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      Sex-differential PTSD symptom trajectories across one year following suspected serious injury Translated title: Trayectorias de síntomas de TEPT diferenciales por sexo a lo largo de un año tras la sospecha de lesión grave Translated title: 疑似严重受伤后一年内的性别差异 PTSD 症状轨迹

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          ABSTRACT

          Background

          Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied.

          Objective

          To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates.

          Method

          We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories.

          Results

          In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates.

          Conclusions

          Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.

          HIGHLIGHTS

          • We investigated sex differences in PTSD symptom trajectories over one-year post-trauma.

          • We observed modest differences.

          • Symptom courses were mostly similar.

          • Yet, the recovering trajectory was more prevalent in women, while the delayed onset trajectory was more prevalent in men.

          Translated abstract

          Antecedentes: Los últimos años han demostrado una mayor aplicación de enfoques prospectivos orientados a la trayectoria para el trastorno de estrés postraumático (TEPT). Aunque generalmente se considera que las mujeres tienen un mayor riesgo de TEPT, las diferencias de sexo y género en las trayectorias de los síntomas del TEPT aún no se han estudiado ampliamente.

          Objetivo: Realizar una investigación en profundidad de las diferencias en las trayectorias de los síntomas del TEPT a lo largo de un año después de un trauma entre hombres y mujeres, interpretando las tendencias generales de las trayectorias observadas en muestras desagregadas por sexo, así como comparar el curso y la evolución de los síntomas dentro de la trayectoria y las tasas de prevalencia.

          Método: Incluimos N = 554 participantes (62.5% hombres, 37.5% mujeres) de una cohorte prospectiva multicéntrica de pacientes del servicio de urgencias con sospecha de lesión grave. La gravedad de los síntomas del TEPT se evaluó 1, 3, 6 y 12 meses después del trauma, utilizando la Escala de TEPT administrada por un médico para el DSM-IV. Se realizó un modelo de mezcla de crecimiento latente sobre los síntomas longitudinales de TEPT en las muestras desagregadas por sexo y en la muestra completa. Se aplicó un modelo bayesiano con antecedentes informativos para una estimación confiable del modelo, considerando la prevalencia desequilibrada de las trayectorias latentes esperadas.

          Resultados: En términos de tendencias generales, se observaron las mismas trayectorias para hombres y mujeres, es decir, resiliente, recuperación, síntomas crónicos y aparición tardía. Los cursos de síntomas dentro de la trayectoria fueron en gran medida comparables, pero las mujeres resilientes tenían más síntomas másque los hombres resilientes. Se observaron diferencias por sexo en las tasas de prevalencia para las trayectorias de recuperación (mayor en mujeres) y de inicio tardío (mayor en hombres). El ajuste del modelo para las muestras desagregadas por sexo fue mejor que para la muestra completa, lo que indica la aplicación preferida de la desagregación por sexo. Los análisis de la muestra completa llevaron a estimaciones sesgadas de las tasas de prevalencia de trayectorias generales y específicas por sexo.

          Conclusiones: Los análisis de trayectoria desagregados por sexo revelaron diferencias limitadas entre los sexos en las trayectorias de los síntomas del TEPT durante el año posterior al trauma en términos de tendencias generales, cursos y tasas de prevalencia. Las tasas de prevalencia de trayectoria sesgada observadas en el conjunto de la muestra enfatizan la necesidad de aplicar técnicas estadísticas apropiadas al realizar investigaciones que tengan en cuenta el sexo.

          Translated abstract

          背景: 近年来, 前瞻性轨迹导向方法在创伤后应激障碍 (PTSD) 中的应用有所增加。尽管通常认为女性 PTSD 有更高的风险, 尚未对 PTSD 症状轨迹中的性别和性别差异进行广泛研究。

          目的: 通过解读在性别分类样本中观察到轨迹的一般趋势, 以及比较轨迹内症状过程和流行率, 对创伤后一年内 PTSD 症状轨迹的男女差异进行深入考查。

          方法: 我们纳入了 N= 554 名参与者 (62.5% 男性, 37.5% 女性), 这些参与者来自多中心前瞻性队列疑似严重受伤的急诊科患者。在创伤后 1, 3, 6 和 12 个月, 使用DSM-IV临床用 PTSD 量表评估 PTSD 症状严重程度。在性别分类样本和整个样本中对纵向 PTSD 症状进行了潜在增长混合模型。考虑到预期潜在轨迹的流行率不平衡, 应用了具有信息先验的贝叶斯模型进行可靠模型估计。

          结果: 就总体趋势而言, 男性和女性观察到相同的轨迹, 即韧性, 恢复, 慢性症状和延迟发作组。轨迹内的症状过程在很大程度上具有可比性, 但韧性组女性比韧性组男性有更高的症状。在恢复组 (女性较高) 和延迟发病组 (男性较高) 轨迹中观察到流行率的性别差异。性别分类样本的模型拟合优于整个样本, 表明首选应用性别分类。对整个样本的分析导致对总体和特定性别轨迹流行率估计有偏。

          结论: 性别分类轨迹分析揭示了创伤后一年内 PTSD 症状轨迹在总体趋势, 病程和流行率方面的性别差异有限。在整个样本中观察到的有偏轨迹流行率强调了在进行性别敏感性研究时应用适当统计技术的必要性。

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          Most cited references64

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              Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

              Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                15 February 2022
                2022
                15 February 2022
                : 13
                : 1
                : 2031593
                Affiliations
                [a ]Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute; , Amsterdam, The Netherlands
                [b ]Division of Clinical Psychological Intervention, Freie Universität Berlin; , Berlin, Germany
                [c ]Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute; , Amsterdam, The Netherlands
                [d ]Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam; , Amsterdam, The Netherlands
                [e ]Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology; Amsterdam Public Health Research Institute, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions; , Amsterdam, The Netherlands
                [f ]Department of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University; , AK Leiden, Netherlands
                [g ]Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands & Arq National Psychotrauma Centre; , Amsterdam, The Netherlands
                [h ]Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University; , Utrecht, The Netherlands
                Author notes
                CONTACT Mirjam van Zuiden m.vanzuiden@ 123456amsterdamumc.nl Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute; , Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
                Author information
                https://orcid.org/0000-0002-1225-2702
                https://orcid.org/0000-0001-9289-7094
                https://orcid.org/0000-0003-3682-2543
                https://orcid.org/0000-0003-3517-1873
                https://orcid.org/0000-0001-5430-9810
                https://orcid.org/0000-0003-1016-9515
                https://orcid.org/0000-0001-7736-2091
                Article
                2031593
                10.1080/20008198.2022.2031593
                8856115
                35186216
                f3253c9c-c765-4f2e-8d04-00786143febc
                © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 3, Tables: 3, References: 65, Pages: 1
                Categories
                Research Article
                Basic Research Article

                Clinical Psychology & Psychiatry
                ptsd,sex,gender,longitudinal,course,onset,injury,latent growth mixture modelling,bayesian,tept,sexo,género,curso,inicio,lesión,modelo de mezcla de crecimiento latente,bayesiano,,性别,纵向,过程,发作,受伤,潜在增长混合模型,贝叶斯

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