Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

Utzon-Frank, Nicolai; Breinegaard, Nina; Bertelsen, Mette; Borritz, Marianne; Eller, Nanna Hurwitz; Nordentoft, Merete; Olesen, Kasper; Rod, Naja Hulvej; Rugulies, Reiner; Bonde, Jens Peter

doi:10.5271/sjweh.3420

Cited by 115 publications

(87 citation statements)

References 59 publications

(95 reference statements)

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“…A systematic meta-analysis of 39 prospective studies reported that 24.5% (95% confidence interval 19.5% to 30.3%) of all PTSD cases were PTSD with delayed expression. 4 Another study using data from the National Health and Resilience in Veterans Study (NHRVS) revealed that approximately 1 in 10 older United States veterans experiences a clinically significant exacerbation of PTSD symptoms in late life. A comparison of immediate and PTSD with delayed expression showed that both were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Sleep disruption is considered an important feature of posttraumatic stress disorder (PTSD), 3 which is a psychiatric disorder characterized by intrusive recollections, avoidance behavior, and hyperarousal state following experience of a traumatic event. 4 A diagnosis of PTSD is made if the characteristic symptoms are present for at least 1 month after exposure to a traumatic event. Symptoms typically begin within 3 months of a traumatic exposure but it may be delayed for months or even years before the diagnostic criteria are met.…”

Section: Introductionmentioning

confidence: 99%

“…This condition is not uncommon and symptoms may manifest several years after returning home from war. 4 A study done in the United Kingdom on Iraq war veterans revealed that deployed soldiers remained at higher risk of the development of PTSD with delayed expression even 5 years after returning home. 10 Previous studies suggested that sleep-disordered breathing and PTSD exhibit significant overlaps in symptoms and may exacerbate each other and these two conditions frequently coexist.…”

Section: Introductionmentioning

confidence: 99%

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Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP

Ullah

Campbell

Bhagat

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) are common in United States veterans. These conditions often coexist and symptoms overlap. Previous studies reported improvement in PTSD symptoms with continuous positive airway pressure (CPAP) therapy for comorbid OSA but its effect has not been assessed in a non-PTSD cohort. We have prospectively assessed the effect of CPAP therapy on clinical symptom improvement as a function of CPAP compliance levels among PTSD and non-PTSD veterans. Methods: Veterans in whom OSA was newly diagnosed were enrolled in our study (n = 192). Assignment to PTSD and non-PTSD cohorts was determined by chart review. Each patient completed the military version of the PTSD Checklist (PCL), Epworth Sleepiness Scale (ESS), and reported nightmare frequency (NMF) at baseline and 6 months after CPAP therapy. CPAP adherence was objectively documented from machine compliance data. Results: We had complete data for 177 veterans (PTSD n = 59, non-PTSD n = 118) for analysis. The mean ages were 51.24 years in the PTSD cohort and 52.36 years in the non-PTSD cohort (P = .30). In the PTSD cohort, the mean total PCL score (baseline = 66.06, post-CPAP = 61.27, P = .004, d = −0.34) and NMF (baseline = 4.61, post-CPAP = 1.49, P = .0001, d = −0.51) decreased after 6 months of CPAP treatment. Linear regression analysis showed that the CPAP compliance was the only significant predictor for these changes among veterans with PTSD (PCL score: P = .033, R 2 = .65; NMF; P = .03, R 2 = .61). Further analysis by CPAP compliance quartiles in this cohort (Q1 = 0% to 25%, Q2 = 26% to 50%, Q3 = 51% to 75%, Q4 > 75%) revealed that mean total PCL score declined in Q2 (change = −3.91, P = .045, d = 0.43), Q3 (change = −6.6, P = .002, d = 0.59), and Q4 (change = −7.94, P = .037, d = 0.49). In the non-PTSD cohort, the PCL score increased despite CPAP therapy in lower CPAP compliance quartiles Q1 (change = 8.71, P = .0001, d = 0.46) and Q2 (change = 4.51, P = .046, d = 0.27). With higher CPAP compliance (in Q3 and Q4) in this cohort, the mean total PCL scores slightly improved with CPAP but they were not statistically significant (P > .05). Conclusions: CPAP treatment reduces total PCL score and NMF in veterans with PTSD and OSA. Those with overt PTSD respond to even lower CPAP compliance, whereas non-PTSD patients require higher compliance to achieve any symptom improvement. Poor CPAP compliance results in increased PCL score in non-PTSD veterans and may lead to overt PTSD if the OSA remains undertreated. I NTRO DUCTI O NSleep is one of the physiologic systems of the body that is affected early when someone undergoes any physical or mental stress.1,2 Sleep disruption is considered an important feature of posttraumatic stress disorder (PTSD), 3 which is a psychiatric disorder characterized by intrusive recollections, avoidance behavior, and hyperarousal state following experience of a traumatic event.4 A diagnosis of PTSD is made if the characteristic symptoms are present for at least...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP

