Sex and gender in psychotrauma research

Figures & data

Table 1. Study characteristics.

Authors (year)	Study design	Sex/Gender	Sample (N; % female, country)	Sex/Gender differences found
Trauma and its consequences in children and adolescents
Bruckmann et al. (2020)	Cross-sectional	Gender (male, female?); how measured is not explicitely stated.	145 foster children and adolescents ages 10–19 years (30.3% female, Austria)	Yes
De Haan et al. (2019)	Cross-sectional	Sex (male, female)	114 participants ages 7–16 years after accidental trauma (43.9% female, Switzerland) and 113 participants ages 6–17 years after interpersonal trauma (70.8% female, Germany)	Yes
Ford et al. (2022)	Cross-sectional	Gender (male, female)	507 children and adolescents ages 7–18 years in mental health treatment (49.0% female, United States of America [USA])	No
Haselgruber et al. (2020)	Cross-sectional	Gender (male, female)	135 trauma-exposed foster children ≤ 18 years (31.1% female, Austria)	Yes
Hiscox et al. (2021)	Cross-sectional	Self-reported sex (male, female)	797 adolescents ages 13–17 years (62.2% female, South Africa)	Yes
Lenferink et al. (2020)	Longitudinal (data was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland)	Use both sex and gender (boys, girls)	Data from 21 longitudinal studies in which self-reported ASD symptoms by children were assessed within 30 days after trauma; 2287 children and adolescents ages 5–18 years (36.4% girls)	Yes
Sadeh et al. (2022)	Cross-sectional (based on medical records)	Gender child (male, female); abstracted from electronic health records	Caregivers of 374 children 0–18 years of age who were admitted to a pediatric rehabilitation department after pediatric traumatic medical events (40.9% female, Israel)	No
Van Duin et al. (2018)	Case study	Gender (boys, girls)	44 substantiated extrafamilial sexual abuse cases (31.8% female, The Netherlands)	Yes
Trauma and its consequences in adults
Authors (year)	Study design	Sex/Gender	Sample (N; % female, country)
Amstadter et al. (2023)	Longitudinal (based on 23 years of data from the Swedish National Registries)	Sex (male, female); obtained from the Total Population Register	Everyone born between 1975 and 1990 (n = 1,541,883 for the self-medication model and n = 1,540,979 for the susceptibility model; 49.0% female) and for the second set of analyses individuals born between 1960 and 1990 (n = 3,829,660; 49.0% female)	Yes
Ásgeirsdóttir et al. (2018)	Stress And Gene Analysis (SAGA) cohort study	Gender (male, female; men, women); how measured is not explicitely stated.	922 adults (56.0% female, Iceland), including women attending a cancer screening programme and a random sample of men from the general population	Yes
Bahati et al. (2023)	Cross-sectional	Gender (male, female)	343 refugees residing in Mbarara City (42.3% female, Uganda)	Yes
Bountress et al. (2021)	Cross-sectional (based on date from the fifth cohort of The Spit for Science project)	Sex assigned at birth (male, female)	897 undergraduate students (78.6% female, USA)	Yes
Charny et al. (2023)	Cross-sectional (online)	Gender (male, female)	488 citizens (no % female available, Israel)	No
Dalgaard et al. (2021)	Archival	Gender (male, female)	1249 survivors of torture and organized violence treated in a specialist outpatient clinic (19.9% female; Denmark)	Yes
Dashorst et al. (2019)	Systematic review	Parental gender (father, mother)	23 quantitative studies (13 included males and females, the other studies consisted of only women)	Yes
Dashorst et al. (2022)	Cross-sectional, clinical	Gender (male, female)	98 adult offspring of World War Two survivors in treatment in one of two clinics specialized in mental health services for war victims (57.0% female, The Netherlands)	Yes
Exenberger et al. (2019)	Cross-sectional, mixed-method	Gender (male, female)	185 German-speaking adults recruited via snowball sampling (66.5% female)	No
Goldberg et al. (2019)	Cross-sectional	Sex (male, female); how measured is not explicitely stated	165 outpatients with major depressive disorder (69.5% female, Spain)	Yes
Haahr-Pedersen et al. (2020)	Nationally representative household sample	Sex (male, female); how measured is not explicitely stated	1,839 adults (52% female, USA)	Yes
