Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 8, pp 1189–1197

Analysis of the longitudinal course of PTSD in 716 survivors of 10 disasters

Original Paper

Abstract

Purpose

Identification of consistent predictors of the temporal course of PTSD has been hampered by non-uniform definitions of onset and remission. Onset and remission of PTSD based on different definitions were examined in a large database of systematically assessed disaster survivors.

Methods

Directly exposed survivors of 10 disasters were studied within approximately 3 months of the disasters and again 1–3 years later, using consistent methods including full diagnostic assessment, allowing aggregation of data from different disasters into a unified database of 716 survivors.

Results

Application of existing definitions of PTSD onset and remission uncovered problems with definitions based on diagnostic threshold as well as onset/remission of symptoms. Few predictors of timing of onset and PTSD remission were identified. Regardless, PTSD symptom group C was found to be pivotal to processes involved in both onset and remission of the disorder.

Conclusions

Research findings related to the onset and remission of PTSD are highly dependent on the definition used. Both symptom-based and diagnostic threshold-based definitions are problematic. Definitions of the onset and remission of PTSD might be more effectively based on the onset and remission of group C symptoms.

Keywords

Posttraumatic stress disorder Disaster Onset Remission Course 

References

  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edition, text revision. American Psychiatric Association, WashingtonGoogle Scholar
  2. 2.
    American Psychiatric Association (2012) G 05 Posttraumatic stress disorder. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165. Accessed 1 July 2012
  3. 3.
    Andrews B, Brewin CR, Philpott R, Stewart L (2007) Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164:1319–1326PubMedCrossRefGoogle Scholar
  4. 4.
    Andrews B, Brewin CR, Stewart L, Philpott R, Hejdenberg J (2009) Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans. J Abnorm Psychol 118:767–777PubMedCrossRefGoogle Scholar
  5. 5.
    Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Klauminzer G, Charney DS, Keane TM (1990) A clinician rating scale for assessing current and lifetime PTSD: the CAPS-1. Behav Therap 13:187–188Google Scholar
  6. 6.
    Blanchard EB, Hickling EJ, Forneris CA, Taylor AE, Buckley TC, Loos WR, Jaccard J (1997) Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims. J Trauma Stress 10:215–234PubMedGoogle Scholar
  7. 7.
    Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 34:669–673PubMedCrossRefGoogle Scholar
  8. 8.
    Boscarino JA, Adams RE (2009) PTSD onset and course following the World Trade Center disaster: findings and implications for future research. Soc Psychiatry Psychiatr Epidemiol 44:887–898PubMedCrossRefGoogle Scholar
  9. 9.
    Breslau N (2001) Outcomes of posttraumatic stress disorder. J Clin Psychiatr 62(Suppl 17):55–59Google Scholar
  10. 10.
    Breslau N (2001) The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatr 62:16–22Google Scholar
  11. 11.
    Breslau N, Chase GA, Anthony JC (2002) The uniqueness of the DSM definition of post-traumatic stress disorder: implications for research. Psychol Med 32:573–576PubMedCrossRefGoogle Scholar
  12. 12.
    Breslau N, Davis GC (1992) Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatr 149:671–675PubMedGoogle Scholar
  13. 13.
    Breslau N, Reboussin BA, Anthony JC, Storr CL (2005) The structure of posttraumatic stress disorder: latent class analysis in 2 community samples. Arch Gen Psychiatry 62:1343–1351PubMedCrossRefGoogle Scholar
