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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| Published in: | Acta psychiatrica Scandinavica Vol. 145; no. 2; pp. 116 - 131 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
Blackwell Publishing Ltd
01.02.2022
John Wiley and Sons Inc |
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| ISSN: | 0001-690X, 1600-0447, 1600-0447 |
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| Abstract | 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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| AbstractList | ObjectiveTo 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.MethodsWe 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).ResultsIn 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.ConclusionDelayed 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. 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. 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). 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. 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. 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. 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.OBJECTIVETo 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.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).METHODSWe 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).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.RESULTSIn 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.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.CONCLUSIONDelayed 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. |
| Author | Bonde, Jens Peter Ellekilde Videbech, Poul Jensen, Johan Høy Mors, Ole Elklit, Ask Flachs, Esben Meulengracht Smid, Geert E. |
| AuthorAffiliation | 1 Department of Occupational and Environmental Medicine Bispebjerg and Frederiksberg Hospital Copenhagen Denmark 3 Copenhagen Stress Research Center Copenhagen Denmark 7 Psychosis Research Unit Aarhus University Hospital – Psychiatry Aarhus Denmark 5 ARQ National Psychotrauma Center Diemen the Netherlands 2 Institute of Public Health University of Copenhagen Copenhagen Denmark 4 Department of Humanist Chaplaincy Studies University of Humanistic Studies Utrecht the Netherlands 6 Danish National Centre for Psychotraumatology University of Southern Denmark Odense Denmark 8 Centre for Neuropsychiatric Depression Research Mental Health Centre Glostrup and Clinical Institute University of Copenhagen Copenhagen Denmark |
| AuthorAffiliation_xml | – name: 2 Institute of Public Health University of Copenhagen Copenhagen Denmark – name: 7 Psychosis Research Unit Aarhus University Hospital – Psychiatry Aarhus Denmark – name: 8 Centre for Neuropsychiatric Depression Research Mental Health Centre Glostrup and Clinical Institute University of Copenhagen Copenhagen Denmark – name: 5 ARQ National Psychotrauma Center Diemen the Netherlands – name: 4 Department of Humanist Chaplaincy Studies University of Humanistic Studies Utrecht the Netherlands – name: 6 Danish National Centre for Psychotraumatology University of Southern Denmark Odense Denmark – name: 3 Copenhagen Stress Research Center Copenhagen Denmark – name: 1 Department of Occupational and Environmental Medicine Bispebjerg and Frederiksberg Hospital Copenhagen Denmark |
| Author_xml | – sequence: 1 givenname: Jens Peter Ellekilde orcidid: 0000-0002-8181-3673 surname: Bonde fullname: Bonde, Jens Peter Ellekilde email: Jens.peter.ellekilde.bonde@regionh.dk organization: University of Copenhagen – sequence: 2 givenname: Johan Høy surname: Jensen fullname: Jensen, Johan Høy organization: Copenhagen Stress Research Center – sequence: 3 givenname: Geert E. orcidid: 0000-0002-9616-5234 surname: Smid fullname: Smid, Geert E. organization: ARQ National Psychotrauma Center – sequence: 4 givenname: Esben Meulengracht surname: Flachs fullname: Flachs, Esben Meulengracht organization: Bispebjerg and Frederiksberg Hospital – sequence: 5 givenname: Ask surname: Elklit fullname: Elklit, Ask organization: University of Southern Denmark – sequence: 6 givenname: Ole surname: Mors fullname: Mors, Ole organization: Aarhus University Hospital – Psychiatry – sequence: 7 givenname: Poul surname: Videbech fullname: Videbech, Poul organization: University of Copenhagen |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34523121$$D View this record in MEDLINE/PubMed |
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| Copyright | 2021 The Authors. published by John Wiley & Sons Ltd. 2021 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd. 2021. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | trajectory analysis subthreshold PTSD veterans forensic psychiatry partial PTSD latent class growth analysis |
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| SecondaryResourceType | review_article |
| Snippet | Objective
To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging... To examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging the gap... ObjectiveTo examine the hypothesis that PTSD with delayed expression in some cases occurs without subthreshold PTSD symptoms above background levels bridging... |
| SourceID | pubmedcentral proquest pubmed crossref wiley |
| SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 116 |
| SubjectTerms | 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 |
| Title | Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review |
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| Volume | 145 |
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