Harb et al. (2023)	Longitudinal	Gender (male and female; men and women)	113 individuals who identified as Black/African American in a Emergency Department at a Level I Trauma Center (61.1% female, USA)	No
Hennemann et al. (2023)	Cross-sectional	Gender (male, female)	1337 bereaved adults with symptoms of prolonged grief disorder (76.1% female; United States of America: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%)	Yes
Ho et al. (2021)	Nationally representative sample	Gender (male, female); Use gender and sex interchangeably.	1,020 adults (51.0% female, Ireland)	Yes
Jin et al. (2022)	Cross-sectional	Use both sex and gender (male, female)	3,479 sexual abuse survivors, university students (51.2% female, China)	Yes
Johnsen et al. (2023)	Longitudinal	Gender (male, female)	89 close friends of those killed on Utøya on 22 July 2011 (76.4% female, Norway)	Yes
Krahé et al. (2023)	Longitudinal	Gender (male, female, or other); also men and women in text	588 university students (52.4% female, Germany)	No
Lonnen and Paskell (2024)	Systematic review	Sex (based on anatomy and typically assigned at birth) or gender (one’s own identity and internal sense of self, which exists on a non-binary spectrum and which may or may not correspond with sex); search terms: 1. Gender, 2. Sex, 3. Nonbinary, 4. Male, 5. Female, 6. Men, 7. Women	12 qualitative or quantitative empirical study using child or adult clinical or non-clinical samples and presented CPTSD separated by gender or sex, or in one gender or sex only	Yes
Mellor et al. (2021)	Systematic review	Gender (male, female); how measured is not explicitely stated	13 empirical studies in refugee and displaced treatment seeking or general populations	No
Nordström et al. (2022)	Cross-sectional (based on the fourth data collection eight years after the Utøya terror attack)	Gender (male, female)	88 bereaved parents and 34 siblings aged 19 and above (59.8% female, Norway)	Yes
Pociunaite et al. (2023)	Longitudinal data from the data-archive of the Measurement Archive of Reactions to Bereavement from Longitudinal European Studies (MARBLES) project	Gender (male, female)	398 bereaved adults (64.2% female, Denmark & The Netherlands)	No
Rasmusson et al. (2018)	Cross-sectional	Gender (male, female)	112 patients in treatment for substance use disorders and 112 matched controls with mild to moderate mental health disorders (each group 43.8% female, Norway)	Yes
Schenker et al. (2023)	Cross-sectional	Sex, biologically (use both male, female and men, women; none of the participants indicated their sex as ‘other’)	41 non-treatment seeking, trauma exposed young adults aged 18–50 years (75.6% female, Australia)	Yes
Søegaard et al. (2021)	Cross-sectional	Self-reported gender (men, women)	110 traumatized patients attending a mental health outpatient clinic (61.8% female, Norway)	Yes
Stelzer et al. (2019)	Cross-sectional	Gender (men, women)	50 bereaved widow(er)s and parents (58% female; USA)	Yes
Wilker et al. (2021)	Cross-sectional	Sex (male, female)	Four civilian post-conflict samples from different countries: Northern Uganda (N = 1665; 54.0% female), Rwanda (N = 433; 46.5% female), Syria (N = 974; 49.3% female) and Sri Lanka (N = 165; 46.5% female)	No
Zhang et al. (2020)	Cross-sectional	Gender parent and gender deceased child (male, female); gender of the child was obtained from the Register of Population Statistics provided by the Health Family Planning Commission of China	149 Chinese Shidu parents who had lost their only child (60.4% female)	Yes
Longitudinal courses children and adolescents
Authors (year)	Study design	Sex/Gender	Sample (N; % female, country)
Glad et al. (2023)	Longitidunal	Sex (men, women); how measured is not explicitely stated	289 survivors of the Utøya Island attack (51.2% female, Norway)	Yes
Hlodversdottir et al. (2018)	Population-based prospective cohort	Gender parent (male, female), gender child (boy, girl)	Children's parents; 1,148 (52.7% female) in the exposed area and 510 (49.0% female) from the non-exposed area (Iceland)	Yes
Porcheret et al. (2022)	Longitudinal	Sex (male, female) at the time of the attack was determined from social security numbers	336 survivors of the Utøya Island attack who completed the study 2.5 and 8.5 years after the attack (47–51% female, Norway)	No
