Abstract
Post-traumatic stress disorder (PTSD) develops according to consensus criteria within the first 1-6 months after a horrifying traumatic event, but it is alleged that PTSD may develop later. The objective was to review the evidence addressing occurrence of PTSD with onset >6 months after a traumatic event (delayed-onset PTSD). Through a systematic search in PubMed, EMBASE, and PsycINFO, we identified 39 studies with prospective ascertainment of PTSD. A meta-analysis was performed in order to obtain a weighted estimate of the average proportion of delayed-onset PTSD cases, and meta-regression was used to examine effects of several characteristics Delayed-onset PTSD was reported in all studies except one, and the average prevalence across all follow-up time was 5.6% [95% confidence interval (95% CI) 4.3-7.3%]. The proportion with delayed-onset PTSD relative to all cases of PTSD was on average 24.5% (95% CI 19.5-30.3%) with large variation across studies. In six studies with sub-threshold symptom data, delayed-onset PTSD seemed most likely an aggravation of early symptoms. The proportion with delayed-onset PTSD was almost twice as high among veterans and other professional groups compared to non-professional victims. Descriptive follow-up data suggest that PTSD may manifest itself >6 months after a traumatic event, delayed-onset PTSD most often, if not always, is preceded by sub-threshold PTSD symptoms, and a higher proportion of PTSD cases are delayed among professional groups. Contextual factors and biased recall may inflate reporting of PTSD and a cautious interpretation of prevalence rates seems prudent.
Highlights
Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies by Nicolai Utzon-Frank, MD,1 Nina Breinegaard, MSc, PhD,1 Mette Bertelsen, MSc, PhD,2 Marianne Borritz, MD, PhD,1 Nanna Hurwitz Eller, MDSc,1 Merete Nordentoft, MD, PhD,3 Kasper Olesen, MSc,1, 4 Naja Hulvej Rod, MSc, PhD,4 Reiner Rugulies, MSc, PhD,5 Jens Peter Bonde, MD, PhD 1
We evaluated whether the paper provided of Post-traumatic stress disorder (PTSD) cases divided by all examined persons at that essential details of each of these characteristics and round
The majority of studies were performed in Europe and the United States and more studies have been undertaken in recent compared to earlier years
Summary
Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies by Nicolai Utzon-Frank, MD, Nina Breinegaard, MSc, PhD, Mette Bertelsen, MSc, PhD, Marianne Borritz, MD, PhD, Nanna Hurwitz Eller, MDSc, Merete Nordentoft, MD, PhD, Kasper Olesen, MSc, Naja Hulvej Rod, MSc, PhD, Reiner Rugulies, MSc, PhD, Jens Peter Bonde, MD, PhD 1. Utzon-Frank N, Breinegaard N, Bertelsen M, Borritz M, Eller NH, Nordentoft M, Olesen K, Rod NH, Rugulies R, Bonde JP. Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies. Scand J Work Environ Health. 2014;40(3):215–229. doi:10.5271/sjweh.3420
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