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. 2025 Dec;16(1):2448385.
doi: 10.1080/20008066.2024.2448385. Epub 2025 Jan 23.

Gender differences in early posttraumatic stress disorder symptoms: a network analysis

Line Rønning  1 , Rachel L Zelkowitz  2   3 , Marilyn L Piccirillo  4   5 , Jianlin Liu  6 , Jordan L Thomas  7 , Jessy Guler  8 , J Joana Kyei  9 , Chris M Hoeboer  10 , Jeanet F Karchoud  11 , Miranda Olff  10   12 , Anke B Witteveen  13 , Mirjam van Zuiden  14   15
Affiliations

Gender differences in early posttraumatic stress disorder symptoms: a network analysis

Line Rønning et al. Eur J Psychotraumatol. 2025 Dec.

Abstract
in English, Spanish

Background: Despite known gender/sex differences in the prevalence of posttraumatic stress disorder (PTSD), potential differences in the associations among PTSD symptoms between men and women in the early post-trauma period are not well-characterized.Objective: This study utilized network analysis to assess potential differences in the associations among PTSD symptom clusters between men and women during the early post-trauma period.Method: We included n = 475 participants (57.5% self-identified women) who recently (≤2 months) experienced an interpersonal or motor vehicle potential traumatic event in the Netherlands. Past month PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5) and composited according to the five-node PTSD symptom cluster dysphoric arousal model. We estimated the network as well as indices of centrality (strength and predictability) and assessed the stability of the modelled networks in subsamples of men (n = 202) and women (n = 273). We compared network structures using the Network Comparison Test (NCT).Results: Results largely demonstrated adequate correlation stability for the estimated network structures for women and men. For both men and women, avoidance symptoms were among the strongest nodes with greatest predictability in the networks. In men, anxious arousal additionally showed high strength whereas re-experiencing showed high predictability. In women, re-experiencing symptoms demonstrated both high strength and predictability. The NCT demonstrated nonsignificant differences in global network structure (M = 0.08, p = .054) and strength (S = .073, p = .067). Post hoc comparisons showed an association of re-experiencing symptoms with negative alterations in cognitions and mood in men but not women (E = .038, p = .005).Conclusion: Results demonstrated possible modest gender differences in aspects of network structure although most elements of the network structure were similar across genders. These results help to characterize gender differences in associations among PTSD symptom clusters during the early post-trauma period, which may inform the potential relevance of future gender-sensitive early intervention strategies to ameliorate the risk for long-term PTSD.

Antecedentes: A pesar de las diferencias conocidas de género/sexo en la prevalencia del trastorno de estrés postraumático (TEPT), las diferencias potenciales en las asociaciones entre los síntomas de TEPT entre hombres y mujeres en el período postraumático temprano no están bien caracterizadas.

Objetivo: Este estudio utilizó el análisis de redes para evaluar las diferencias potenciales en las asociaciones entre los grupos de síntomas de TEPT entre hombres y mujeres durante el período postraumático temprano.

Método: Incluimos n = 475 participantes (57.5% mujeres autoidentificadas) que recientemente (≤2 meses) experimentaron un evento potencialmente traumático, interpersonal o de vehículo motorizado en los Países Bajos. Los síntomas de TEPT del mes anterior se midieron con la Lista de verificación de TEPT para DSM-5 (PCL-5) y se compusieron de acuerdo con el modelo de excitación disfórica de grupo de síntomas de TEPT de cinco nodos. Estimamos la red, así como los índices de centralidad (fuerza y predictibilidad) y evaluamos la estabilidad de las redes modeladas en submuestras de hombres (n = 202) y mujeres (n = 273). Comparamos las estructuras de la red utilizando la Prueba de Comparación de Redes (NCT por sus siglas en ingles).

