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 costs3456. While effective psychotherapies for PTSD are available in specialty mental healthcare settings, patients do not routinely receive them due to limited time, fear of being stigmatized or reluctance to disclose emotional problems[7,8]. "
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    • "Most symptoms subthreshold occur within six months of exposure to the combat events according to DSM-V criteria. Delayed-onset PTSD with no prior history of PTSD symptoms is uncommon[69]. In military cases of delayed onset PTSD symptoms, 38.2% of the cases could be accounted for by an exacerbation of previously recorded symptoms[70]. "

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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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