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Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics

Published online by Cambridge University Press:  02 January 2018

B. Christopher Frueh ,
Anouk L. Grubaugh ,
Derik E. Yeager  and
Kathryn M. Magruder
B. Christopher Frueh*
Affiliation:
The Menninger Clinic and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
Anouk L. Grubaugh
Affiliation:
Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
Derik E. Yeager
Affiliation:
Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
Kathryn M. Magruder
Affiliation:
Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
*
B. Christopher Frueh, Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, USA. Email: [email protected]
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Abstract

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Background

Only limited empirical data support the existence of delayed-onset post-traumatic stress disorder (PTSD).

Aims

To expand our understanding of delayed-onset PTSD prevalence and phenomenology.

Method

A cross-sectional, epidemiological design (n = 747) incorporating structured interviews to obtain relevant information for analyses in a multisite study of military veterans.

Results

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 posttrauma.

Conclusions

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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 194 , Issue 6 , June 2009 , pp. 515 - 520
Copyright
Copyright © Royal College of Psychiatrists, 2009 

Footnotes

This work was partially supported by grants VCR-99-010-2 from Veterans Affairs Health Services Research and Development (Veterans Affairs HSR&D) to K.M.M., grant CD-207015 from Veterans Affairs HSR&D to A.L.G., grant MH074468 from the National Institute of Mental Health (NIMH) to B.C.F and awards from the McNair Foundation and Menninger Foundation. This work was also supported by the Office of Research and Development, Medical Research Service, Department of Veterans Affairs. All views and opinions expressed herein are those of the authors and do not necessarily reflect those of our respective institutions or the Department of Veterans Affairs.

Declaration of interest

None.

