Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review

Objective To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap between the traumatic exposure(s) and the clinical diagnosis. Methods We performed systematic searches of peer‐reviewed papers in Eng...

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Vydáno v:Acta psychiatrica Scandinavica Ročník 145; číslo 2; s. 116 - 131
Hlavní autoři: Bonde, Jens Peter Ellekilde, Jensen, Johan Høy, Smid, Geert E., Flachs, Esben Meulengracht, Elklit, Ask, Mors, Ole, Videbech, Poul
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Blackwell Publishing Ltd 01.02.2022
John Wiley and Sons Inc
Témata:
Background levels
Forensic psychiatry
Forensic science
Humans
Latent class analysis
latent class growth analysis
Mathematical models
Meta-analysis
partial PTSD
Population studies
Post traumatic stress disorder
Prospective Studies
Stress Disorders, Post-Traumatic - epidemiology
subthreshold PTSD
Systematic Review
Systematic Reviews
trajectory analysis
veterans
trajectory analysis
subthreshold PTSD
veterans
forensic psychiatry
partial PTSD
latent class growth analysis
ISSN:0001-690X, 1600-0447, 1600-0447
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Popis
Shrnutí:Objective To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap between the traumatic exposure(s) and the clinical diagnosis. Methods We performed systematic searches of peer‐reviewed papers in English referenced in Pubmed, Embase, or PsycINFO and ascertained 34 prospective studies of PTSD symptom trajectories identified by latent class growth statistical modeling. Studies with delayed and low‐stable trajectories provided appropriate data for this study. We computed the difference between the delayed trajectory PTSD symptom sumscore and the low‐stable PTSD sumscore at the observed points in time after the traumatic event(s). Results In 29 study populations, the latent class growth analyses displayed delayed trajectories, and in these, we identified 110 data points (% PTSD sumscore difference/months since traumatic exposure). The median PTSD symptom sumscore was 25% higher during the initial 6 months among individuals in the delayed trajectory compared to those in low‐stable trajectory. From this level, the difference widened and reached a plateau of 40–50% higher. The variation was large, and the baseline participation rate and loss to follow‐up were exceeding 25% in the majority of the studies. Heterogeneity of populations, measures, and analyses precluded formal meta‐analysis. Conclusion Delayed PTSD is preceded by PTSD symptoms during the first year in most cases. Still, few individuals may experience an asymptomatic delay. The results underpin the rationale for monitoring PTSD symptoms and may inform forensic assessments in that delayed PTSD without symptoms bridging the traumatic event is rare.
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ISSN:0001-690X
1600-0447
1600-0447
DOI:10.1111/acps.13372