Raymond et al. (2022)	Longitudinal	Sex (boys, girls)	84 children ages 9–14 years (50.0% female, Canada)	Yes
Zhang et al. (2022)	Longitudinal	Gender (male, female); how measured is not explicitely stated.	217 children and adolescents ages 8–17 years at four emergency departments exposed to single-event trauma (42.9% female, England)	No
Longitudinal courses adults
Authors (year)	Study design	Sex/Gender	Sample (N; % female; country)
Boersma-van Dam et al. (2021)	Longitudinal multi-centre	Gender (male, female)	111 partners of adult burn survivors (80.2% female; Belgium and The Netherlands)	No
Diamond et al. (2022)	Meta-analysis	Sample sex distribution (% male)	78 studies, representing 79 independent samples (an overall average of 53.0% male)	Yes
Nissen et al. (2019)	Longitudinal	Gender (male, female)	2108 ministerial employees who had been exposed to a terrorist attack on 22 July 2011 in Oslo, Norway (56.5% female)	Yes
Opaas et al. (2022)	Longitudinal	Gender (male, female)	54 trauma-affected refugee patients (35.2% female; Norway)	Yes
Swart et al. (2020)	Longitudinal	Gender (male, female)	85 adult patients referred to a specialized mental health clinic (71.8% female; The Netherlands)	Yes
Van Zuiden et al. (2022)	Longitudinal	Biological sex (men, women)	554 adults from a multi-centre prospective cohort of emergency department patients with suspected severe injury (37.5% female, The Netherlands)	Yes
Treatment children and adolescents
Authors (year)	Study design	Sex/Gender	Sample (N; % female)
Jensen et al. (2022)	Naturalistic observational study (pre-post)	Sex; how measured is not stated	73 youth referred to one of 23 Norwegian child and adolescent mental health clinics that fulfilled the criteria for PTSD or CPTSD according to ICD-11 (89.0% female)	No
Pfeiffer et al. (2020)	Secondary analysis of two RCT studies in Norway and Germany	Gender (male, female)	52 therapists (78.8% female) and 153 patients (72.3% female)	No
Treatment adults
Authors (year)	Study design	Sex/Gender	Sample (N; % female)
Barawi et al. (2020)	Systematic review	Gender (male, female); how measured is not explicitely stated	25 randomized controlled trials (RCTs)	No
Bauer et al. (2021)	Feasibility study, mixed-method	Gender (identified as male, female)	80 trauma-exposed rural Veterans (66.50% female, USA)	No
Lely et al. (2019)	Systematic review and meta-analysis	Gender (male, female); how measured is not explicitely stated	16 RCTs (N = 947; 48.2% female)	No
Nordin & Perrin (2019)	Pilot; pre-post with 9-month follow-up	Gender (male, female); how measured is not explicitely stated	276 patients at a clinic for a highly specialized treatment programme for refugee survivors of torture or other organized violence (38.4% female, Denmark)	No
Therapist characteristics
Authors (year)	Study design	Sex/Gender	Sample (N; % female)
Gossmann et al. (2021)	Online experiment	Gender (male, female)	768 licenced psychotherapists (73.4% female, 0.7% diverse, Germany)	No
Lueders et al. (2022)	Cross-sectional, online	Gender (male, female, diverse)	148 outpatient medical and psychological psychotherapists in Saxony, Germany (79.7% female)	Yes
High risk professions
Authors (year)	Study design	Sex/Gender	Sample (N; % female)
Behnke et al. (2019)	Cross-sectional	Biological sex (male, female)	102 rescue workers (35.3% female, Germany)	Did not interpret
Blais et al. (2021)	Meta-analysis	Sex (male, female); how measured is not explicitely stated. In the analyses % females.	37 cross-sectional studies (N = 18,766; 27.29% female)	No
Frank et al. (2018)	Cross-sectional	Gender (male, female)	5,980 regular force or reserve force personnel who had been deployed at least once (11.1% female)	Yes
Kindermann et al. (2020)	Cross-sectional	Gender (male, female)	71 emergency call-takers and dispatchers who work in an emergency control centre (14.1 female, Germany)	No
Leshem et al. (2023)	Cross-sectional	Gender of the parent (father, mother)	56 veterans, mothers and fathers; ‘directly active veterans’ and ‘indirectly active veterans’	Yes
Rentmeesters & Hermans (2023)	Cross-sectional (web-based survey)	Gender (male, female)	1,465 police officers (28.9% female, Belgium)	No
