The course of PTSD in naturalistic long-term studies: High variability of outcomes. A systematic review

• Published in: Nordic journal of psychiatry Vol. 69; no. 7; pp. 483 - 496
• Main Authors: Steinert, Christiane, Hofmann, Mareike, Leichsenring, Falk, Kruse, Johannes
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2015
• Subjects: Adult; Aged; Cohort Studies; Comorbidity; Course; Disaster Victims - psychology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posttraumatic stress disorder; Pragmatic Clinical Trials as Topic - methods; Predictors; Prevalence; Prospective Studies; PTSD; Recovery; Remission; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Treatment Outcome; Veterans - psychology; PTSD; Remission; Posttraumatic stress disorder; Course; Recovery; Predictors
• ISSN: 0803-9488; 1502-4725; 1502-4725
• DOI: 10.3109/08039488.2015.1005023

Background: With a lifetime prevalence of 8% posttraumatic stress disorder (PTSD) is one of the most common mental disorders; nevertheless, its longitudinal course is largely unknown. Aims: Our aim was to conduct a systematic review summarizing available findings on the prospective, naturalistic long-term course of PTSD and its predictors. Methods: Databases MEDLINE and PsycINFO were searched. Main selection criteria were: 1) naturalistic cohort study with a follow-up period of at least 3 years, 2) adult participants with observer-rated or probable PTSD at baseline. Results: Twenty-four cohorts (25 studies) were retrieved (14 with observer-assessed, 10 with probable PTSD). In total, they comprised about 10,500 participants with PTSD at baseline that were included in the long-term follow-ups. Studies investigating patient populations with observer-assessed PTSD found that between 18% and 50% of patients experienced a stable recovery within 3-7 years; the remaining subjects either facing a recurrent or a more chronic course. Outcomes of community studies and studies investigating probable PTSD varied considerably (remission rates 6-92%). Social factors (e.g. support) as well as comorbid physical or mental health problems seem to be salient predictors of PTSD long-term course and special focus should be laid on these factors in clinical settings. Conclusions: Included studies differed notably with regard to applied methodologies. The resulting large variability of findings is discussed. More standardized systematic follow-up research and more uniformed criteria for remission and chronicity are needed to gain a better insight into the long-term course of PTSD.