Delayed-onset posttraumatic stress disorder among 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: 7.99). 07/2009; 194(6):515-20. DOI: 10.1192/bjp.bp.108.054700
Source: PubMed


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.

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    • "Posttraumatic Stress Disorder (PTSD) is highly prevalent in Veterans Affairs (VA) primary care patients, with an estimated 12% prevalence rate [1] [2]. PTSD is associated with significant functional impairment, compromised health, early mortality, and substantial economic costs [3] [4] [5] [6]. "
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    • "Criterion D includes seven symptoms of " negative alterations in cognition and mood that are associated with the traumatic event(s) " and would require at least three symptoms for diagnosis (two for children). Recent studies have found that requiring both avoidance and numbing for a PTSD diagnosis would result in a decrease in PTSD's prevalence by about 1–2% points (Elhai, Ford, Ruggiero, & Frueh, 2009; Forbes et al., 2011). The DSM-5 proposed Criterion D clarifies that endorsement of the traumatic amnesia item should not be due to head injury or substance use. "
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    ABSTRACT: We empirically investigated recent proposed changes to the posttraumatic stress disorder (PTSD) diagnosis for DSM-5 using a non-clinical sample. A web survey was administered to 585 college students using the Stressful Life Events Screening Questionnaire to assess for trauma exposure but with additions for the proposed traumatic stressor changes in DSM-5 PTSD. For the 216 subjects endorsing previous trauma exposure and nominating a worst traumatic event, we administered the original PTSD Symptom Scale based on DSM-IV PTSD symptom criteria and an adapted version for DSM-5 symptoms, and the Center for Epidemiological Studies-Depression Scale. While 67% of participants endorsed at least one traumatic event based on DSM-IV PTSD's trauma classification, 59% of participants would meet DSM-5 PTSD's proposed trauma classification. Estimates of current PTSD prevalence were .4-1.8% points higher for the DSM-5 (vs. the DSM-IV) diagnostic algorithm. The DSM-5 symptom set fit the data very well based on confirmatory factor analysis, and neither symptom set's factors were more correlated with depression.
    Journal of anxiety disorders 09/2011; 26(1):58-64. DOI:10.1016/j.janxdis.2011.08.013 · 2.68 Impact Factor
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    • "Other skeptics of delayed-onset PTSD have criticized the empirical data upon which it is based and have questioned the existence of the phenomenon (McNally 2003; Spitzer et al. 2007). Moreover, at least four large-scale epidemiological studies have now reported zero or extremely low rates of delayed-onset PTSD (Breslau et al. 1991, 1997; Frueh et al. 2009; Helzer et al. 1987), although other studies have reported more significant percentages of delayed-onset PTSD (McFarlane 2010; Prigerson et al. 2001). One problem with the research on this construct is a lack of clarity regarding the conceptual definition of " delayed-onset. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD), added to the DSM nosology in 1980, has become a widely used and studied psychiatric diagnosis—though it has also been the subject of much criticism and controversy. In this paper, we review and discuss a number of issues related to the future of PTSD within the DSM, including the conceptual basis of the disorder, summary of proposed changes to DSM-V, the empirical basis for or against specific disorder criteria, forensic implications, and conclusions and recommendations regarding the future of the disorder in DSM. Overall, the current proposed changes for DSM-V represent a modest improvement over DSM-IV criteria, though they are incremental and relatively minor in nature. As such, they are unlikely to have a meaningful impact on prevalence rates, treatment approaches, or forensic applications of the disorder—and the disorder, as defined, remains problematic in many ways. The empirical data on latent structure of responses to traumatic and general life stressors seem to indicate that perhaps PTSD should be replaced by a dimensional general stress response disorder within the DSM system. KeywordsPosttraumatic stress disorder-DSM-Life stressors-Trauma
    Psychological Injury and Law 12/2010; 3(4):260-270. DOI:10.1007/s12207-010-9088-6
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