Shin et al. (2023)	Cross-sectional	Gender (male, female)	483 firefighters (8.1% female; South Korea)	No
Stevelink et al. (2019)	Cross-sectional	Gender (male, female)	1,448 serving and ex-serving personnel of the armed forces who self-reported a stress, emotional or mental health problem in the past 3 years (15.1% female, United Kingdom)	Yes
(Neuro)biological factors
Authors (year)	Study design	Sex/Gender	Sample (N: % female)
Ancelin et al. (2020)	Cross-sectional (based on a longitudinal study ofneuropsychiatric disorders in community-dwelling French elderly, the Esprit study)	Sex (male, female); how measured is not explicitely stated	377 community-dwelling older adults (≥ 65 years of age); 165 no trauma (57.6% female), 137 trauma without re-experiencing (43.8% female), 75 trauma with re-experiencing (64.0% female)	Yes
Engel et al. (2020)	Prospective	Sex (male, female)	100 participants, including 54 men, 27 women using hormonal contraception, and 19 cycling women (The Netherlands)	Yes
Gultig et al. (2023)	Birth cohort	Sex (male, female)	439 term-born singleton adults 71–74 years of age (54.2% female; The Netherlands)	Yes
Llorens et al. (2023)	Cross-sectional	Sex (male, female)	53 adolescents ages 14–17 years with attention deficit and hyperactivity disorder (35.8% female, Spain)	Yes
Sexual orientation
Authors (year)	Study design	Sex/Gender	Sample (N; % female)
Van der Watt et al. (2023)	Case-case-control	Sex (male, female, intersexual)	2,022 university students (71.7% female, 0.1% intersex); 886 individuals who endorsed current PTSS (South Africa) in relation to a single specific non-marital romantic relationship dissolutions (RRD) event (casegroup 1), 592 individuals who endorsed PTSS in relation to a single specific DSM-5 congruent event for PTSD (casegroup 2), 544 individuals who endorsed PTSS in relation to another single stressful event (not an RRD and not a DSM-5 criterion A event)	Yes
Measures
Authors (year)	Study design	Sex/Gender	Sample (N & % female; country)
Anderson et al. (2023)	Cross-sectional	Gender identity (cisgender women, cisgender men, genderfluid or nonbinary). Analysis restricted to cisgender women vs. cisgender men.	91 women and men seeking detoxification treatment (41.8% cisgender women); 310 cisgender women at a rural college (USA)	Yes
Bondjers et al. (2019)	Prospective	Gender (male, female); how measured is not explicitely stated	186 adults who had experienced a potentially traumatic event (79.0% female; Sweden)	No
Carmassi et al. (2021)	Cross-sectional	Sex / Gender (male, female); how measured is not explicitely stated	265 health care workers who repeatedly experienced the deaths of patients during COVID-19 emergency (68.3% female; Italy)	Yes
Fresno et al. (2023)	Cross-sectional	Gender (male, female)	275 young adults (74.2% female, Chile)	Yes
Frewen et al. (2021)	Cross-sectional	Sex (male, female)	1,268 via the website of the Global Collaboration on Traumatic Stress (84.4% female); 1,378 actively via Amazon’s MTurk (42.1% female; international ‘English speaking’)	Yes
Hoppen et al. (2022)	Cross-sectional	Sex / Gender (male, female)	209 individuals between 18 and 70 years old seeking treatment for childhood trauma-related PTSD (76.6% female); 556 adults who had suffered at least one traumatic life event reporting different levels of PTSD symptoms (61.8% female); 156 healthy adults (79.5% female; Netherlands, Germany, and Australia)	Yes
Leuchter et al. (2021)	Cross-sectional	Sex / Gender (male, female)	140 individuals (≥ 18 years) from the general population (80.0% female, Germany)	Yes
Nielsen et al. (2023)	Cross-sectional	Gender (male, female)	490 treatment-seeking refugees (41.8% female; Denmark)	Yes
Stevenson et al. (2023)	Cross-sectional	Sex at birth (male, female)	6,765 adults, including 3,625 adults with a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or psychosis ‘not otherwise specified’ (39.3% female, South Africa)	Yes
Van der Feltz-Cornelis & De Beurs (2023)	Cross-sectional	Gender (male, female); how measured is not explicitely stated (‘both genders’)	298 patients with anxiety and depressive disorders (56.3% female); 234 patients with somatics symptom and related disorders (61.4% female; The Netherlands)	No

