attribution of anxiety-related autonomic arousal as symptoms of whiplash injury. Alternatively, anxiety may differentially affect the willingness of men and women to report pain and other health indices. Anxiety is an important factor in understanding gender differences in whiplash-related symptoms such as chronic pain and disability, and requires further investigation.

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Publications:
Elklit, A. & Jones, A. (2006).The Association between Anxiety and Chronic Pain After Whiplash Injury: Gender-specific Effects. Clinical Journal of Pain, 22 (5), 487-490. Doi: 10.1097/01.ajp.0000208247.18251.bb

Background
This study examined the relationship between alcohol misuse and different types of childhood maltreatment in a sample of young adults while controlling for posttraumatic stress disorder (PTSD) symptoms and current mental disorders. This study further examined if these associations were different for males and females.

Results
Three types of child maltreatment were assessed; emotional abuse (N =263), sexual abuse (N=59), and multiple abuse (N=64) alongside a non-abused (N=2595) control group. Findings indicated the three maltreatment groups were all related to alcohol misuse. Maltreated women in particular had a 16-to-25-fold increased risk of alcohol misuse. For males these associations were attenuated with odds ratios (OR) ranging between 3 and 5 for emotional and multiple abuse groups. PTSD symptoms were associated with alcohol misuse for both genders, whilst current mental health disorder was non-significant for both males and females.

Conclusion
A significant relationship was found between the child maltreatment and alcohol misuse. This relationship was significantly stronger for maltreated women, which identifies a gap in the literature. High associations between maltreatment and alcohol misuse in females may suggest alcohol is used as a coping strategy following childhood maltreatment.

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Publications:
Cronin, S., Murphy, S. & Elklit, A. (2016). Investigating the Relationship between Childhood Maltreatment and Alcohol Misuse in a sample of Danish young adults: Exploring Gender Differences. Nordic Studies on Alcohol and Drugs, 33, 287-298. Doi: https://doi.org/10.1515/nsad-2016-0022

The study was a pilot study aimed at investigating gender differences in expressive writing as an intervention for parents of children with leukaemia. The study found that expressive writing has a significant effect as an intervention and that there are significant gender differences for the intervention.

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Publications:
Christiansen, D. M., Martino, M. L., Elklit, A. & Freda, M. F. (2022). Sex differences in the outcome of expressive writing in parents of children with leukaemia. Clinical Psychology in Europe, 4(1), e5533. Doi: 10.23668/psycharchives.5191

The aim of the present study was to examine specifically whether the relationship between coping style and symptoms of whiplash injury change as a function of gender. A total of 1709 sufferers of whiplash associated disorder (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic and Accident Victims completed questionnaires measuring demographic and psychological factors (including coping style), and symptoms of whiplash trauma (including pain). Men and women were not found to differ significantly in their use of coping strategies, however emotion focused coping strategies were related significantly more strongly to whiplash related symptoms in men compared to women. Women were found to display more symptoms related to whiplash injury compared to men. Possible reasons for the present findings are discussed in light of related research indicating mood as a potential moderating variable in the relationship between maladaptive coping style and degree of symptoms related to injury in men.

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Publications: 
Jones, A. & Elklit, A. (2007). The Association between Gender, Coping, and Whiplash Related Symptoms in Sufferers of Whiplash Associated Disorder. Scandinavian Journal of Psychology,48 (1), 75-80. Doi: 10.1111/j.1467-9450.2006.00543.x