Late-onset Posttraumatic Stress Disorder Research Articles

Finding meanings in Late onset Post Traumatic Stress Disorder – a review of the literature

IntroductionAbout a decade ago, the idea of a Late-Onset Post Traumatic Stress Disorder (LO-PTSD) emerged, in order to characterize the later-life emergence of symptoms related to early-life warzone trauma among aging combat Veterans.ObjectivesThis paper provides a review of the changes happened during the onset of a late form of PTSD and how can mental health professionals intervene.MethodsReview of the literature from 2015 to present, using search engines such as Pubmed and Google Schoolar, using the following keywords: Late-Onset Post Traumatic Stress Disorder, triggers, prevention, interventionResultsAt first, there was hypothesized that aging-related challenges (role transition and loss, death of family members and friends, physical and cognitive decline) might lead to increased reminiscence, and possibly distress, among Veterans who had previously dealt successfully with earlier traumatic events. However, recent studies have proposed that in later life many combat Veterans confront and rework their wartime memories in an effort to find meaning and build coherence. Through reminiscence, life review, and wrestling with issues such as integrity versus despair, they intentionally reengage with experiences they avoided or managed successfully earlier in life, perhaps without resolution or integration. This process can lead positively to personal growth or negatively to increased symptomatology.ConclusionsTherefore the role of preventive intervention in enhancing positive outcomes for Veterans who reengage with their wartime memories in later life should be reconsidered.DisclosureNo significant relationships.

A Case Report of Home-Based Cognitive-Behavioural Treatment for Late-Onset Post-Traumatic Stress Disorder, Triggered by Mask-Wearing in the Context of the COVID-19 Pandemic.

A small but clinically significant number of people experience delayed-onset Post-traumatic stress disorder (PTSD); symptoms of trauma years after the events which are now being re-experienced. The following case report describes the use of the cognitive-behavioural treatment for PTSD with a woman experiencing flashbacks to domestic abuse endured more than 20 years ago. Mask-wearing mandated as a result of the COVID-19 pandemic triggered non-contextualised memories of life-threatening physical violence by an abuser who covered his face. She had been managing her flashbacks and intrusive thoughts with both behavioural and experiential forms of avoidance. An 18-session intervention was provided in her own home due to physical health difficulties. Treatment focused on managing hyper-arousal, reducing thought suppression, in-vivo exposure, stimulus-discrimination and re-contextualising traumatic memories. Regular outcome measurements were kept and results are presented as a single-case experimental design in ‘AB’ format (i.e. baseline period pre intervention). Symptoms of trauma fell to levels non-indicative of PTSD and speak to the evidence base for this modality, even when applied to delayed-onset difficulties in a non-traditional therapy setting. This conclusion is lent extra credence by an experimental design with good internal validity.

Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study

BackgroundThe link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. MethodsWe performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. ResultsOverall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. ConclusionsLongitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.

Late-onset PTSD and coping strategies for frontline nurses during the COVID-19 epidemic in China.

AimTo evaluate the late‐onset post‐traumatic stress disorder (PTSD) situation, coping strategies and social supports for frontline clinical nurses 6 months after involvement in fighting against coronavirus disease 2019 (COVID–19) outbreak in China.DesignA cross‐sectional design.MethodsWe recently randomly distributed a questionnaire online to Chinese nurses who had taken care of COVID‐19 patients since the end of January 2020. The questionnaire was made up of three professional scales, the impact of event scale‐revised, simplified coping style questionnaire and social support rating scale included.ResultsThe general prevalence of late‐onset PTSD among frontline nurses was 88.19%. Nurses who worked in Hubei Province (the kindle place of the COVID‐19 outbreak) showed lower risk of late‐onset PTSD symptoms than those who did not. We also found that positive coping strategies were correlated with less late‐onset PTSD symptoms. Meanwhile, getting more social supports could help these nurses to obtain positive coping strategies.

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study.

The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.