Bruckmann, P., Haselgruber, A., Sölva, K., & Lueger-Schuster, B. (2020). Comparing rates of ICD-11 and DSM-5 posttraumatic stress disorder in Austrian children and adolescents in foster care: Prevalence, comorbidity and predictors. European Journal of Psychotraumatology, 11(1), Article 1767988. https://doi.org/10.1080/20008198.2020.1767988

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De Haan, A., Tutus, D., Goldbeck, L., Rosner, R., & Landolt, M. A. (2019). Do dysfunctional posttraumatic cognitions play a mediating role in trauma adjustment? Findings from interpersonal and accidental trauma samples of children and adolescents. European Journal of Psychotraumatology, 10(1), Article 1596508. https://doi.org/10.1080/20008198.2019.1596508

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Ford, J. D., Charak, R., Karatzias, T., Shevlin, M., & Spinazzola, J. (2022). Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach. European Journal of Psychotraumatology, 13(2), Article 2133488. https://doi.org/10.1080/20008066.2022.2133488

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Haselgruber, A., Sölva, K., & Lueger-Schuster, B. (2020). Symptom structure of ICD-11 complex posttraumatic stress disorder (CPTSD) in trauma-exposed foster children: Examining the International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA). European Journal of Psychotraumatology, 11(1), Article 1818974. https://doi.org/10.1080/20008198.2020.1818974

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Hiscox, L. V., Hiller, R., Fraser, A., Rabie, S., Stewart, J., Seedat, S., Tomlinson, M., & Halligan, S. L. (2021). Sex differences in post-traumatic stress disorder in a high adversity cohort of South African adolescents: An examination of depressive symptoms, age, and trauma type as explanatory factors. European Journal of Psychotraumatology, 12(1), Article 1978669. https://doi.org/10.1080/20008198.2021.1978669

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Lenferink, L. I. M., Egberts, M. R., Kullberg, M.-L., Meentken, M. G., Zimmermann, S., Mertens, Y. L., Schuurmans, A. A. T., Sadeh, Y., Kassam-Adams, N., & Krause-Utz, A. (2020). Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: Findings from an international data archive. European Journal of Psychotraumatology, 11(1), Article 1717156. https://doi.org/10.1080/20008198.2020.1717156

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Sadeh, Y., Dekel, R., Brezner, A., Landa, J., & Silberg, T. (2022). . Families following pediatric traumatic medical events: Identifying psychosocial risk profiles using latent profile analysis. European Journal of Psychotraumatology, 13(2), Article 2116825. https://doi.org/10.1080/20008066.2022.2116825

