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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Vydané v:Acta psychiatrica Scandinavica Ročník 145; číslo 2; s. 116 - 131
Hlavní autori: Bonde, Jens Peter Ellekilde, Jensen, Johan Høy, Smid, Geert E., Flachs, Esben Meulengracht, Elklit, Ask, Mors, Ole, Videbech, Poul
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Blackwell Publishing Ltd 01.02.2022
John Wiley and Sons Inc
Predmet:
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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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.
AbstractList 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.
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.
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
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  fullname: Bonde, Jens Peter Ellekilde
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/34523121$$D View this record in MEDLINE/PubMed
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Keywords trajectory analysis
subthreshold PTSD
veterans
forensic psychiatry
partial PTSD
latent class growth analysis
Language English
License Attribution-NonCommercial
2021 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
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PublicationPlace United States
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– name: Aalborg
– name: Hoboken
PublicationTitle Acta psychiatrica Scandinavica
PublicationTitleAlternate Acta Psychiatr Scand
PublicationYear 2022
Publisher Blackwell Publishing Ltd
John Wiley and Sons Inc
Publisher_xml – name: Blackwell Publishing Ltd
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35014031 - Acta Psychiatr Scand. 2022 Feb;145(2):113-115
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– reference: 35014031 - Acta Psychiatr Scand. 2022 Feb;145(2):113-115
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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...
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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
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Facps.13372
https://www.ncbi.nlm.nih.gov/pubmed/34523121
https://www.proquest.com/docview/2621005645
https://www.proquest.com/docview/2572938261
https://pubmed.ncbi.nlm.nih.gov/PMC9293462
Volume 145
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