Are Gender Differences in Post-Traumatic Stress Disorder Rates Attenuated in Substance Use Disorder Patients?
Canadian Psychology › Vol. 47 Nbr. 2, May 2006
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Summary
Deykin and Buka (1997) examined the prevalence of PTSD among 297 adolescents (75 female; 222 male) who were receiving treatment for chemical dependency at public residential treatment centres. As assessed by structured clinical interview, trauma exposure was reported by about 75% of the sample with no significant difference between the girls and the boys in reported trauma exposure (i.e., 80% vs. 73%, respectively; χ^sup 2^ [1, N= 297] = 1.47, ns (see footnote I)). The most common traumatic events for the girls were rape, seeing someone hurt or killed, physical assault, and threat of injury. The most common traumatic events for the boys were seeing someone hurt or killed, threat of injury, and sudden injury or accident. The girls were over 10 times more likely than the boys to have been raped (40% vs. 4%; χ^sup 2^ [1, N= 297] = 66.56, p < .001). Boys were about twice as likely as the girls (20% vs. 8%; χ^sup 2^ [1, N = 297] = 5.93, p < .05, see footnote 1 on page 115) to have experienced a sudden injury or accident (an experience that carries a low risk of PTSD). The observed lifetime prevalence of PTSD in this sample of SUD adolescents (30%) was about five times higher than rates seen in adolescents in the community. Among boys, there was a significantly higher risk for PTSD among those who had a greater number of traumas. This relationship was not present among girls. The authors suggested that this gender difference might reflect the fact that boys are exposed to more lower-risk traumas. Among the SUD females, PTSD was the most commonly co-occurring disorder, whereas PTSD ranked as the second most commonly co-occurring disorder in the SUD males. Females (vs. males) had a significantly higher lifetime prevalence (45% vs. 24%; χ^sup 2^ [1,N= 297] = 11.87, p < .01; see footnote 1 page 115) and current (past four weeks) prevalence (40% vs. 12%; χ^sup 2^ [1, N= 297] = 28.01, p < .001) of PTSD. Among those with a history of trauma, females were significantly more likely than males to have lifetime PTSD (57% vs. 33%, χ^sup 2^ [1, N = 297] = 9.96, p < .01). The significantly higher rate of PTSD among females versus males was partially due to a greater frequency of rape in the females, which carries a high risk of PTSD development (cf. [Kessler, Sonnega] et al., 1995). Attesting to the fact that rape is a high-risk event for PTSD development, in this sample, males who had been raped had the same high probability of developing PTSD as females who had been raped. Females also had higher rates of other Axis I comorbidity than males, which may make them more vulnerable to the development of PTSD (cf. Breslau et al., 1991; Giaconia et al., 1995), irrespective of the type of trauma exposure.
We review 15 studies that examined rates of post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients to determine whether the typical female-greaterthan-male gender difference in PTSD rates is attenuated in SUD samples. Since the majority of studies reviewed did not find a gender difference in PTSD rates, we critically examined methodological factors that might account for this attenuation, but none appeared to completely account for the variability in detection of gender differences across studies. Several factors may contribute to making rates of PTSD among SUD males equivalent to the high rates observed in SUD females: 1) the risky lifestyle associated with men's substance abuse may increase their exposure to traumatic events, 2) a history of more severe trauma characteristics may be apparent among men with SUDs, or 3) attenuated gender differences in rates of other comorbidities that increase PTSD risk (e.g., depression) may exist. Clinical implications are discussed.See the full content of this document
Extract
Are Gender Differences in Post-Traumatic Stress Disorder Rates Attenuated in Substance Use Disorder Patients?
According to epidemiological studies, post-traumatic stress disorder (PTSD) is a highly comorbid condition among those with substance use disorders (SUDs; see review by Stewart, 1996). In the National Comorbidity Survey, a large-scale epidemiologic survey conducted in the U.S., Kessler and colleagues (1997) found that those with alcohol dependence were at 3-4 times increased risk of lifetime PTSD as compared to those without alcohol dependence. Moreover, the presence of comorbid PTSD among individuals being treated for SUDs is related to poorer treatment adherence (Hien, Nunes, Rudnick Levin, & Fraser, 2000) and outcomes, including higher relapse rates (e.g., Ouimette, Brown, & Najavits, 1998; Ouimette, Finney, & Moos, 1999). It has been suggested that if patients with comorbid SUD-PTSD were to receive trauma-specific treatment, they might avoid overutilizing or misusing expensive inpatient SUD treatments, thereby reducing the cost of clinical care (e.g., Brown, Recupero, & Stout, 1995).
The delineation of gender variations in the presentation of this comorbidity may identify factors that will improve treatment outcomes (Sonne et al., 2003). A fairly consistent finding across epidemiologic studies on PTSD rates in the general adult population is that women are about twice as likely to have PTSD as men (e.g., Breslau, Chilcoat, Kessler, Peterson, & Lucia, 1999; Breslau, Davis, Andreski, & Peterson, 1991; Breslau, Davis, Andreski, Peterson, & Schultz, 1997; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Moreover, women experience qualitatively different traumatic life experiences than do men. These findings have led to an interest in understanding gender differences in PTSD and their implications for etiology and treatment of the disorder (e.g., Kimerling, Ouimette, & Weitlauf, in press).Early research on comorbid PTSD-SUDs focused almost exclusively on male veterans whose pathology arose in the context of combat trauma; more recently, a focus has emerged on women with comorbid PTSD-SUDs (Najavits, Weiss, & Shaw, 1997). The major purpose of this article is to examine gender as an important individual difference variable with respect to trauma and PTSD among patients with SUDs. This brief review focuses on rates of trauma and PTSD among clinical samples of male and female SUD patients. Summaries of the methods and findings of the studies reviewed in this article are provided in Tables 1 and 2, for trauma exposure rates and PTSD rates, respectively.Gender Differences in Adult SamplesBrown et al. (1995) studied the prevale...See the full content of this document
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