EMDR as a Treatment Approach of PTSD Complicated by Comorbid Psychiatric, Somatic, and Cognitive Disorders: A Case Report of an Older Woman With a Borderline and Avoidant Personality Disorder

Traumatic life events can result in severe psychiatric conditions among which posttraumatic stress disorder (PTSD) is the most prevalent. Due to high comorbidity with other psychiatric diagnoses, PTSD treatment is challenging. In older adults, the presentation of PTSD symptoms is especially complicated because of even higher comorbidity, higher rates with other mental disorders, and cognitive and somatic conditions. Eye movement desensitization and reprocessing (EMDR) is an evidence-based treatment for trauma in younger adults. There is limited empirical research on the treatment effects of EMDR in older adults. Moreover, the impact of successful EMDR treatment on the comorbid disorders, especially personality and cognitive dysfunctions, is unclear. In this case report, EMDR treatment effects for late-onset PTSD with comorbid borderline and avoidant personality disorders, as well as cognitive disorders and multiple somatic problems, will be presented in an older woman.

État de stress post-traumatique consécutif à une maladie d’Alzheimer : émergence d’une pathologie sous-jacente dans le très grand âge

Old age leads to complex semiologies, mixing several diseases, whose expression is linked to the influence of life history. Accordingly, even if neurodegenerative diseases today constitute one of the main diseases affecting aging people, the interrelations between neurodegenerative and psychiatric disorders are particularly poorly understood. Two assumptions coexist about the interrelation between post-traumatic stress disorders and dementias. According to the first one, post-traumatic stress disorders contribute or worsen neurodegenerative disorders. The second one supposes that dementias lead to late-onset post-traumatic stress disorders. In the absence of regular life-long health follow-up, the entanglement of both symptomatologies in the oldest age people makes impossible to valid one or the other or both. It is however possible to clinically precise the relations between post-traumatic stress disorder and Alzheimer's disease through the characterization of cognitive and psychiatric symptoms, and also through the collection of patient's autobiography. This approach is illustrated by the case of a 93-year-old veteran, living in a nursing retirement home. His neurodegenerative disorder had altered his memory and his executive abilities. His discourse was coherent, with temporal distortions and intrusions of real recent events. He presented all diagnostic criteria for post-traumatic stress disorder, with numerous repetitions of intrusive memories of war events in which he was powerless, amnesia for some elements of the trauma, and major efforts to avoid thinking about wartime. Yet, he had demonstrated a willingness to share his memories with his family as soon as he returned from war. The collection of life story, including information sharing behaviors about the traumatogenic events, and psychopathology characteristics of both pathologies in a life-course perspective showed that the Alzheimer's disease revealed a post-traumatic stress disorder. After several decades of adaptation to traumatic memories, cognitive autonomy loss was associated with the emergence of late-onset post-traumatic stress disorder.

Latent trajectories of trauma symptoms and resilience: the 3-year longitudinal prospective USPER study of Danish veterans deployed in Afghanistan.

To identify trajectories of posttraumatic stress disorder (PTSD) symptoms from before to 2.5 years after deployment and to assess risk factors for symptom fluctuations and late-onset PTSD. 743 soldiers deployed to Afghanistan in 2009 were assessed for PTSD symptoms using the PTSD Checklist (PCL) at 6 occasions from predeployment to 2.5 years postdeployment (study sample = 561). Predeployment vulnerabilities and deployment and postdeployment stressors were also assessed. Six trajectories were identified: a resilient trajectory with low symptom levels across all assessments (78.1%) and 5 trajectories showing symptom fluctuations. These included a trajectory of late onset (5.7%), independently predicted by earlier emotional problems (OR = 5.59; 95% CI, 1.57-19.89) and predeployment and postdeployment traumas (OR = 1.10; 95% CI, 1.04-1.17 and OR = 1.13; 95% CI, 1.00-1.26). Two trajectories of symptom fluctuations in the low-to-moderate range (7.5% and 4.1%); a trajectory of symptom relief during deployment, but with a drastic increase at the final assessments (2.0%); and a trajectory with mild symptom increase during deployment followed by relief at return (2.7%) were also found. Symptom fluctuation was predicted independently by predeployment risk factors (depression [OR = 1.27; 95% CI, 1.16-1.39], neuroticism [OR = 1.10; 95% CI, 1.00-1.21], and earlier traumas [OR = 1.09; 95% CI, 1.03-1.16]) and deployment-related stressors (danger/injury exposure [OR = 1.20; 95% CI, 1.04-1.40]), but not by postdeployment stressors. The results confirm earlier findings of stress response heterogeneity following military deployment and highlight the impact of predeployment, perideployment, and postdeployment risk factors in predicting PTSD symptomatology and late-onset PTSD symptoms.

