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