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Amstadter, A. B., Lönn, S., Sundquist, J., Sundquist, K., & Kendler, K. S. (2023). Post-traumatic stress disorder and drug use disorder: Examination of aetiological models in a Swedish population-based cohort. European Journal of Psychotraumatology, 14(2), Article 2258312. https://doi.org/10.1080/20008066.2023.2258312

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Bahati, R., Ashaba, S., Sigmund, C. D., Rukundo, G. Z., & Ainamani, H. E. (2023). Gender differences in substance use and associated factors among urban refugees in Uganda. European Journal of Psychotraumatology, 14(2), Article 2238583. https://doi.org/10.1080/20008066.2023.2238583

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Bountress, K. E., Cusack, S. E., Conley, A. H., Aggen, S. H., Vassileva, J., Dick, D. M., Amstadter, A. B., & The Spit for Science Working Group (2021). Unpacking the impact of the COVID-19 pandemic: Identifying structural domains. European Journal of Psychotraumatology, 12(1), Article 1932296. https://doi.org/10.1080/20008198.2021.1932296

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Charny, S., Cao, G., Gafter, L., Bar-Shalita, T., & Lahav, Y. (2023). Sensory modulation and trauma-related symptoms during rocket attacks. European Journal of Psychotraumatology, 14(2), Article 2213110. https://doi.org/10.1080/20008066.2023.2213110

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Dalgaard, N. T., Bjerre, K., & Thørgersen, M. H. (2021). Twenty seven years of treating survivors of torture and organized violence – associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD. European Journal of Psychotraumatology, 12(1), Article 1904712. https://doi.org/10.1080/20008198.2021.1904712

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Dashorst, P., Huntjens, R., Mooren, T. M., Kleber, R. J., & de Jong, P. J. (2022). Personal characteristics of World War Two survivor offspring related to the presence of indirect intrusions. European Journal of Psychotraumatology, 13(2), Article 2101349. https://doi.org/10.1080/20008198.2022.2101349

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Harb, F., Bird, C. M., Webb, E. K., Torres, L., de Roon-Cassini, T. A., & Larson, C. L. (2023). Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation. European Journal of Psychotraumatology, 14(2), Article 2211486. https://doi.org/10.1080/20008066.2023.2211486

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Ho, G. W. K., Hyland, P., Karatzias, T., Bressington, D., & Shevlin, M. (2021). Traumatic life events as risk factors for psychosis and ICD-11 complex PTSD: A gender-specific examination. European Journal of Psychotraumatology, 12(1), Article 2009271. https://doi.org/10.1080/20008198.2021.2009271

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Jin, Y., Xu, S., Wang, Y., Li, H., Wang, X., Sun, X., & Wang, Y. (2022). Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: A network analysis. European Journal of Psychotraumatology, 13(2), Article 2141508. https://doi.org/10.1080/20008066.2022.2141508

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Johnsen, I., Mikkelsen, J. S., Opheim, A. A., & Gjestad, R. (2023). To lose a friend: The relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011. European Journal of Psychotraumatology, 14(2), Article 2264118. https://doi.org/10.1080/20008066.2023.2264118

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Krahé, B., Schuster, I., & Tomaszewska, P. (2023). Pathways from childhood sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood: A three-wave longitudinal study. European Journal of Psychotraumatology, 14(2), Article 2263321. https://doi.org/10.1080/20008066.2023.2263321

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Lonnen, E., & Paskell, R. (2024). Gender, sex and complex PTSD clinical presentation: A systematic review. European Journal of Psychotraumatology, 15(1), https://doi.org/10.1080/20008066.2024.2320994

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Mellor, R., Werner, A., Moussa, B., Mohsin, M., Jayasuriya, R., & Tay, A. K. (2021). Prevalence, predictors and associations of complex post-traumatic stress disorder with common mental disorders in refugees and forcibly displaced populations: A systematic review. European Journal of Psychotraumatology, 12(1), Article 1863579. https://doi.org/10.1080/20008198.2020.1863579

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Data availability statement

No empirical data were collected. All articles retrieved from the European Journal of Psychotraumatology are open access available from www.tandonline.com/zept.