References

1 Andrews, B, Brewin, CR, Philpott, R, Stewart, L. Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 2007; 164: 1319–26.Google Scholar
2 McNally, RJ. Progress and controversy in the study of posttraumatic stress disorder. Annual Rev Psychol. 2003; 54: 229–52.Google Scholar
3 Spitzer, RL, First, MB, Wakefield, JC. Saving PTSD from itself in DSM-V. J Anx Disorders 2007; 21: 233–41.Google Scholar
4 Helzer, JE, Robins, LN, McEvoy, LM. Post-traumatic stress disorder in the general population. Findings from the Epidemiological Catchment Area survey. New Engl J Med 1987; 317: 1630–4.Google Scholar
5 Breslau, N, Davis, GC, Andreski, P, Peterson, E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 1991; 48: 216–22.Google Scholar
6 Breslau, N, Davis, GC, Peterson, EL, Schultz, L. Psychiatric sequelae of posttraumatic stress disorder. Arch Gen Psychiatry 1997; 54: 81–7.Google ScholarPubMed
7 Engdahl, B, Dikel, TN, Eberly, R, Blank, A Jr. Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war. Am J Psychiatry 1998; 155: 1740–5.Google Scholar
8 Prigerson, HG, Maciejewski, PK, Rosenheck, RA. Combat trauma: trauma with highest risk of delayed onset and unresolved post-traumatic stress disorder symptoms, unemployment, and abuse among men. J Nerv Ment Dis 2001; 189: 99–108.Google Scholar
9 Southwick, SM, Morgan, CA III, Darnell, A, Bremner, D, Nicolaou, AL, Nagy, LM, et al. Trauma-related symptoms in veterans of Operation Desert Storm: a 2-year follow-up. Am J Psychiatry 1995; 152: 1150–5.Google Scholar
10 Buckley, TC, Blanchard, EB, Hickling, EJ. A prospective examination of delayed-onset PTSD secondary to motor vehicle accidents. J Abnormal Psychology 1996; 105: 617–25.Google Scholar
11 Bremner, JD, Southwick, SM, Darnell, A, Charney, DS. Chronic PTSD in Vietnam combat veterans. Course of illness and substance abuse. Am J Psychiatry 1996; 153: 369–75.Google Scholar
12 Gray, MJ, Bolton, EE, Litz, BT. A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers. J Consult Clin Psychology 2004; 72: 909–13.Google Scholar
13 Grieger, TA, Cozza, SJ, Ursano, RJ, Hoge, C, Martinez, PE, Engel, CC, et al. Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry 2006; 163: 1777–83.Google Scholar
14 Solomon, Z, Mikulincer, M. Trajectories of PTSD. A 20-year longitudinal study. Am J Psychiatry 2006; 163: 659–66.Google Scholar
15 Magruder, KM, Frueh, BC, Knapp, RG, Davis, L, Hamner, MB, Martin, RH, et al. Prevalence of posttraumatic stress disorder in VA primary care clinics. Gen Hosp Psychiatry 2005; 27: 169–79.Google Scholar
16 Grubaugh, AL, Magruder, KM, Waldrop, AE, Elhai, JD, Knapp, RG, Frueh, BC. Subthreshold PTSD in primary care. Prevalence, psychiatric disorders, healthcare use, and functional status. J Nerv Ment Dis 2005; 193: 658–64.Google ScholarPubMed
17 Frueh, BC, Grubaugh, AL, Acierno, A, Elhai, JD, Cain, G, Magruder, KM. Age differences in posttraumatic stress disorder, psychiatric disorders, and healthcare service use among veterans in Veterans Affairs primary care clinics. Am J Geriatric Psychiatry 2007; 15: 660–72.Google Scholar
18 Acierno, R, Ruggiero, K, Galea, S, Resnick, HS, Koenen, K, Roitzsch, J, et al. Psychological sequelae resulting from the 2004 Florida hurricanes: implications for post-disaster intervention. Am J Public Health 2007; 97 (suppl 1): s103–8.Google Scholar
19 Acierno, R, Resnick, H, Kilpatrick, D, Stark-Riemer, W. Assessing elder victimization. Demonstration of a methodology. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 644–53.Google Scholar
20 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM–IV). APA, 1994.Google Scholar
21 Resnick, HS. Psychometric review of Trauma Assessment for Adults (TAA). In Measurement of Stress, Trauma and Adaptation (ed Stamm, BH): 362–5. Sidran Press, 1996.Google Scholar
22 Kilpatrick, DG, Acierno, R, Saunders, B, Resnick, HS, Best, CL, Schnurr, PP. Risk factors for adolescent substance abuse and dependence. Data from a national sample. J Consult Clin Psychol 2000; 68: 19–30.CrossRefGoogle ScholarPubMed
23 Blake, DD, Weathers, FW, Nagy, LN, Kaloupeh, D, Klauminzer, G, Charney, D, et al. A clinician rating scale for assessing current and lifetime PTSD. The CAPS-1. Behav Therapist 1990; 18: 187–8.Google Scholar
24 Weathers, FW, Keane, TM, Davidson, JRT. Clinician administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.CrossRefGoogle Scholar
25 Blanchard, EB, Hickling, EJ, Taylor, AE, Loos, WR, Gerardi, RJ. Psychological morbidity associated with motor vehicle accidents. Behav Res Ther 1994; 32: 283–90.CrossRefGoogle ScholarPubMed
26 Ware, JE, Sherbourne, CD. The MOS 36-item Short-Form Health Survey (SD–36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–83.Google Scholar
27 Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996; 34: 669–73.CrossRefGoogle ScholarPubMed