Resultados: Los resultados demostraron en gran medida una adecuada estabilidad de correlación para la estructura de red estimada para mujeres y hombres, respectivamente. Tanto para hombres como para mujeres, los síntomas de evitación se encontraban entre los nodos más fuertes con mayor predictibilidad en las redes. En los hombres, la excitación ansiosa mostró además una alta fuerza, mientras que la reexperimentación mostró una alta predictibilidad. En las mujeres, los síntomas de reexperimentación demostraron tanto una alta fuerza como predictibilidad. La NCT demostró diferencias no significativas en la estructura de la red global (M = 0.08, p = .054) y la fuerza (S = .073, p = .067). Las comparaciones post hoc mostraron una asociación entre la reexperimentación de síntomas y alteraciones negativas en las cogniciones y el estado de ánimo en los hombres, pero no en las mujeres (E = .038, p = .005).

Conclusión: Los resultados demostraron posibles diferencias de género modestas en aspectos de la estructura de la red, aunque la mayoría de los elementos de la estructura de la red fueron similares en ambos sexos. Estos resultados ayudan a caracterizar las diferencias de género en las asociaciones entre los grupos de síntomas de TEPT durante el período postraumático temprano, lo que puede dar luces sobre la posible relevancia de futuras estrategias de intervención temprana sensibles al género para mejorar el riesgo de TEPT a largo plazo.

Keywords: PTSD; TEPT; análisis de redes; estrés; gender; género; network analysis; stress; trauma.

Plain language summary

Individuals in the early post-trauma period (≤2 months since trauma) self-reported PTSD symptoms.Networks based on the 5-factor dysphoric arousal model of PTSD were compared across self-identified men and women.Avoidance showed high strength in both networks, whereas re-experiencing also showed high strength in women; anxious arousal was among the strongest nodes for men.There were modest, possible differences in aspects of network structure and no differences in network strength between women and men.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Network Models Using 5-Cluster PTSD Model Subscales for Women (left) and Men (right). Notes: Reexp = re-experiencing symptoms (PCL-5 B1, B2, B3, B4, B5); Avoid = avoidance symptoms (PCL-5 C1, C2); NACM = negative alterations in cognition and mood symptoms (PCL-5 D1, D2, D3, D4, D5, D6, D7); DA = dysphoric arousal symptoms (PCL-5 E1, E2, E5, E6); AA = anxious arousal symptoms (PCL-5 E3, E4). Green lines show associations (edges) between symptom clusters (nodes) in the networks; inset numbers refer to estimates (bootstrapped edge weights). Visualizations of edge weights were determined within each gender-stratified network separately, thus edge weights of similar values may have slightly different thicknesses across networks. Navy blue rings denote the degree to which a given node is predicted by other symptom clusters in the network (predictability).
Figure 2.
Figure 2.
Stability of Node Strength (top) and Edge Weight Estimates (bottom) for Women (left) and Men (right). Notes: Stability plots demonstrate the average correlation between strength and edge weight estimates calculated from the original networks with strength and edge weight estimates calculated from 10,000 bootstrapped networks sampled with increasingly smaller subsets of data. Shading around the line plot reflects the 95% confidence interval around the average correlation estimate.
Figure 3.
Figure 3.
Node Strength for PTSD Cluster in Women (left) and Men (right). Notes: Reexp = re-experiencing symptoms (PCL-5 B1, B2, B3, B4, B5); Avoid = avoidance symptoms (PCL-5 C1, C2); NACM = negative alterations in cognition and mood symptoms (PCL-5 D1, D2, D3, D4, D5, D6, D7); DA = dysphoric arousal symptoms (PCL-5 E1, E2, E5, E6); AA = anxious arousal symptoms (PCL-5 E3, E4). Plots depict raw values.
Figure 4.
Figure 4.
Edge weight differences between PTSD Cluster for Women (left) and Men (right). Note: Reexp = re-experiencing symptoms (PCL-5 B1, B2, B3, B4, B5); Avoid = avoidance symptoms (PCL-5 C1, C2); NACM = negative alterations in cognition and mood symptoms (PCL-5 D1, D2, D3, D4, D5, D6, D7); DA = dysphoric arousal symptoms (PCL-5 E1, E2, E5, E6); AA = anxious arousal symptoms (PCL-5 E3, E4). Pairs of edges that differ significantly within the subsamples (i.e. women vs. men) are denoted via a black box. Grey shading denotes nonsignificant differences between pairs of edge weights.
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