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Women are more likely than men to experience long-term posttraumatic stress disorder after major trauma

Long-term posttraumatic stress disorder (PTSD) afflicts 35 percent of trauma victims. Regardless of the type or severity of traumatic injury, women are more than twice as likely as men to suffer from PTSD, according to a study supported by the Agency for Healthcare Research and Quality (HS07611). Trauma care providers need to be alert to those at risk for developing PTSD, including the higher risk of women, in order to improve the outcomes of trauma victims, suggests Troy L. Holbrook, Ph.D.

Dr. Holbrook and colleagues at the University of California, San Diego, enrolled 1,048 adult trauma patients triaged at four trauma center hospitals between 1993 and 1996. The researchers measured patients' quality of life (QOL) after injury using a Quality of Well-being (QWB) scale that measured mobility, physical activity, and social activity; early symptoms of acute stress reaction (SASR) at discharge using the Impact of Events Scale (score over 30 equals SASR); and PTSD at 6, 12, and 18 months after discharge.

PTSD affected 30 percent of trauma victims at 6 months and 35 percent by 18 months (prolonged PTSD). Women were at more than double the risk of men for PTSD. The association of the patient's sex with PTSD was independent of the mechanism of injury and injury event-related factors such as perceived threat to life.

Prolonged PTSD was associated with significantly reduced quality of life (lower QWB scores) in both men and women, with women having markedly lower QWB scores at each followup than men. Normal healthy adults usually score in the range of 0.830 to 0.900 with 1.000 representing asymptomatic full function. The mean discharge QWB score in these patients was 0.401 and the mean 6-month followup score was 0.633. The researchers conclude that these trauma victims need not only sophisticated clinical care, but also rehabilitative and support services for the immense emotional fallout that follows trauma.

See "Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: Women are at higher risk for adverse outcomes than men," by Dr. Holbrook, David B. Hoyt, M.D., F.A.C.S., Murray B. Stein, M.D., and William J. Sieber, Ph.D., in the November 2002 Journal of Trauma, Injury, Infection, and Critical Care 53, pp. 882-888.

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