  14. 14.
    Carty J, O’Donnell ML, Creamer M (2006) Delayed-onset PTSD: a prospective study of injury survivors. J Affect Disord 90:257–261PubMedCrossRefGoogle Scholar
  15. 15.
    Ehlers A, Mayou RA, Bryant B (1998) Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 107:508–519PubMedCrossRefGoogle Scholar
  16. 16.
    First MB, Spitzer RL, Gibbon M, Williams JB (1996) Structured clinical interview for DSM-IV axis I disorders—patient edition (SCID-I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New YorkGoogle Scholar
  17. 17.
    Green BL, Lindy JD, Grace MC, Gleser GC, Leonard AC, Korol M, Winget C (1990) Buffalo Creek survivors in the second decade: stability of stress symptoms. Am J Orthopsychiatr 60:43–54CrossRefGoogle Scholar
  18. 18.
    Johnson SD, North CS, Smith EM (2002) Psychiatric disorders among victims of a courthouse shooting spree: a three-year follow-up study. Comm Ment Health J 38:181–194CrossRefGoogle Scholar
  19. 19.
    Karamustafalioglu OK, Zohar J, Guveli M, Gal G, Bakim B, Fostick L, Karamustafalioglu N, Sasson Y (2006) Natural course of posttraumatic stress disorder: a 20-month prospective study of Turkish earthquake survivors. J Clin Psychiatry 67:882–889PubMedCrossRefGoogle Scholar
  20. 20.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060PubMedCrossRefGoogle Scholar
  21. 21.
    Koren D, Arnon I, Klein E (2001) Long term course of chronic posttraumatic stress disorder in traffic accident victims: a three-year prospective follow-up study. Behav Res Ther 39:1449–1458PubMedCrossRefGoogle Scholar
  22. 22.
    Kupchik M, Strous RD, Erez R, Gonen N, Weizman A, Spivak B (2007) Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: a comparison of PTSD and non-PTSD subjects. Depress Anxiety 24:244–250PubMedCrossRefGoogle Scholar
  23. 23.
    Maes M, Delmeire L, Schotte C, Aleksander J, Creten T, Mylle J, Struyf A, Pison G, Rousseeuw PJ (1998) Epidemiologic and phenomenological aspects of post-traumatic stress disorder: DSM-III-R diagnosis and diagnostic criteria not validated. Psychiatr Res 81:179–193CrossRefGoogle Scholar
  24. 24.
    McMillen JC, North CS, Smith EM (2000) What parts of PTSD are normal: intrusion, avoidance, or arousal? Data from the Northridge, California earthquake. J Trauma Stress 13:57–75PubMedCrossRefGoogle Scholar
  25. 25.
    Norris FH, Friedman MJ, Watson PJ (2002) 60,000 Disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry 65:240–260PubMedGoogle Scholar
  26. 26.
    Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60,000 Disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239PubMedGoogle Scholar
  27. 27.
    North CS (2012) An exploration of causality in the development and timing of disaster-related PTSD. In: Widom CS (ed) Psychopathology and violence, chap 9. Oxford University Press, New York, pp 219–230Google Scholar
  28. 28.
    North CS, Hong BA, Surís A, Spitznagel EL (2008) Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm. Psychiatry 71:35–45PubMedGoogle Scholar
  29. 29.
    North CS, Kawasaki A, Spitznagel EL, Hong BA (2004) The course of PTSD, major depression, substance abuse, and somatization after a natural disaster. J Nerv Ment Dis 192:823–829PubMedCrossRefGoogle Scholar
  30. 30.
    North CS, Nixon SJ, Shariat S, Mallonee S, McMillen JC, Spitznagel EL, Smith EM (1999) Psychiatric disorders among survivors of the Oklahoma city bombing. JAMA 282:755–762PubMedCrossRefGoogle Scholar
  31. 31.
    North CS, Oliver J, Pandya A (2012) Examining a comprehensive model of disaster-related PTSD in systematically studied survivors of ten disasters. Am J Public Health 102:e40–e48Google Scholar
