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

• Main Authors: Nicolai Utzon-Frank, Nina Breinegaard, Mette Bertelsen, Marianne Borritz, Nanna Hurwitz Eller, Merete Nordentoft, Kasper Olesen, Naja Hulvej Rod, Reiner Rugulies, Jens Peter Bonde
• Format: Article
• Language: English
• Published: Nordic Association of Occupational Safety and Health (NOROSH) 2014-05-01
• Series: Scandinavian Journal of Work, Environment & Health
• Subjects: mental disease; disaster; catastrophe; review; meta-analysis; accident; systematic review; deployment; trajectory; post-traumatic stress disorder; ptsd
• Online Access: https://www.sjweh.fi/show_abstract.php?abstract_id=3420

OBJECTIVE: 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). METHODS: 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 RESULTS: 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. CONCLUSION: 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.