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

  • B. Christopher Frueh (a1), Anouk L. Grubaugh (a2), Derik E. Yeager (a2) and Kathryn M. Magruder (a2)
Abstract
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.

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Copyright
Corresponding author
B. Christopher Frueh, Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, USA. Email: frueh@hawaii.edu
Footnotes
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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.

Footnotes
References
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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.
2 McNally, RJ. Progress and controversy in the study of posttraumatic stress disorder. Annual Rev Psychol. 2003; 54: 229–52.
3 Spitzer, RL, First, MB, Wakefield, JC. Saving PTSD from itself in DSM-V. J Anx Disorders 2007; 21: 233–41.
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.
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.
6 Breslau, N, Davis, GC, Peterson, EL, Schultz, L. Psychiatric sequelae of posttraumatic stress disorder. Arch Gen Psychiatry 1997; 54: 81–7.
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.
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: 99108.
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.
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.
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.
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.
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.
14 Solomon, Z, Mikulincer, M. Trajectories of PTSD. A 20-year longitudinal study. Am J Psychiatry 2006; 163: 659–66.
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.
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.
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.
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): s1038.
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.
20 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM–IV). APA, 1994.
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.
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: 1930.
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.
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.
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.
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.
27 Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996; 34: 669–73.
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): 2233.
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.
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.
31 Jones, E, Palmer, I, Wessely, S. War pensions (1900–1945): changing models of psychological understanding. Br J Psychiatry 2002; 180: 374–9.
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.
33 Hotopf, M, Wessely, S. Can epidemiology clear the fog of war? Lessons from the 1990–91 Gulf War. Int J Epidemiol 2005; 34: 791800.
34 Giuffra, LA, Risch, N. Diminished recall and the cohort effect of major depression: a simulation study. Psychol Med 1994; 24: 375–83.
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.
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.
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.
38 Shephard, B. ‘Pitiless psychology’: the role of prevention in British military psychiatry in the Second World War. Hist Psychiatry 1999; 10: 491510.
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.
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.
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.
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.
27 Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996; 34: 669–73.
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): 2233.
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.
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.
31 Jones, E, Palmer, I, Wessely, S. War pensions (1900–1945): changing models of psychological understanding. Br J Psychiatry 2002; 180: 374–9.
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.
33 Hotopf, M, Wessely, S. Can epidemiology clear the fog of war? Lessons from the 1990–91 Gulf War. Int J Epidemiol 2005; 34: 791800.
34 Giuffra, LA, Risch, N. Diminished recall and the cohort effect of major depression: a simulation study. Psychol Med 1994; 24: 375–83.
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.
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.
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.
38 Shephard, B. ‘Pitiless psychology’: the role of prevention in British military psychiatry in the Second World War. Hist Psychiatry 1999; 10: 491510.
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Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics

  • B. Christopher Frueh (a1), Anouk L. Grubaugh (a2), Derik E. Yeager (a2) and Kathryn M. Magruder (a2)
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