Article

Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics

Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, USA.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.34). 07/2009; 194(6):515-20. DOI: 10.1192/bjp.bp.108.054700
Source: PubMed

ABSTRACT Only limited empirical data support the existence of delayed-onset post-traumatic stress disorder (PTSD).
To expand our understanding of delayed-onset PTSD prevalence and phenomenology.
A cross-sectional, epidemiological design (n = 747) incorporating structured interviews to obtain relevant information for analyses in a multisite study of military veterans.
A small percentage of veterans with identified current PTSD (8.3%, 7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only (5.4%, 2/37) met criteria for delayed onset with PTSD symptoms initiating more than 6 months after the index trauma. Altogether only 0.4% (3/747) of the entire sample had current PTSD with delayed-onset symptoms developing more than 1 year after trauma exposure, and no PTSD symptom onset was reported more than 6 years post-trauma.
Retrospective reports of veterans reveal that delayed-onset PTSD (current, subthreshold or lifetime) is extremely rare 1 year post-trauma, and there was no evidence of PTSD symptom onset 6 or more years after trauma exposure.

0 Followers
 · 
103 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Research over the past 30 years has changed the landscape of trauma and general stress studies, leading to the new conceptual and clinical questions regarding the nature of psychopathological reactions to trauma. In this introduction to this special issue, we review several well‚Äźdocumented scientific findings that continue to surprise laypeople and mental health experts alike. The articles in this special issue will further our understanding of modern psychological responses to adversity.
    Clinical Psychology Science and Practice 09/2012; 19(3). DOI:10.1111/cpsp.12000 · 2.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: U.S. Army Combat Medic serves as both Soldier and provider of combat casualty care, often in the heat of battle and with limited resources. Yet little is known about their help-seeking behavior and perceived stigma and barriers to care. Participants were three groups of U.S. Army Combat Medics surveyed at 3- and 12-months postdeployment from assignment with line units vs. those Medics who had never deployed to combat. The primary data source was surveys of mental health service utilization, perceived stigma and barriers to care, and depression and post-traumatic stress disorder screens. Medics who received help in the past year from a mental health professional ranged from 18% to 30%, with 18% to 30% seeking mental health assistance from other sources. Previously deployed Medics were more likely to obtain assistance than those who never deployed. Those meeting a mental health screening criteria were more likely to report associated stigma and barriers to care. Findings indicate that Medics in need of assistance report greater perceived barriers to mental health care, as well as stigma from seeking treatment, and that depression may be a salient issue for Medics. The longitudinal nature of the ongoing study will help determine the actual trajectory and onset of depression and post-traumatic stress disorder.
    Military medicine 08/2014; 179(8S):55-62. DOI:10.7205/MILMED-D-12-00367 · 0.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nearly 100 years ago, Ivan Pavlov demonstrated that dogs could learn to use a neutral cue to predict a biologically relevant event: after repeated predictive pairings, Pavlov's dogs were conditioned to anticipate food at the sound of a bell, which caused them to salivate. Like sustenance, danger is biologically relevant, and neutral cues can take on great salience when they predict a threat to survival. In anxiety disorders such as posttraumatic stress disorder (PTSD), this type of conditioned fear fails to extinguish, and reminders of traumatic events can cause pathological conditioned fear responses for decades after danger has passed. In this review, we use fear conditioning and extinction studies to draw a direct line from Pavlov to PTSD and other anxiety disorders. We explain how rodent studies have informed neuroimaging studies of healthy humans and humans with PTSD. We describe several genes that have been linked to both PTSD and fear conditioning and extinction and explain how abnormalities in fear conditioning or extinction may reflect a general biomarker of anxiety disorders. Finally, we explore drug and neuromodulation treatments that may enhance therapeutic extinction in anxiety disorders.
    Neurobiology of Learning and Memory 12/2013; DOI:10.1016/j.nlm.2013.11.014 · 4.04 Impact Factor