Brief Eclectic Psychotherapy for an Older Dutch Woman With Late-Onset Posttraumatic Stress Disorder Complicated by a Cerebral Vascular Accident

Posttraumatic stress disorder (PTSD) is a mental disorder that is known to have deleterious psychological, physical, and social impacts on individuals. Recognition of PTSD in older adults is difficult due to the complicated presentation taking into account that PTSD symptoms may be masked by other psychiatric and/or somatic diagnoses that are more common in older adults. Furthermore, some older adults may underreport their PTSD symptoms, and the relationship between current symptoms and distant traumas may be difficult to detect. Limited empirical research has been done on the manifestation, course, and treatment of PTSD in older adults. In this article, the literature on PTSD in older adults is reviewed, including discussion of common diagnostic problems, illustrated by a case report of an older woman with late-onset PTSD after a cerebral vascular accident (CVA). In conclusion, identifying PTSD in older adults can be difficult. However, detecting PTSD in older adults is critically important so that possibly hidden or masked trauma symptoms can be addressed in treatment, even if there are complicating factors such as a CVA.

The clinical picture of late-onset PTSD: A 20-year longitudinal study of Israeli war veterans

Delayed-onset posttraumatic stress disorder (PTSD) has been under medico-legal debate for years. Previous studies examining the prevalence and clinical characteristics of delayed-onset PTSD have yielded inconclusive findings. This study prospectively examines the prevalence and clinical picture of late-onset PTSD among Israeli war veterans. It also evaluates whether or not late-onset PTSD erupts after a completely non-symptomatic period. 675 Israeli veterans from the 1982 Lebanon War, with and without antecedent combat stress reaction (CSR), have been assessed 1, 2 and 20 years post-war. They were divided into 4 groups, according to the duration of delay in PTSD onset. Participants completed self-report questionnaires tapping psychopathology, combat exposure and socio-demographics. 16.5% of the veterans suffered from late-onset PTSD. A longer delay in PTSD onset was associated with less severe psychopathology. Also, CSR was associated with a shorter delay in PTSD onset. Finally, the vast majority of veterans already suffered from PTSD symptoms prior to late PTSD onset. Our results offer further validation for the existence of delayed-onset PTSD. Delayed-onset PTSD appears to be a unique sub-type of PTSD, with an attenuated clinical picture. In addition, delayed-onset PTSD may be the result of an incubation process, wherein symptoms already exist prior to PTSD onset.

Late-onset posttraumatic stress disorder following a disaster: A longitudinal study.

In disaster survivors, the occurrence of mental health problems beyond the immediate aftermath of the disaster has repeatedly been reported. The aim of the present study was to evaluate the course of symptoms and mental health services (MHS) utilization in late-onset posttraumatic stress disorder (PTSD) four years following a disaster and to examine whether late-onset PTSD can be explained within a longitudinal framework of PTSD. Residents affected by a fireworks disaster (N 1083) participated in surveys 2–3 weeks (T1), 18 months (T2), and almost 4 years (T3) following the disaster. PTSD was assessed at T2 and T3. Participants endorsing disaster-related late-onset PTSD (PTSD at T3 only) were compared to participants endorsing persistent PTSD (at both T2 and T3), recovered PTSD (at T2 only), and no PTSD using latent growth modeling and multinomial logistic regression. Participants endorsing late-onset PTSD comprised 4% of the total sample. They reported high initial intrusion and avoidance and experienced progression of avoidance/numbing and hyperarousal symptoms. They were more likely than all other participants to use MHS at T3. Late-onset PTSD was associated with high education level, severe disaster exposure, number of reported stressful life events, and perceived lack of social support. These results suggest that individuals with late-onset PTSD are likely to endorse prodromal distress, but experience clinically relevant symptom progression leading to increased MHS utilization. Stressful life events and perceived lack of social support may contribute to PTSD symptom progression. Foreseeable stressors in the aftermath of a disaster may be a target for secondary prevention of late-onset PTSD.