28 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM–IV and ICD–10. J Clin Psychiatry 1998; 59 (suppl 20): 22–33.Google Scholar
29 Frueh, BC, Grubaugh, AL, Elhai, JD, Buckley, TC. US Department of Veterans Affairs disability policies for PTSD: administrative trends and implications for treatment, rehabilitation, and research. Am J Public Health 2007; 97: 2143–5.CrossRefGoogle ScholarPubMed
30 Lee, KA, Vaillant, GE, Torrey, WC, Elder, G. A 50-year prospective study of the psychological sequelae of World War II combat. Am J Psychiatry 1995; 152: 516–22.Google Scholar
31 Jones, E, Palmer, I, Wessely, S. War pensions (1900–1945): changing models of psychological understanding. Br J Psychiatry 2002; 180: 374–9.Google Scholar
32 Jones, E, Vermaas, RH, McCartney, H, Beech, C, Palmer, I, Hyams, K, et al. Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis. Br J Psychiatry 2003; 182: 158–63.Google Scholar
33 Hotopf, M, Wessely, S. Can epidemiology clear the fog of war? Lessons from the 1990–91 Gulf War. Int J Epidemiol 2005; 34: 791–800.Google Scholar
34 Giuffra, LA, Risch, N. Diminished recall and the cohort effect of major depression: a simulation study. Psychol Med 1994; 24: 375–83.Google Scholar
35 Eaton, WW, Kalaydjian, A, Scharfstein, DO, Mezuk, B, Ding, Y. Prevalence and incidence of depressive disorder: the Baltimore ECA follow-up, 1981–2004. Acta Psychiatr Scand 2007; 116: 182–8.Google Scholar
36 Wessely, S, Unwin, C, Hotopf, M, Hull, L, Ismail, K, Nicolaou, V, et al. Stability of recall of military hazards over time. Evidence from the Persion Gulf War of 1991. Br J Psychiatry 2003; 183: 314–22.Google Scholar
37 Frueh, BC, Elhai, JD, Grubaugh, AL, Monnier, J, Kashdan, TB, Sauvageot, JA, et al. Documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder. Br J Psychiatry 2005; 186: 467–72.Google Scholar
38 Shephard, B. ‘Pitiless psychology’: the role of prevention in British military psychiatry in the Second World War. Hist Psychiatry 1999; 10: 491–510.Google Scholar
23 Blake, DD, Weathers, FW, Nagy, LN, Kaloupeh, D, Klauminzer, G, Charney, D, et al. A clinician rating scale for assessing current and lifetime PTSD. The CAPS-1. Behav Therapist 1990; 18: 187–8.Google Scholar
24 Weathers, FW, Keane, TM, Davidson, JRT. Clinician administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.Google Scholar
25 Blanchard, EB, Hickling, EJ, Taylor, AE, Loos, WR, Gerardi, RJ. Psychological morbidity associated with motor vehicle accidents. Behav Res Ther 1994; 32: 283–90.Google Scholar
26 Ware, JE, Sherbourne, CD. The MOS 36-item Short-Form Health Survey (SD–36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–83.CrossRefGoogle Scholar
27 Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996; 34: 669–73.Google Scholar
28 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM–IV and ICD–10. J Clin Psychiatry 1998; 59 (suppl 20): 22–33.Google Scholar
29 Frueh, BC, Grubaugh, AL, Elhai, JD, Buckley, TC. US Department of Veterans Affairs disability policies for PTSD: administrative trends and implications for treatment, rehabilitation, and research. Am J Public Health 2007; 97: 2143–5.Google Scholar
30 Lee, KA, Vaillant, GE, Torrey, WC, Elder, G. A 50-year prospective study of the psychological sequelae of World War II combat. Am J Psychiatry 1995; 152: 516–22.Google Scholar
31 Jones, E, Palmer, I, Wessely, S. War pensions (1900–1945): changing models of psychological understanding. Br J Psychiatry 2002; 180: 374–9.Google Scholar
32 Jones, E, Vermaas, RH, McCartney, H, Beech, C, Palmer, I, Hyams, K, et al. Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis. Br J Psychiatry 2003; 182: 158–63.Google Scholar
33 Hotopf, M, Wessely, S. Can epidemiology clear the fog of war? Lessons from the 1990–91 Gulf War. Int J Epidemiol 2005; 34: 791–800.Google Scholar
34 Giuffra, LA, Risch, N. Diminished recall and the cohort effect of major depression: a simulation study. Psychol Med 1994; 24: 375–83.Google Scholar
35 Eaton, WW, Kalaydjian, A, Scharfstein, DO, Mezuk, B, Ding, Y. Prevalence and incidence of depressive disorder: the Baltimore ECA follow-up, 1981–2004. Acta Psychiatr Scand 2007; 116: 182–8.Google Scholar
36 Wessely, S, Unwin, C, Hotopf, M, Hull, L, Ismail, K, Nicolaou, V, et al. Stability of recall of military hazards over time. Evidence from the Persion Gulf War of 1991. Br J Psychiatry 2003; 183: 314–22.Google Scholar
37 Frueh, BC, Elhai, JD, Grubaugh, AL, Monnier, J, Kashdan, TB, Sauvageot, JA, et al. Documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder. Br J Psychiatry 2005; 186: 467–72.Google Scholar
38 Shephard, B. ‘Pitiless psychology’: the role of prevention in British military psychiatry in the Second World War. Hist Psychiatry 1999; 10: 491–510.Google Scholar
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