Ullah

Campbell

Bhagat

et al. 2017

Journal of Clinical Sleep Medicine

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“…13,14 Furthermore, posttraumatic stress disorder may have a delayed onset or increase in severity over time. 15,16 Data are available on physician visits throughout Alberta for all those (not just workers) normally resident in Fort McMurray. 17 Compared to the first week in December 2015 (before the fire), in the same week in 2016 (9 mo after the fire), physician visits for anxiety increased by 14% and for depression by 28%, whereas visits for substance use disorder decreased markedly.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Fort McMurray wildfires on the health of evacuated workers: follow-up of 2 cohorts

Cherry

Haynes

2017

CMAJ Open

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Background: Wildfire engulfed Fort McMurray, Alberta on May 3, 2016, leading to a total evacuation. Access to 2 active cohorts allowed us to rapidly assess health effects in those evacuated. Methods:People working in Fort McMurray who had been recruited before the fire for 2 occupational health cohort studies completed a questionnaire (online or via telephone) 3-26 weeks after evacuation. The questionnaire asked about respiratory and mental health and experiences since the fire. Results:Of the 129 participants, 109 were in the Fort McMurray area on May 3. Thirty-seven (33.9%) of the participants who were in Fort McMurray on May 3 reported a health condition, including respiratory symptoms (n = 17) and mental ill health (n = 17), immediately after the fire. At follow-up, a mean of 102 days after the fire, 11 participants (10.1%) reported a fire-related health condition, including mental ill health (n = 8) and respiratory symptoms (n = 2). There was no difference before and after the fire in use of alcohol, cigarettes, recreational drugs or medication. One in 4 participants (32 [24.6%]) had not worked since the fire, and fewer than half (58 [44.6%]) had returned to Fort McMurray. Of the 90 participants evacuated, 15 (16.7%) had scores indicative of moderate or severe anxiety or depression on the Hospital Anxiety and Depression Scale. Those evacuated had significantly higher mean anxiety (p = 0.01) and depression (p = 0.04) scores than those not evacuated. Regression modelling showed that anxiety scores were higher for women, with longer time since the fire and with evacuation to a motel. Depression scores were higher for women and with financial loss because of lack of work. Interpretation:Although evacuation was associated with higher anxiety and depression scores, persisting ill health was not widespread at early follow-up after the fire. Although these results are encouraging, these "healthy worker" results cannot be generalized to all evacuees. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN, 5(3) E639

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“…Mental bozukluklarýn Tanýsal ve Sayýmsal El Kitabý 5. Baský (DSM-5)'e göre travmatik olayla ilgili istenmeyen düþüncelerin bireyin aklýna gelmesi, travmatik durumu yeniden yaþan-týlýyor gibi hissetme, olayýn hatýrlatýcýlarýndan kaçýnma ve her an kaygýlý olma hali gibi belirtilerin en az üç tanesi bireyde mevcut ise kiþi TSSB tanýsý alabilir; travmatik yaþantýnýn üzerinden en az altý ay geçtikten sonra TSSB semptomlarý görülmeye baþ-landýðý durumlarda ise kiþiye "Geç Baþlangýçlý TSSB" tanýsý konulabilmektedir (1).Utzon-Frank ve arkadaþlarý 39 prospektif çalýþmayý deðer-lendirdikleri gözden geçirme çalýþmasýnda gecikmiþ baþlangýçlý TSSB sýklýðýný %5.6, tüm TSSB'lere oranýný ise %24,5 olarak bulmuþlardýr (2). Ayrýca stresli hayat olaylarý ve TSSB'ye majör depresyon eþlik edebilir(3).…”

Section: Gýrýþunclassified

Treatment refractory or trauma overlooked? A case of EMDR responsive late onset PTSD

Yasar¹,

Altunbas²,

Abamor³

et al. 2017

J Clin Psy

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SUMMARYTraumatic events experienced in different periods of life may soon alter negative psychological changes. These negative shifts might be indications of pathology depending on their duration and consequences. In cases of Post Traumatic Stress Disorder with delayed expression (PTSD with delayed expression), which is a traumarelated disorder, stress related symptoms are observed after 6 months or later following traumatic event.Although the clinical picture be complicated, scrutinizing the patient's existing symptoms and psychiatric history, detecting underlying problems and traumas, and then conducting a proper treatment accordingly may help provide recovery for its patients. In this case study, treatment of a PTSD with delayed expression comorbid Major Depressive Disorder (MDD) resistant to pharmacotherapy, which emerged after a childhood sexual trauma had become triggered in adulthood, will be discussed.

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Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

Cited by 115 publications

References 59 publications

Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP

Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP

Effects of the Fort McMurray wildfires on the health of evacuated workers: follow-up of 2 cohorts

Treatment refractory or trauma overlooked? A case of EMDR responsive late onset PTSD

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