  32. 32.
    North CS, Pfefferbaum B (2002) Research on the mental health effects of terrorism. JAMA 288:633–636PubMedCrossRefGoogle Scholar
  33. 33.
    North CS, Pfefferbaum B, Kawasaki A, Lee S, Spitznagel EL (2011) Psychosocial adjustment of directly exposed survivors 7 years after the Oklahoma city bombing. Compr Psychiatry 52:1–8PubMedCrossRefGoogle Scholar
  34. 34.
    North CS, Ringwalt CL, Downs D, Derzon J, Galvin D (2011) Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Arch Gen Psychiatry 68:173–180PubMedCrossRefGoogle Scholar
  35. 35.
    North CS, Smith EM, McCool RE, Lightcap PE (1989) Acute post-disaster coping and adjustment. J Trauma Stress 2:353–360CrossRefGoogle Scholar
  36. 36.
    North CS, Smith EM, McCool RE, Shea JM (1989) Short-term psychopathology in eyewitnesses to mass murder. Hosp Comm Psychiatr 40:1293–1295Google Scholar
  37. 37.
    North CS, Smith EM, Spitznagel EL (1994) Posttraumatic stress disorder in survivors of a mass shooting. Am J Psychiatr 151:82–88PubMedGoogle Scholar
  38. 38.
    North CS, Surís AM, Davis M, Smith RP (2009) Toward validation of the diagnosis of posttraumatic stress disorder. Am J Psychiatr 166:1–8CrossRefGoogle Scholar
  39. 39.
    Perkonigg A, Pfister H, Stein MB, Hofler M, Lieb R, Maercker A, Wittchen HU (2005) Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. Am J Psychiatr 162:1320–1327PubMedCrossRefGoogle Scholar
  40. 40.
    Robins LN, Cottler LB, Compton WM, Bucholz K, North CS, Rourke KM (2000) Diagnostic interview schedule for the DSM-IV (DIS-IV). Washington University, St. LouisGoogle Scholar
  41. 41.
    Robins LN, Helzer JE, Cottler L, Goldring E (1989) NIMH diagnostic interview schedule, version III-revised. Washington University, St. LouisGoogle Scholar
  42. 42.
    Robins LN, Smith EM (1983) The diagnostic interview schedule/disaster supplement. Washington University, St. LouisGoogle Scholar
  43. 43.
    Schnurr PP, Lunney CA, Sengupta A (2004) Risk factors for the development versus maintenance of posttraumatic stress disorder. J Trauma Stress 17:85–95PubMedCrossRefGoogle Scholar
  44. 44.
    Smid GE, Mooren TT, van der Mast RC, Gersons BP, Kleber RJ (2009) Delayed posttraumatic stress disorder: systematic review, meta-analysis, and meta-regression analysis of prospective studies. J Clin Psychiatry 70:1572–1582PubMedCrossRefGoogle Scholar
  45. 45.
    Smith EM, North CS, McCool RE, Shea JM (1990) Acute postdisaster psychiatric disorders: identification of persons at risk. Am J Psychiatr 147:202–206PubMedGoogle Scholar
  46. 46.
    World Health Organization (1990) Composite international diagnostic interview. World Health Organization, GenevaGoogle Scholar
  47. 47.
    Zlotnick C, Rodriguez BF, Weisberg RB, Bruce SE, Spencer MA, Culpepper L, Keller MB (2004) Chronicity in posttraumatic stress disorder and predictors of the course of posttraumatic stress disorder among primary care patients. J Nerv Ment Dis 192:153–159PubMedCrossRefGoogle Scholar
  48. 48.
    Zlotnick C, Warshaw M, Shea MT, Allsworth J, Pearlstein T, Keller MB (1999) Chronicity in posttraumatic stress disorder (PTSD) and predictors of course of comorbid PTSD in patients with anxiety disorders. J Trauma Stress 12:89–100PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag (outside the USA) 2012

Authors and Affiliations

  1. 1.The VA North Texas Health Care SystemDallasUSA
  2. 2.Departments of Psychiatry and Surgery/Division of Emergency MedicineThe University of Texas Southwestern Medical CenterDallasUSA
  3. 3.The University of Texas at DallasRichardsonUSA

Personalised recommendations