Exploring the moderating role of sex between perceived social support and (complex) posttraumatic stress symptom severity in a multi-country sample

Background: Perceived social support is an established predictor of post-traumatic stress disorder (PTSD) after exposure to a traumatic event (1). Sex is an important factor that could differentiate responses to social support (2), yet this has been little explored. Symptoms of complex PTSD are also common following trauma but have been under researched in this context and yielded mixed results (3). Large scale studies with culturally diverse samples are particularly lacking
Objectives: In a multi-country sample, we examined: a) sex differences in perceived social support and both posttraumatic stress symptom severity (PTSS) and complex posttraumatic stress symptom severity (CPTSS); b) associations between social support, and PTSS/CPTSS; and c) the potential moderating role of sex in the relationship between perceived social support and trauma-related distress
Method: We conducted a cross-sectional analysis of data from a pre-existing international dataset (4). The study was part of the Global Collaboration on Traumatic Stress initiative (https://www.global-psychotrauma.net/child-maltreatment). Adult participants were recruited from multiple countries and completed indices of trauma, social functioning, and mental health (ethical approval id-num-21-07). Participants who had been exposed to mixed trauma types, completed the Multidimensional Scale of Perceived Social Support (MSPSS) (5) and the International Trauma Questionnaire (which captures PTSS/CPTSS) (6). Regression analyses examined associations between sex, perceived social support, and PTSS/CPTSS; and tested for sex by social support interactions in predicting PTSS/CPTSS scores. Models were adjusted for age and socioeconomic status (SES)
Results: The final sample comprised 2483 participants from 39 different countries (Mage=30 years, 69.9% females), with the highest proportions from India (15.4%), South Africa (15.0%), Switzerland (13.7%), Germany (9.9%), and Israel (9.7%). As expected, females vs. males showed higher PTSS (B=.23, 95% CI=.16, .30, p<.001) and CPTSS (B =.20, 95% CI=.12, .27, p<.001). However, we found no evidence of sex differences in perceived social support (B=.052, 95% CI=-.053, .157, p=.328). We also found a robust, inverse association between perceived social support and PTSS (B=-.23, 95% CI=-.29, -.17, p<.001). In addition, we found weak evidence that the relationship between MSPSS and PTSS scores was moderated by sex (B=.07, 95% CI=.004, .14, p=.04). Sex stratified analyses showed a slightly stronger inverse association between MSPSS and PTSS scores in males vs. females (B= -.22, 95% CI=-.29, -.15, p<.001). When this analysis was repeated with CPTSS as the outcome the findings were similar, with a strong inverse association between MSPSS and CPTSS scores. However, there was no evidence of moderation by sex
Conclusion: Our results suggest that females showed higher PTSS/CPTSS than males and an inverse association was found between perceived social support and posttraumatic distress that did not vary substantially by sex. Individuals who feel more socially supported have lower trauma-related distress, and this association is similar in males and females. PTSD/CPTSD interventions may benefit thus from augmenting perceived social support, regardless of sex. Nonetheless, future research should uncover the potentially complex relationship between perceived social support and PTSS/CPTSS in longitudinal samples, to establish the directionality of this relationship, underlying mechanisms, differences between PTSD and CPTSD, and the true role of sex.