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2. Gender Differences in Mental Illness Following a Traumatic Event

2.1 Genders Differences in Prevalence

2.1.1 Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is among the most common responses a person can have in response to a traumatic event[1]. Research has found that women have elevated rates of PTSD compared to men[2]. According to epidemiological studies, women are two to three times are likely as men to develop PTSD[3]. The lifetime prevalence of PTSD is reported to be about 10-12% in women and 5-6% in men[3]. Women are also four times as likely to develop chronic PTSD compared to men[4]. Additionally, women are at greater risk for developing PTSD despite exposure to fewer traumatic events than men[4]. There are even observed differences in the type of symptoms endorsed by men and women[3]. Women are more likely to endorse specific sub-clusters of symptoms, such as re-experiencing symptoms (e.g. flashbacks) and hyper-arousal symptoms[3]. These differences have been found to be persistent across cultures[2].

2.1.2 Depression

While PTSD is perhaps the most well-known psychological response to a trauma, depression can also develop following exposure to traumatic events[1]. Women are twice as likely as men to experience depression; the lifetime prevalence of major depressive disorder (MDD) is 21.3% in women and 12.7% in men[5].

2.2 High-impact Traumas and Gender Differences in Mental Illness

2.2.1 Posttraumatic Stress Disorder

Some have theorized that the observed gender differences are due to women being exposed to more high impact-traumas, such as sexual assault[3]. Epidemiological studies have found that men are more likely to have PTSD as a result of experiencing combat, war, accidents, nonsexual assaults, disaster or fire, and witnessing death or injury.[6] Meanwhile, women are more likely to have PTSD attributable to rape, sexual assault, sexual molestation, and childhood sexual abuse[6][7]. However, despite the theorized explanation that gender differences were due to differential exposure rates to high impact traumas such as sexual assaults, a meta-analysis found that when excluding instances of sexual assault or abuse, women remained at greater for developing PTSD[7]. Additionally, it has been found that when only looking at those who have experienced sexual assaults, women remained approximately twice as likely as men to develop PTSD[4]. Thus, it is likely that exposure to specific traumatic events such as sexual assault only partially accounts for the observed gender differences in PTSD[7].

2.2.2 Depression

Research suggest that gender differences in exposure to traumatic events have serve as an explanation for observed differences in MDD[5]. It has been indicated in research that women have been found to have two times the rate of sexual assault as men when sexual assault is defined as being pressured or forced into unwanted sexual contact[5]. A history of sexual assault is thought to be related to increased rates of depression. For example, studies of survivors of childhood sexual assault found that the rates of childhood sexual assault ranged from 7-19% for women and 3-7% for men. This gender discrepancy in childhood sexual assault in turn contributed to 35% of the observed gender difference in adult depression[5]. It is also thought that the increased likelihood of adverse traumatic experiences in childhood may also help to explain the observed gender difference in MDD. Studies show that women have been found to have an increased risk of experiencing traumatic events in childhood, especially childhood sexual abuse[8]. This increased risk of experiencing traumatic events in childhood has been associated with an increased risk of developing depression, making women more sensitive to developing depression than men[8].

2.3 Biology and Gender Differences in Mental Illness

2.3.1 Posttraumatic Stress Disorder

Biological differences is a proposed mechanism contributing to observed gender differences in PTSD. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been proposed for both men and women[9]. The HPA helps to regulate an individual’s stress response by changing the amount of stress hormones released into the body, such as cortisol[5]. However, a meta-analysis found that women have greater dysregulation than men; women have been found to have lower circulating cortisol concentrations compared to healthy controls, where men did not have this difference in cortisol[10]. It is also thought that gender differences in threat appraisal might contribute to observed gender differences in PTSD as well by contributing to HPA dysregulation[11]. Women are reported to be more likely to appraise events as stressful and to report higher perceived distress in response to traumatic events compared to men, potentially leading to an increased dysregulation of the HPA in women than in men[11]. However, research looking at potential biological explanations for gender differences in PTSD is in its infancy, and further research is needed before conclusions can be drawn.

2.3.2 Depression

As with PTSD, there has also been some evidence of a biological difference between men and women that may contribute to the observed gender difference[5]. Expanding on the research concerning the HPA and PTSD, one existing hypothesis is that women are more likely than men to have a dysregulated HPA in response to a traumatic event, like in PTSD. This dysregulation may occur as a result of the increased likelihood of women experiencing a traumatic event, as traumatic events have been known to contribute to HPA dysregulation[5]. Differences in stress hormone levels can influence moods due to the negative effect of high cortisol concentrations on biochemicals that regular mood such as serotonin[5]. Research has found that people with MDD have elevated cortisol levels in response to stress and that low serotonin levels are related to the development of depression[5]. Thus, it is possible that a dysregulation in the HPA, when combined with the increased history of traumatic events, may contribute to the gender differences seen in depression[5].

