Personal characteristics, such as age, can influence one’s degree of risk for developing post-traumatic stress disorder. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for effects of age on risk for PTSD?

Moderate to high quality evidence found small associations between younger age and more PTSD symptoms in women following childbirth, and in professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Moderate quality evidence found small associations between older age and more symptoms following burn injuries, and following earthquakes.

There was a medium-sized effect of more PTSD symptoms in older adults (>60-65 years) than younger adults (<60 years) following exposure to any natural disaster. However, there was also a medium-sized effect of less severe PTSD symptoms in older adults following exposure to any man-made disaster. Review authors suggest the disparity in findings between natural and human-induced disasters may be explained by older adults being less likely to receive advanced warnings or to evacuate during a natural disaster, and therefore may experience greater disruption or perceived loss, while previous experiences may better prepare older people to cope with man-made disasters.

There were no effects of age on risk of PTSD after a fall in elderly people (age 65 to 90 compared to over 90 years), following a traumatic brain injury at any age, and in combat-exposed military personnel and veterans.

August 2021

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Personal characteristics, such as cognitive and psychological factors, can influence one’s degree of risk for developing PTSD. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for cognitive and psychological factors on risk for PTSD?

Moderate quality evidence found shorter post-trauma amnesia and more memory of the traumatic event in people with a traumatic brain injury were associated with increased risk of PTSD. There were also associations between depressed mood, poor cognition, distress, and anxiety in people with a spinal cord injury and increased PTSD symptoms.

Moderate to high quality evidence found depression and anxiety, negative subjective and objective birth experiences, fear of childbirth, history of PTSD, negative emotions, dissociation, poor coping and stress, previous psychological problems, and lack of control were all associated with increased risk of PTSD in women following childbirth.

Moderate quality evidence found risk factors associated with PTSD following a burn injury include more life threat perception, intrusion symptoms, substance use disorders, avoidance symptoms, dissociation, negative emotions or distress, acute stress symptoms, having previous psychiatric disorders, need for psychological treatment, more anxiety and depression, having low openness and low narcissism, and feeling responsible for the burn injury.

Moderate to high quality evidence found rates of PTSD following a coronavirus infection (severe acute respiratory syndrome [SARS], Middle East respiratory syndrome [MERS], or coronavirus disease 2019 [COVID-19]) were greater in people with a sense of lack of control.

Moderate to high quality evidence found significant associations between more PTSD symptoms in children and adolescents exposed to any trauma and the following risk factors: post-trauma thought suppression, post-trauma blame others, post-trauma distraction, post-trauma psychological problem, peri-trauma fear, peri-trauma perceived life threat, post-trauma parental psychological problem, pre-trauma low intelligence, pre-trauma low self-esteem, pre-trauma psychological problem, and pre-trauma parent psychological problem. Moderate to low quality evidence found a medium-sized effect of increased rates of PTSD in adults and children who experienced fear during earthquakes.

Moderate quality evidence found good negative predictive power and moderate positive predictive power of acute stress disorder in predicting PTSD. Positive predictive power is the proportion of people who developed PTSD who initially met the criteria for acute stress disorder. Negative predictive power is the proportion of people who did not develop PTSD who did not initially meet the criteria for acute stress disorder.

August 2021

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Personal characteristics, such as level of education, can influence one’s degree of risk for developing post-traumatic stress disorder. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for education and risk for PTSD?

Moderate to high quality evidence found a small effect of fewer years of education increased the risk of PTSD in women following childbirth.

Moderate to low quality evidence found having more years at school was associated with more PTSD in children exposed to earthquakes but having less years at school was associated with more PTSD in adults exposed to earthquakes.

There were no associations in people with a traumatic brain injury.

August 2021

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Personal characteristics can influence one’s degree of risk for developing PTSD. How such personal characteristics may effect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for ethnicity and risk for PTSD?

Moderate to high quality evidence found a small association between increased risk of PTSD following childbirth in White vs. other participants.

Moderate to low quality evidence found a small association between increased PTSD symptoms following Hurricane Katrina and increased minority ethnicity.

Moderate quality evidence found the rate of PTSD was higher in Black samples than in White samples (49% vs. 29%) after road traffic accidents.

Moderate to high quality evidence found a small association between increased PTSD symptoms following any trauma in children and adolescents and increased Black or minority ethnicity.

Moderate to high quality evidence found no association between ethnicity and PTSD symptoms in professionals indirectly exposed to trauma through their therapeutic work with trauma victims.

August 2021

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Personal characteristics, such as family factors, can influence one’s degree of risk for developing PTSD. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence on family and social factors on risk for PTSD?

Moderate to low quality found small increases in rates of PTSD following earthquakes in adults with low vs. high SES, low vs. high employment, and low vs. high social support. This quality evidence also found a small increase in PTSD symptoms following a burn injury in unmarried vs. married patients.

Moderate to high quality evidence found low social support was associated with more PTSD symptoms following childbirth. There were no associations between PTSD following childbirth and socio-economic factors or marital status. This quality evidence also found associations between more PTSD symptoms in children and adolescents following any trauma and poor family functioning, low social support, low SES, and pre- and post-trauma parental psychological problems.

