Sex Differences in Incidence and Predictors of Depression and Posttraumatic Stress Symptoms Among African Americans Experiencing Motor Vehicle Collision

Background: Evidence suggests that African Americans (AAs) experience increased rates of adverse posttraumatic neuropsychiatric sequelae (APNS) versus non-Hispanic whites, but few prospective studies of APNS development have been performed in this understudied population. In this analysis, we evaluated for sex differences in the rates of posttraumatic depressive symptoms (PDS) and posttraumatic stress symptoms (PTSS) in AAs experiencing MVC. Methods: AA individuals presenting to the Emergency Department (ED) within 24 hours of MVC were enrolled. Six-week follow-up surveys included an evaluation of PDS (CES-D) and PTSS (IES-R). Multivariate regression analyses adjusting for study site and participant age were used to assess the influence of sex on PDS and PTSS. In secondary analyses, ensemble learning (Random Forest) methods were used to identify the most influential predictors of these outcomes in women and men. Results: Participants (n=927, 62% female) presenting to the ED for care following MVC were enrolled. Six-week follow-up survey data was obtained in 85%. AA women had higher PDS scores (F=4.733, p=0.030) and higher PTSS scores (F=4.216, p=0.040) six weeks after MVC than men. Secondary analyses identified substantial sex differences in predictive factors. For example, among AA women the most strongly associated individual factors included both peritraumatic psychological factors (e.g., dissociation, loss of control) and pain severity, whereas in men such factors included only psychological characteristics (e.g. distress, catastrophizing). Conclusions: Among AAs experiencing MVC, DPS and PTSS are more prevalent in women than men. Epidemiologic risk factors also differ in women and men, suggesting potential differences in underlying pathogenic mechanisms