PTSD is associated with medical and psychiatric comorbidities. Less is known regarding differences in PTSD comorbidities and service use by gender.

To examine variations in comorbidities for PTSD by gender and implications for quality of care.

We identify the prevalence of PTSD, medical and psychiatric comorbidities diagnosed by gender within outpatient, inpatient and emergency services.

We conducted a retrospective analysis using existing medical records from all outpatient, inpatient and emergency department (ED) encounters in 2010–2012 in a safety net health care system in the US. We identified the rates of PTSD diagnosis by gender, co-occurring diagnoses in ED and inpatient care, and rate of different comorbid diagnoses following initial PTSD diagnosis.

Women in the sample had twice the likelihood of having a diagnosis of PTSD as compared to men (1.9% vs. 3.6%, P > 0.001), the most common comorbid diagnoses for ED visits were substance use disorder (SUD), depression, anxiety and pain. Men were more likely to have pain as a diagnosis in the ED as compared to women (P > 0.001). In inpatient services, men with PTSD were more likely to be diagnosed with a SUD (35% vs. 26%, P > 0.001) and women more likely diagnosed with comorbid depression (32% vs. 43%, P > 0.001). Men were more likely to have combined medical and substance use disorders and women more likely to have combined medical and psychiatric disorders.

Given the different patterns of comorbidity by gender, services should focus on tailoring services early to contend with these differences.

The authors have not supplied their declaration of competing interest.