August 2021

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Personality and temperament are thought to be relatively stable over time. One of the main personality models includes five traits of; 1) neuroticism: vulnerability to emotional instability and self-consciousness, 2) extraversion: predisposition towards sociability, assertiveness, and social interaction, 3) openness: cognitive disposition to new experiences, creativity, and aesthetics, 4) agreeableness: tendency towards being sympathetic, trusting, and altruistic, and 5) conscientiousness: tendency towards dutifulness and competence.

A maladaptive combination of personality and temperament traits may constitute a risk factor for the development of psychological dysfunctions. Moreover, temperament traits are considered one of the most important moderators of the relationship between stress and psychopathology.

What is the evidence regarding personality and temperament in people with PTSD?

Moderate quality evidence found personality risk factors associated with PTSD following a burn injury were high neuroticism, low openness, and low narcissism.

Moderate to high quality evidence found small increases in PTSD symptoms with high-arousal temperament traits of emotional reactivity and perseveration. Decreased low-arousal temperament traits of endurance, briskness, activity, and sensory sensitivity were also associated with PTSD symptoms. There was a medium-sized increase in PTSD symptoms with alexithymic traits. These involves difficulties applying appropriate labels to emotional experiences, difficulty communicating and expressing emotional experiences and needs to others, and a cognitively rigid thinking style that attends to external information over internal information.

There was a large increase in PTSD symptoms associated with rumination. Rumination is the tendency to passively focus on emotional distress and its causes and consequences. This association was found with all PTSD symptom clusters of intrusions, avoidance, hyperarousal, and negative thoughts and mood.

There were medium-sized effects between increased PTSD symptoms and increased fearful attachment style. Small associations were found between more symptoms and insecure attachment style, anxious attachment style, avoidant attachment style, and preoccupied attachment style. There was no association with dismissing attachment style. Attachment style is formed in childhood through infant interactions with their primary caregiver. These interactions determine a child’s immediate emotional responses to stress and emotion-regulation in later life.

Medium-sized reductions in PTSD symptoms was associated with more hope. Small to medium-sized reductions in PTSD symptoms was associated with more optimism and more self-efficacy. Self-efficacy is belief in one’s ability to perform specific behaviours.

August 2021

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Personal characteristics can influence one’s degree of risk for developing PTSD following a new trauma exposure. This includes having previous trauma exposures. How personal characteristics affect the development of PTSD would be influenced by other personal characteristics, as well as differences in the trauma experience itself.

What is the evidence regarding having multiple trauma exposures and risk for PTSD?

Moderate to high quality evidence found small to medium-sized associations between having a history of trauma or a history of PTSD and increased PTSD symptoms following childbirth. High quality evidence found a small association between having a trauma history and having PTSD symptoms in people exposed to workplace secondary trauma. Moderate quality evidence found a small association between having prior trauma exposure and increased risk of PTSD following exposure to an earthquake. Moderate to high quality evidence found a small association between increased negative life events and more PTSD symptoms following any trauma in children and adolescents.

August 2021

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Personal characteristics, including gender, can influence one’s degree of risk for developing PTSD. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for effects of sex on risk for PTSD?

Overall, the risk of PTSD following exposure to any trauma was higher for females than for males. This has been observed in both adults and children. The quality of this evidence is generally moderate to high.

For children and adolescents, there were small associations between increased PTSD symptoms in females following any trauma exposure (females 21% vs. males 11%). Risk of PTSD was highest in females exposed to interpersonal trauma (33%). There were more PTSD symptoms in girls following the death of a parent, sibling, or close friend. The prevalence of PTSD in adolescent detention centres was higher in females than males (18.2% vs. 8.6%).

Small effects showed both adult and child females had an increased risk of PTSD following earthquakes, with the overall incidence of PTSD in females following earthquakes at 35% and 23% for males. The prevalence of PTSD following road traffic accidents was also higher in females than males (adult females: 28% vs. 20% for males, child and adolescent females: 34% vs. 22% for males).

There was a small increase in PTSD symptoms in females than males following a burn injury, and a medium-sized increase in rates of PTSD in females after a coronavirus infection (severe acute respiratory syndrome [SARS], Middle East respiratory syndrome [MERS], or coronavirus disease 2019 [COVID-19]). In the general population, a trend effect was found of greater risk of PTSD in females during the COVID-19 pandemic.

A small association was found between increased PTSD symptoms in mothers compared to fathers of chronically ill children. After the loss of a child, the prevalence of PTSD in mothers ranged from 23% to 49.1% within 3 months post-loss, from 0.6% to 37% between 3 months and 12 months post-loss, and from 3.3% to 15.2% by 18 years post-loss. In fathers, prevalence of PTSD ranged from 5% to 8.4% between 7 weeks and 18 years post-loss.

A small increase in the risk of PTSD was found in female than male military personnel and veterans.

Lifetime rates of PTSD were nearly twice as high in women than men over 65 years, although there were no differences in rates of PTSD between males and females aged over 65 years after a fall. There were also no differences in rates of PTSD between males and females following a traumatic brain injury or following exposure to secondary workplace trauma (looking after trauma victims).

August 2021

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