# Sex differences in treatment outcomes among U.S. service members with comorbid PTSD and MDD

## TL;DR

This study found that sex may influence treatment outcomes for PTSD and depression among U.S. service members, with differences observed in therapy effectiveness.

## Contribution

The study identifies sex as a potential moderator of treatment outcomes in PTSD and MDD therapies for service members.

## Key findings

- Sex moderated PTSD treatment outcomes in CPT but not in BA + CPT.
- Servicewomen in CPT showed greater PTSD symptom reduction compared to servicemen at posttreatment.
- BA + CPT showed no significant sex differences in PTSD outcomes at posttreatment or follow-up.

## Abstract

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are prevalent and deleterious conditions that commonly co-occur among service members. Identifying factors such as sex that could be linked to treatment response among service members with these conditions is critical for improving care delivery.

This study examined sex differences in treatment outcomes among U.S. active duty service members with comorbid PTSD and MDD (N = 94; 55% women, 45% men) in a randomized controlled trial comparing behavioral activation-enhanced cognitive processing therapy (BA + CPT) and standard CPT. PTSD and MDD symptom severity was assessed at pretreatment, posttreatment, and 3-month follow-up.

Intent-to-treat multilevel models indicated treatment condition moderated the relationship between sex and PTSD symptoms (p = .020) but not depression (p = .16). On average, Clinician-Administered PTSD Scale for DSM-5 scores decreased significantly more among servicewomen who received CPT versus BA + CPT at posttreatment (p = .004) and 3-month follow-up (p = .049). There were no significant differences in outcomes among servicemen (ps > 0.05). In CPT, servicewomen reported significantly greater PTSD symptom reduction compared to servicemen at posttreatment (p = .039) but not at follow-up (p = .088). In BA + CPT, PTSD symptoms did not significantly differ between sexes at posttreatment (p = .054) or follow-up (p = .29).

Findings suggest sex may differentially impact outcomes for CPT but not BA + CPT among service members with PTSD and MDD and could help inform shared decision-making between patients and providers.

ClinicalTrials.gov registry; registration number NCT02874131; date of registration: 08-22-2016.