Some groups are disproportionately represented among those experiencing trauma. This means that they may be exposed to trauma at particularly high rates or be at increased risk for repeated victimization. For these groups, co-occurring issues and unique adversities can complicate recovery from trauma. Others face significant challenges related to access to services or require services that are specially adapted for their needs (NCTSN, 2024).

3.1 Veterans

PTSD has long been associated with military combat. Veterans, especially those who have been injured in combat, are at especially high risk for developing PTSD. Younger veterans who served in the Gulf War, Iraq or Afghanistan may be even more likely than veterans of earlier conflicts to suffer adverse psychiatric outcomes. According to an analysis of the 2019-2020 National Health and Resilience in Veterans Study, younger veterans showed the greatest burden of trauma and were more likely to screen positive for PTSD. One quarter Iraq/Afghanistan veterans in the study reported recent suicidal thoughts (Na et al., 2023).

Many veterans of Iraq and Afghanistan have experienced long-lasting post-concussive symptoms from traumatic brain injuries. Brain injuries can cause psychiatric symptoms that are similar to PTSD, such as difficulty sleeping and concentrating, irritability, and depressed mood. The overlap between PTSD and symptoms associated with a brain injury is being intensively studied, with one study finding that post-concussion symptoms improved following PTSD treatment (Porter et al., 2024).

Military sexual trauma (MST), psychological trauma that is caused by sexual assault and/or sexual harassment that occurred during a soldier’s military service. It is highly prevalent among female veterans. Military sexual assault is strongly associated with PTSD and suicidal ideation and suicide attempts, leading to calls for better understanding of how to address suicide risk among survivors of MST (Monteith et al., 2023).

Male service members are not entirely spared from military sexual assault. According to the Department of Defense, 5.7% of male service members have experienced military sexual harassment and 1.6% have been sexually assaulted. These estimates are probably low, given the reluctance to report and disclose these traumas, even in a healthcare setting (Livingston and Blaise, 2024).

3.2 Women

Women experience PTSD at two to three times the rate of men, with the lifetime prevalence of 10-12%. This may be due to the different types of traumas that are more common among women, like sexual assault, child sexual abuse, and violence by an intimate partner. Sexual assault is one of the highest risk factors for PTSD, particularly when it occurs multiple times or early in life (Novotney, 2023). For women, lower income, younger age, and behavioral health conditions have also been identified as risk factors for PTSD (Schein et al., 2021).

Survivors of interpersonal violence and sexual assault often have heightened arousal and fixation on nonthreatening stimuli. Survivors may be unable to respond to real danger due to numbness and an inability to assess risks accurately. Female children who have been sexually abused or otherwise mistreated, especially before the age of twelve, often experience a neurobiological impact on their brain development, which can have an effect on executive functioning, emotional regulation, and learning (Eder-Moreau et al., 2022).

There are also sex-specific social, environmental, and biological factors that contribute to the likelihood that a woman or girl will develop PTSD. Some research shows that the time of life, menstrual phase, and cultural/social expectations may predict whether or not a female trauma survivor will develop PTSD (Eder-Moreau et al., 2022).

Women with PTSD are most likely to experience flashbacks if they are traumatized during the mid-luteal phase of their cycle (when progesterone and estrogen in the form of estradiol are at their peak, triggering ovulation hormones). However, women who have been exposed to trauma during low-estradiol phases of their cycle have more overall psychological symptoms, such as depression and phobic anxiety. Different symptoms are exacerbated at different points in the cycle, though more research is needed to determine the protective effects of progesterone and estradiol (Mu et al., 2022).

Emotional coping strategies and personality traits that are culturally more acceptable for women may also play a role in the severity of PTSD symptoms. For example, ruminating, which may be perceived as being emotionally open or sharing, may lead to less cognitive flexibility, which in turn leads to more negative psychological outcomes.

3.3 Children and Teens

Children and teens do not always present with the same symptoms of PTSD that adults do. Young children may regress after a trauma. Wetting the bed after they have learned to use the toilet is a common sign that a child is experiencing PTSD. Children may stop talking or be unable to speak, and may re-enact the trauma during playtime. They may be clingy, have tantrums, show increased fearfulness or be emotionally numb. Adolescents may show symptoms more similar to those of adults, including thoughts of revenge and guilt over their failure to prevent the traumatizing event from happening (NIMH, 2022).

