TY - JOUR

T1 - Time course of symptoms in posttraumatic stress disorder with delayed expression

T2 - A systematic review

AU - Bonde, Jens Peter Ellekilde

AU - Jensen, Johan Hoy

AU - Smid, Geert E.

AU - Flachs, Esben Meulengracht

AU - Elklit, Ask

AU - Mors, Ole

AU - Videbech, Poul

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - forensic psychiatry

KW - latent class growth analysis

KW - partial PTSD

KW - subthreshold PTSD

KW - trajectory analysis

KW - veterans

KW - PROSPECTIVE TRAJECTORIES

KW - MILITARY PERSONNEL

KW - MENTAL-HEALTH

KW - ONSET PTSD

KW - ISRAELI VETERANS

KW - RESILIENCE

KW - INJURY

KW - RISK

KW - RECOGNITION

KW - PREVALENCE

U2 - 10.1111/acps.13372

DO - 10.1111/acps.13372

M3 - Review

C2 - 34523121

VL - 145

SP - 116

EP - 131

JO - Acta Psychiatrica Scandinavica. Supplementum

JF - Acta Psychiatrica Scandinavica. Supplementum

SN - 0065-1591

IS - 2

ER -