![]() ![]() To evaluate delayed-onset posttraumatic stress to the initial trauma, we ensured that PTSD symptoms (particularly reexperiencing and avoidance) were indexed in relation to the initiating traumatic event. The current study describes a multisite, longitudinal investigation of trauma injury survivors who were assessed for PTSD symptoms during hospitalization and again at 3, 12, and 24 months after the trauma. The aims of this study were to examine longitudinally the trajectory of PTSD symptoms and to identify the factors associated with delayed-onset PTSD symptoms. The evidence is limited, however, by the cross-sectional design of studies that rely on retrospective recall of symptoms, small sample sizes, and/or abbreviated or self-reported measurement of PTSD symptoms. 14 These findings suggest that delayed reactions after a period of apparent absence of symptoms may be fueled by acute fear reactions that are subsequently compounded by stressors in the subsequent period. Cumulative stressors in the aftermath of trauma are greater in those who develop delayed-onset PTSD relative to those who maintain their symptom-free status over time, 9 - 13 although not all studies have observed this pattern. In terms of acute predictors, delayed-onset cases have been associated with stronger PTSD reactions in the period immediately after trauma exposure, 4, 8 as well as elevated heart rate after trauma 4 (relative to asymptomatic people in the acute phase). 2, 3 Hence, questions remain about the sequencing of symptom development over time in the pathway to delayed-onset PTSD.ĭata concerning the mechanisms of delayed-onset PTSD are scant. 3 - 7 In addition, however, meta-analyses indicate that PTSD can develop after a protracted symptom-free period. 2, 3 Delayed-onset PTSD is more likely after a period of subsyndromal PTSD (usually defined as meeting at least 2 of the 3 symptom clusters) in the acute symptom period. ![]() 1 Meta-analyses estimated that delayed-onset PTSD occurs in approximately 25% of cases of PTSD. One of the most poorly understood presentations of posttraumatic stress disorder (PTSD) is delayed-onset PTSD, which is defined as the onset of symptoms at least 6 months after trauma exposure. This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms, particularly in those with no acute symptoms. This study also points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity. In those who displayed no PTSD at 3 months, PTSD severity at 24 months was predicted by initial PTSD symptom severity, MTBI, length of hospitalization, and the number of stressful events experienced between 3 and 24 months.Ĭonclusions and Relevance These data highlight the complex trajectories of PTSD symptoms over time. ![]() In those who displayed subsyndromal or full PTSD at 3 months, PTSD severity at 24 months was predicted by prior psychiatric disorder, initial PTSD symptom severity, and type of injury. Results Of those who met PTSD criteria at 24 months, 44.1% reported no PTSD at 3 months and 55.9% had subsyndromal or full PTSD. Main Outcome and Measure Severity of PTSD was determined at each assessment with the Clinician-Administered PTSD Scale. A total of 1084 traumatically injured patients were assessed during hospital admission from April 1, 2004, through February 28, 2006, and 785 (72.4%) were followed up at 3, 12, and 24 months after injury. Objective To test the roles of initial psychiatric reactions, mild traumatic brain injury (MTBI), and ongoing stressors on delayed-onset PTSD.ĭesign, Setting, and Participants In this prospective cohort study, patients were selected from recent admissions to 4 major trauma hospitals across Australia. Current models do not adequately explain the delayed increases in PTSD symptoms after trauma exposure. Importance Delayed-onset posttraumatic stress disorder (PTSD) accounts for approximately 25% of PTSD cases. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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