Regardless of age, many children and adolescents experience physical symptoms such as headaches, stomachaches, sweating, and increased heart rate. They may refuse to go to bed, where they might experience nightmares or insomnia. As with adults, symptoms can include trouble concentrating and loss of interest in previously enjoyed activities (NIMH, 2022).

Adverse childhood experiences (ACEs) such as abuse, rejection, witnessing interpersonal violence, losing parents or other caregivers, or living with adults who suffer from substance use disorder often predict PTSD as well as other psychological problems like depression and suicide (Cruz et al., 2022).

As adults, children who were exposed to multiple adverse childhood experiences are often misdiagnosed. Sometimes, clinicians miss their underlying PTSD, treating them instead for the psychiatric problems that have developed in the wake of their childhood trauma. People who have experienced multiple, repeated adverse childhood experiences are at higher risk for poor physical health, poverty, and reliance on alcohol and drugs (Cruz et al., 2022).

Children and adolescents who are exposed to political violence are also vulnerable to developing PTSD. Displaced children, whose guardians may have been killed, disabled or gone missing during a conflict, are at higher risk of developing PTSD than children in the general population. For example, nearly half of the children surveyed recently from a conflict zone in Amhara (a regional state in northern Ethiopia) showed signs of PTSD (Biset et al., 2022).

The COVID-19 pandemic and lockdown measures led to an increase in PTSD among children and adolescents worldwide. Social isolation, economic impacts, death, and fear of death were contributing factors. One Saudi study estimated that PTSD among children had gone up from a pre-pandemic level of 1.7% to 13% during the pandemic, with no significant gender variation (Sayed et al., 2021).

In India, nearly 70% of children and adolescents in one survey reported symptoms of post-traumatic stress, while rates among children and adolescents in China was more than 85%. In India, direct exposure to hospitalization and indirect exposure via electronic media were found to be significantly associated with post-traumatic stress symptoms, particularly arousal. Rural people of all ages, who lived with less reliable medical infrastructure, are especially susceptible to post-traumatic stress (Bhushan et al., 2022).

Some research suggests that puberty itself can be so difficult for some adolescents that they display symptoms of PTSD, from intrusive thoughts and feelings of isolation to a loss of control and a sense of profound helplessness and confusion (Tarazi-Sahab et al., 2022).

3.4 Healthcare Professionals and Caregivers

PTSD can arise from witnessing a traumatic event, including someone else’s death or injury. For this reason, it can be a serious occupational hazard for first responders and healthcare professionals, who are exposed to trauma on a regular basis. During the COVID-19 pandemic, stress and burnout among healthcare workers was an international concern (Rice et al., 2023).

One study found that among healthcare workers who were on the frontlines during the COVID-19 pandemic, younger age, nursing role, and 60+ hour work weeks were strongly associated with high levels of PTSD symptoms. Older healthcare workers were less likely to report symptoms of PTSD than younger workers, and physicians reported fewer symptoms than nurses. Among nurses, those who worked in the ICU showed higher levels of PTSD symptoms than non-ICU nurses (Rice et al., 2023).

Caregivers are also subject to PTSD, as they struggle to adjust to the increased responsibilities related to caring for a loved one. It is not uncommon for caregivers to experience a decrease in their social, leisure, and professional opportunities. Being a young, female caregiver, with low income and a low level of education are all risk factors for caregiver PTSD. The risk of PTSD climbs with time spent in the ICU or bedside with a seriously ill patient. The type of relationship between the caregiver and patient, good coping mechanisms, illness-related distress, and the availability of support networks play a role in the psychiatric well-being of caregivers (Carmassi et al., 2020).

Caring for people with severe mental illness is a risk factor for developing PTSD. In one study of caregivers for people with schizophrenia or bipolar disorder, over 15% of caregivers met the diagnostic criteria for PTSD. These caregivers work under a great deal of stress, are subject to aggression, and often experience a low quality of life. Caregivers may blame themselves for poor outcomes, experience high levels of stress over hospitalizations, and struggle with keeping track of medications (Rady et al., 2021).

Answers: #2 is False; #4 is False.