Late-Onset PTSD in Unaccompanied Refugee Minors: Exploring the Predictive Utility of Depression and Anxiety Symptoms

Following resettlement in Western countries, unaccompanied refugee minors (URM) are at risk of developing posttraumatic stress disorder (PTSD). It is unclear to what extent PTSD in this group may become manifest at later stages following resettlement and which factors are associated with late onset. We examined data from URM collected 1 (T1) and 2 years (T2) following resettlement for differences between groups with no PTSD, PTSD at T1, and late-onset PTSD (at T2 only) using multinomial regression and path analysis. Of the children and adolescents (ages 12–18) completing both assessments (N = 554), 223 (40%) met criteria for PTSD at T1, and 88 (16%) endorsed late-onset PTSD. Late-onset PTSD was associated with traumatic event exposure, older age, and low education. In the late-onset PTSD group, the predictive effects of traumatic event exposure on symptom severity at T2 were fully mediated by depression and anxiety symptoms at T1. These results suggest that late-onset PTSD is a clinically relevant problem among URM that may be heralded by early depression and anxiety symptoms.

Transtorno de estresse pós-traumático de início tardio? Reflexões diagnósticas baseadas em um relato de caso

OBJETIVO: Neste estudo, o objetivo foi relatar o caso de uma paciente com transtorno de estresse pós-traumático (TEPT) de início aparentemente tardio e os diferentes dilemas surgidos durante seu diagnóstico. MÉTODO: Relato de caso. RESULTADOS: Paciente feminina, de 34 anos, casada e do lar, apresentou TEPT 25 anos após o desabamento de sua residência durante uma enchente. O quadro surgiu após relatos na imprensa de eventos semelhantes associados ao soterramento de dezenas de vítimas em um município vizinho. CONCLUSÃO: Este caso sugere que pacientes podem desenvolver quadros semelhantes ao TEPT de início tardio após a reexposição a eventos previamente desprovidos de impacto emocional.

Psychotische Syndrome bei kriegstraumatisierten älteren Patienten

Late-onset post-traumatic stress disorder (PTSD) patients with traumatic experiences from World War II often present psychotic features. Twelve psychotic elderly PTSD patients were compared with 22 nonpsychotic elderly PTSD patients for age, marital status, age of traumatization, age of onset of psychiatric symptoms, and psychiatric comorbidities. The contents of delusions and hallucinations were registered as well as trauma details. The psychotic PTSD patients were significantly older (80 years vs 74), later traumatized (20 years vs 14), more frequently demented (75% vs 27%), and more frequently widowed (83% vs 50%). The contents of their psychotic features often were related to traumatic experiences in early life. Psychoses of traumatized elderly patients should be registered regarding psychotic content to discover a possible relation between traumatic experiences and psychosis. The International Classification of Diseases 11th Edition should include the subtype "PTSD with simultaneous psychotic features."

Brief Report: The Risk of Posttraumatic Stress Disorder in Mothers of Children Diagnosed with Pediatric Cancer and Type I Diabetes

To evaluate the risk of and predictors of enduring and late-onset posttraumatic stress disorder (PTSD) among mothers of children diagnosed with type I diabetes and cancer. Mothers (N = 99) of children diagnosed with cancer or diabetes for at least 12 months completed a structured clinical interview for PTSD and self-report measures of PTSD, depression, anxiety, and stressful life events. There was no significant difference in the rate of PTSD between the two groups. Overall, fewer mothers (7%) met criteria for PTSD on the structured clinical interview than those on a self-report measure of PTSD (17%). Mothers who reported more depressive symptoms, anxiety, and stressful life events tended to report significantly more PTSD symptoms. The findings extend prior research regarding the prevalence rate and predictors of PTSD and PTSD symptoms in pediatric populations. It is recommended that clinicians exercise caution when interpreting prevalence rates for PTSD that are derived from self-report measures.

Commentary: the impact of past trauma in later life

The author sees her suicidal ideas and overdose as resting squarely on traumatic experience unresolved for 50 years, an immutable pathogenic secret (‘traumatic’ memory) only now surfacing as ‘late onset post-traumatic stress disorder’ (PTSD) (see Ong & Carter, pp. 435-436, this issue). I