Skip to main content
Log in

Vietnam Veteran Perceptions of Delayed Onset and Awareness of Posttraumatic Stress Disorder

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Although 40 years have passed since the Vietnam War, demand for treatment of posttraumatic stress disorder (PTSD) among veterans from this conflict has increased steadily. This study investigates the extent to which two factors, delayed onset or awareness of PTSD symptoms, may influence this demand. Using data from two studies of Vietnam Veterans in outpatient (n = 353) and inpatient (n = 721) PTSD treatment, this analysis examines retrospective perceptions of the time of symptom onset and awareness of the connection between symptoms and war-zone stress. The association of these two constructs with pre-war, wartime, and post-war clinical variables are analyzed. Delay in onset of symptoms was reported by 50 % of outpatients and 35 % of inpatients. Delay in awareness was reported by 60 % of outpatients and 65 % of inpatients. Onset of symptoms occurred within six years and onset of awareness within 20 years in 90 % of individuals. Reported delays in onset and awareness were associated with more numerous negative life events after military service and before the onset of symptoms. Findings suggest that providers, administrators, and policy makers should be aware of the potential for protracted treatment demand among veterans from current conflicts, due in part by delay in onset and awareness of symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hermes EDH, Rosenheck RA, Desai R, Fontana A: Recent trends in the treatment of posttraumatic stress disorder and other mental health disorders in the Veterans Health Administration. Psychiatric Services 63:471–76, 2012.

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association Task Force on DSM-IV: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 4th edn, Washington, DC, American Psychiatric Association, 2000.

    Google Scholar 

  3. Andrews B, Brewin CR, Philpott R, Stewart L: Delayed-onset posttraumatic stress disorder: A systematic review of the evidence. American Journal of Psychiatry 164:1319–26, 2007.

    Article  PubMed  Google Scholar 

  4. Bryant RA, Harvey AG: Delayed-onset posttraumatic stress disorder: A prospective evaluation. Australian & New Zealand Journal of Psychiatry 36:205–9, 2002.

    Article  PubMed  Google Scholar 

  5. Smid GE, Mooren TM, van der Mast RC, Gersons BPR, Kleber RJ: Delayed posttraumatic stress disorder: Systematic review, meta-analysis, and meta-regression analysis of prospective studies. Journal of Clinical Psychiatry 70:1572–82, 2009.

    Article  PubMed  Google Scholar 

  6. Andrews B, Brewin CR, Stewart L, Philpott R, Hejdenberg J: Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military Veterans. Journal of Abnormal Psychology 118:767–77, 2009.

    Article  PubMed  Google Scholar 

  7. Frueh BC, Grubaugh AL, Yeager DE, Magruder KM: Delayed-onset post-traumatic stress disorder among war Veterans in primary care clinics. British Journal of Psychiatry 194:515–20, 2009.

    Article  PubMed Central  PubMed  Google Scholar 

  8. McFarlane AC: The longitudinal course of posttraumatic morbidity: The range of outcomes and their predictors. Journal of Nervous and Mental Disease 176:30–39, 1998.

    Article  CAS  PubMed  Google Scholar 

  9. Solomon Z, Mikulincer M: Trajectories of PTSD: A 20-year longitudinal study. American Journal of Psychiatry 163:659–66, 2006.

    Article  PubMed  Google Scholar 

  10. Adams RE, Boscarino JA: Predictors of PTSD and delayed PTSD after disaster: The impact of exposure and psychosocial resources. Journal of Nervous and Mental Disease 194:485–93, 2006.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Keane TM, Caddell JM, Taylor KL: Mississippi scale for combat-related posttraumatic stress disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology 56:85–90, 1998.

    Article  CAS  PubMed  Google Scholar 

  12. Weathers FW, Litz BT: Psychometric properties of the clinician-administered PTSD scale, CAPS-1. PTSD Research Quarterly 5:2–6, 1994.

    Google Scholar 

  13. McLellan AT, Luborsky L, Cacciola J, Griffith J, Evans F, Barr HL, O’Brien CP: New data from the addiction severity index: Reliability and validity in three centers. Journal of Nervous and Mental Disease 173:412–23, 1985.

    Article  CAS  PubMed  Google Scholar 

  14. Boulanger G, Kadushin C (Eds.): The Vietnam Veteran Redefined: Fact and Fiction, Hillsdale, Erlbaum Associates, 1986.

    Google Scholar 

  15. Helzer JE, Robins LN, McEvoy L: Posttraumatic stress disorder in the general population. New England Journal of Medicine 317:1630–38, 1987.

    Article  CAS  PubMed  Google Scholar 

  16. Keane TM, Fairbank JA, Caddell JM, Zimering RT, Taylor KL, Mora CA: A clinical evaluation of a scale to measure combat exposure. Journal of Consulting and Clinical Psychology 1:53–55, 1989.

    Google Scholar 

  17. Fontana A, Rosenheck R: A causal model of the etiology of war-related PTSD. Journal of Traumatic Stress 6:475–500, 1993.

    Article  Google Scholar 

  18. Holmes TH, Rahe RH: The social readjustment rating scale. Journal of Psychosomatic Research 11:213–218, 1967.

    Article  CAS  PubMed  Google Scholar 

  19. Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D: New onset and persistent symptoms of post-traumatic stress disorder self-reported after deployment and combat exposures: prospective population based US military cohort study. British Medical Journal 336:336–71, 2008.

    Google Scholar 

  20. Gray MJ, Bolton EE, Litz BT: A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia Peacekeepers. Journal of Consulting and Clinical Psychology 72:909–13, 2004.

    Article  PubMed  Google Scholar 

  21. Wessely S, Unwin C, Hotopf M, Hull L, Ismail K, Nicolaou V, David A: Stability of recall of military hazards over time Evidence from the Persian Gulf War of 1991. British Journal of Psychiatry 183:314–22, 2003.

    Article  CAS  PubMed  Google Scholar 

  22. Weathers FW, Keane TM, Davidson JR: Clinician‐Administered PTSD Scale: A review of the first ten years of research. Depress Anxiety 13:132–56, 2001.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This analysis was supported by the New England Mental Illness Research and Education Center. The funding source had no role in the design, analysis or interpretation of data or in the preparation of the report or decision to publish.

Conflicts of interest

Dr. Hermes and Dr. Fontana report no financial relationships with competing commercial interests. Dr. Rosenheck two has received research support from Janssen Pharmaceutica Products and Wyeth Pharmaceuticals within the last year in addition to AstraZeneca pharmaceuticals LP, Bristol-Myers Squibb, and Eli Lilly and Co in the past. He has received consulting fees from Bristol-Myers Squibb, Eli Lilly and Co., Roche Pharmaceuticals and Janssen Pharmaceutica Products. He has testified as an expert in Jones ex rel. the State of Texas v. Janssen Pharmaceutica Products.

Human Subjects Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eric Hermes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hermes, E., Fontana, A. & Rosenheck, R. Vietnam Veteran Perceptions of Delayed Onset and Awareness of Posttraumatic Stress Disorder. Psychiatr Q 86, 169–179 (2015). https://doi.org/10.1007/s11126-014-9311-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-014-9311-9

Keywords

Navigation