Biological Sex as a Moderator of the Association of Military Sexual Trauma and Posttraumatic Stress Disorder Total and Symptom Cluster Severity

Posttraumatic stress disorder (PTSD) is a multifaceted disorder comprised of distinct symptom clusters and is commonly diagnosed in military service members/veterans (SM/Vs), particularly in those with history of military sexual trauma (MST). Evidence and theory suggest that females and males may have different traumatic responses following MST, though research investigating this association has limitations, such as modeling the sexes separately or not covarying for MST severity. The current study examined the moderating role of sex on the association of MST severity and PTSD total and symptom cluster severity. Participants were 1,161 SM/Vs (female: n = 782, 67.36%) who completed online self-report questionnaires. Due to the substantial portion of zeros on the outcome measure (n = 210, 18.07%), two-part hurdle models were utilized to assess the moderating role of sex on the association of MST severity and the presence or severity of overall PTSD symptoms and symptom clusters. Results showed that among those who experienced assault MST, females were at higher risk for the presence of intrusive, avoidance, anhedonia, and dysphoric arousal symptom clusters. Among those who experienced harassment-only MST, males were at higher risk of more severe symptoms overall and in the intrusive, avoidance, negative alterations in cognitions and mood, and dysphoric arousal symptom clusters. No other significant differences were observed. Results from this study suggest that male and female SM/Vs have unique responses to the different severities of MST. Sex-specific interventions may be warranted in targeting posttraumatic responses that are specific to males and females