2.4 Coping Mechanisms and Gender Differences in PTSD

For PTSD, genders differences in coping mechanisms has been proposed as a potential explanation for observed gender differences in PTSD prevalence rates[3]. Studies have found that women tend to respond differently to stressful situations than men. For example, men are more likely than women to react using the fight-or-flight response[3]. Additionally, men are more likely to use problem-focused coping[3], which is known to decrease the risk of developing PTSD when a stressor is perceived to be within an individual’s control[12]. Women, meanwhile, are thought to use emotion-focused, defensive, and palliative coping strategies[3]. As well, women are more likely to engage in strategies such as wishful thinking, mental disengagement, and the suppression of traumatic memories. These coping strategies have been found in research to correlate with an increased likelihood of developing PTSD[4]. Women are more likely to blame themselves following a traumatic event than men, which has been found to increase an individual’s risk of PTSD[4]. In addition, women have been found to be more sensitive to a loss of social support following a traumatic event than men[3]. A variety of differences in coping mechanisms and use of coping mechanisms may likely play a role in observed gender differences in PTSD.

These described differences in coping mechanisms are in line with a preliminary model of sex-specific pathways to PTSD. The model, proposed by Christiansen and Elklit[2], suggests that there are sex differences in the physiological stress response. In this model, variables such as dissociation, social support, and use of emotion-focused coping may be involved in the development and maintenance of PTSD in women, whereas physiological arousal, anxiety, avoidant coping, and use of problem-focused coping may be more likely to be related to the development and maintenance of PTSD in men[2]. However, this model is only preliminary and further research is needed.

For more about gender differences in coping mechanisms, see the Coping (psychology) page.

  1. ^ a b (us), Center for Substance Abuse Treatment (2014). Understanding the Impact of Trauma. Substance Abuse and Mental Health Services Administration (US).
  2. ^ a b c d Christiansen, Dorte M. (2015). "Examining Sex and Gender Differences in Anxiety Disorders". A Fresh Look at Anxiety Disorders. InTech. ISBN 9789535121497.
  3. ^ a b c d e f g h i j Olff, Miranda (27 July 2017). "Sex and gender differences in post-traumatic stress disorder: an update". European Journal of Psychotraumatology. 8 (sup4): 1351204. doi:10.1080/20008198.2017.1351204. ISSN 2000-8198.
  4. ^ a b c d e Tolin, David; Breslau, Naomi (1 January 2007). "Sex differences in risk of PTSD". PTSD Research Quarterly. 18: 1–7.
  5. ^ a b c d e f g h i j Nolen-Hoeksema, Susan (October 2001). "Gender Differences in Depression". Current Directions in Psychological Science. 10 (5): 173–176. doi:10.1111/1467-8721.00142. ISSN 0963-7214.
  6. ^ a b Kessler, Ronald C. (1995-12-01). "Posttraumatic Stress Disorder in the National Comorbidity Survey". Archives of General Psychiatry. 52 (12): 1048. doi:10.1001/archpsyc.1995.03950240066012. ISSN 0003-990X.
  7. ^ a b c Tolin, David F.; Foa, Edna B. (2006). "Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research". Psychological Bulletin. 132 (6): 959–992. doi:10.1037/0033-2909.132.6.959. ISSN 1939-1455.
  8. ^ a b Piccinelli, Marco; Wilkinson, Greg (2000). "Gender differences in depression: Critical review". The British Journal of Psychiatry. 177 (6): 486–492. doi:10.1192/bjp.177.6.486. ISSN 0007-1250.
  9. ^ Donner, Nina C.; Lowry, Christopher A. (2013). "Sex differences in anxiety and emotional behavior". Pflugers Archiv : European journal of physiology. 465 (5): 601–626. doi:10.1007/s00424-013-1271-7. ISSN 0031-6768.
  10. ^ Meewisse, Marie-Louise; Reitsma, Johannes B.; Vries, Giel-Jan De; Gersons, Berthold P. R.; Olff, Miranda (2007). "Cortisol and post-traumatic stress disorder in adults: Systematic review and meta-analysis". The British Journal of Psychiatry. 191 (5): 387–392. doi:10.1192/bjp.bp.106.024877. ISSN 0007-1250.
  11. ^ a b Olff, Miranda; Langeland, Willie; Draijer, Nel; Gersons, Berthold P. R. (2007). "Gender differences in posttraumatic stress disorder". Psychological Bulletin. 133 (2): 183–204. doi:10.1037/0033-2909.133.2.183. ISSN 1939-1455.
  12. ^ Hundt, Natalie; Williams, Ann; Mendelson, Jenna; Nelson-Gray, Rosemery (1 April 2013). "Coping mediates relationships between reinforcement sensitivity and symptoms of psychopathology". Personality and Individual Differences. 54: 726–731. doi:10.1016/j.paid.2012.11.028.
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