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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    • "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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