Weissman Myrna M, Neria Yuval, Das Amar, Feder Adriana, Blanco Carlos, Lantigua Rafael, Shea Steven, Gross Raz, Gameroff Marc J, Pilowsky Daniel, Olfson Mark
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Gend Med. 2005 Jun;2(2):76-87. doi: 10.1016/s1550-8579(05)80014-2.
Debate surrounds the nature of gender differences in rates of posttraumatic stress disorder (PTSD).
The goal of this study was to quantify and explore the reasons for gender differences in rates of PTSD in low income, primary care patients after the World Trade Center (WTC) attack of September 11, 2001.
A survey was conducted at a large primary care practice in New York City 7 to 16 months after the WTC attack. The study involved a systematic sample of primary care patients aged 18 to 70 years. The main outcome measures were the Life Events Checklist, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, all administered by a bilingual research staff.
A total of 3807 patients were approached at the primary care clinic. Of the 1347 who met eligibility criteria, 1157 (85.9%) consented to participate. After the addition of the WTC/PTSD supplement to the study, the total number of patients was 992, of whom 982 (99.0%) completed the survey. Both sexes had high rates of direct exposure to the WTC attack and high rates of lifetime exposure to stressful life events. Overall, females had lower rates of exposure to the attack compared with males (P < 0.05). Hispanic females had the highest rate of PTSD in the full sample. Gender differences in rates of PTSD were largely accounted for by differences in marital status and education. The rate of current major depressive disorder (MDD) was higher in females than in males (P < 0.001), and the reverse was true for substance abuse (P < 0.001). Gender differences for MDD and substance abuse persisted even after adjustments for demographic differences between the sexes.
The increased rate of PTSD in women attending a primary care clinic was mediated by their social and economic circumstances, such as living alone without a permanent relationship and with little education or income. The increased rate of MDD in women appeared to be less dependent on these circumstances. These findings have implications for the treatment of women with PTSD in primary care and for research on gender differences in rates of psychiatric disorders.
创伤后应激障碍（PTSD）发病率的性别差异本质存在争议。
本研究的目的是量化并探究2001年9月11日世贸中心（WTC）袭击后低收入初级保健患者中PTSD发病率性别差异的原因。
在WTC袭击后7至16个月，于纽约市一家大型初级保健机构进行了一项调查。该研究纳入了18至70岁初级保健患者的系统样本。主要结局指标包括生活事件清单、创伤后应激障碍清单-平民版以及精神障碍初级保健评估患者健康问卷，均由双语研究人员进行评估。
在初级保健诊所共接触了3807名患者。符合入选标准的1347名患者中，1157名（85.9%）同意参与。在研究中加入WTC/PTSD补充内容后，患者总数为992名，其中982名（99.0%）完成了调查。男女直接暴露于世贸中心袭击的比例都很高，终生暴露于应激性生活事件的比例也很高。总体而言，与男性相比，女性暴露于袭击的比例较低（P < 0.05）。西班牙裔女性在整个样本中PTSD发病率最高。PTSD发病率的性别差异在很大程度上由婚姻状况和教育程度的差异所致。当前重度抑郁症（MDD）的发病率女性高于男性（P < 0.001），而物质滥用情况则相反（P < 0.001）。即使对男女之间的人口统计学差异进行调整后，MDD和物质滥用的性别差异仍然存在。
在初级保健诊所就诊的女性中PTSD发病率增加是由其社会和经济状况介导的，例如独自生活、没有稳定关系且教育程度或收入较低。女性中MDD发病率的增加似乎较少依赖于这些状况。这些发现对初级保健中PTSD女性患者的治疗以及精神障碍发病率性别差异的研究具有启示意义。
