Carty Jessica, O'Donnell Meaghan L, Creamer Mark
Australian Centre for Posttraumatic Mental Health, Australia.
J Affect Disord. 2006 Feb;90(2-3):257-61. doi: 10.1016/j.jad.2005.11.011. Epub 2005 Dec 27.
Recent studies have indicated that delayed-onset posttraumatic stress disorder (PTSD) (i.e., the development of PTSD more than 6 months posttrauma) is generally characterised by subsyndromal diagnoses within the first 6 months. This study sought to examine the relationship between sub-clinical levels of PTSD symptoms at 3 months posttrauma and delayed onset PTSD at 12 months in a large sample of traumatic injury survivors.
Three hundred and one consecutively admitted injury survivors were assessed at 3 and 12 months posttrauma. PTSD was diagnosed according to DSM-IV criteria, while partial and subsyndromal diagnoses were based on recent definitions developed by Mylle and Maes [Mylle, J., Maes, M., 2004. Partial posttraumatic stress disorder revisited. J. Affect. Disord. 78, 37-48].
Eight percent of participants was diagnosed with 3-month PTSD while 10% was diagnosed with 12-month PTSD. Nearly half (47%) of 12-month PTSD cases were of delayed onset. The majority of those with delayed-onset were diagnosed with partial or subsyndromal PTSD at 3 months. Ten percent of delayed onset cases did not meet partial or subsyndromal criteria.
As symptoms were not assessed at 6 months (the DSM cut-off for delayed PTSD), it could not be conclusively determined that delayed-onset cases had not developed PTSD between 3 and 6 months posttrauma.
A considerable proportion of 12-month PTSD diagnoses was delayed in onset. While most demonstrated 3-month morbidity in the form of partial and subsyndromal diagnoses, a minority did not. Thus, clinicians should consider subthreshold diagnoses as potential risk factors for delayed-onset PTSD. Future research is required to identify factors that may predict delayed-onset PTSD in trauma survivors without evidence of prior PTSD pathology.
近期研究表明，延迟性创伤后应激障碍（PTSD）（即创伤后6个月以上出现PTSD）通常在前6个月内表现为亚综合征诊断。本研究旨在调查大量创伤性损伤幸存者中创伤后3个月时PTSD症状的亚临床水平与12个月时延迟性PTSD之间的关系。
对301名连续入院的损伤幸存者在创伤后3个月和12个月时进行评估。PTSD根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准进行诊断，而部分和亚综合征诊断则基于Mylle和Maes近期提出的定义[Mylle, J., Maes, M., 2004. 重新审视部分创伤后应激障碍。《情感障碍杂志》78, 37 - 48]。
8%的参与者被诊断为创伤后3个月PTSD，10%被诊断为创伤后12个月PTSD。12个月PTSD病例中近一半（47%）为延迟性发作。大多数延迟性发作的患者在3个月时被诊断为部分或亚综合征PTSD。10%的延迟性发作病例不符合部分或亚综合征标准。
由于未在6个月时（DSM对延迟性PTSD的界定时间）评估症状，无法确凿判定延迟性发作病例在创伤后3至6个月期间未发生PTSD。
相当一部分12个月PTSD诊断为延迟性发作。虽然大多数以部分和亚综合征诊断的形式在3个月时出现发病情况，但少数并非如此。因此，临床医生应将阈下诊断视为延迟性PTSD的潜在危险因素。未来需要开展研究以确定可能预测创伤幸存者延迟性PTSD的因素，这些幸存者此前无PTSD病史证据。
