Table 2 PTSD assessments and definitions of recovery and recurrence

An et al. (2022) [33]

17-item Child PTSD Symptom Scale (CPSS)

6, 9, 12 and 18 months after the tornado

PTSD symptoms decreasing from above the cut-off at T1 to T2 to below the cut-off at T3

PTSD symptoms increasing from below the cut-off at T3 to above the cut-off at T4 (trajectory labelled ‘recurrent dysfunction’)

Not reported

Andersen et al. (2014) [34]

PTSD Checklist, Civilian Version (PCL-C); Structured Clinical Interview for DSM-IV (T6 only)

T1: 5–6 weeks pre-deployment

T2: During deployment

T3: 1–3 weeks post-deployment

T4: 2 months post-deployment

T5: 7 months post-deployment

T6: 2.5 years post-deployment

Temporary ‘symptom relief’ during deployment

‘Drastic symptom increase’ following the temporary relief and continuing through 2.5 years (labelled ‘relieved-worsening’ trajectory)

Some participants reported to have psychological or psychiatric treatment after deployment; data not presented

Ansell et al. (2011) [35]

Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Version; weekly ‘psychiatric status ratings’

Weekly ratings for 7 years

Remission defined as eight consecutive weeks with minimal or no symptoms

Relapse defined as, after remission, experiencing four consecutive weeks with symptoms meeting full diagnostic criteria

All participants were recruited from in- and outpatient clinical programmes

Armenta et al. (2019) [36]

PTSD Checklist-Civilian Version (PCL-C)

Baseline (T1) and four follow-up assessments, approximately every 3 years between 2001–2016

Lower level of symptoms at first follow-up

Symptoms steadily worsened over the remainder of the study period (labelled ‘relapse’ trajectory)

Not reported

Benítez et al. (2012) [37]

Structured Clinical Interview for DSM-IV, patient version

T1 (intake) and follow-up interviews at 1-year intervals for 5 years

8 consecutive weeks of PTSD at a Psychiatric Status Rating (PSR) level of 2 or less

Onset of PTSD symptoms at a PSR level of 5 or greater for 2 consecutive weeks following a recovery period

Medication – SSRI (25.1%); Medication – benzodiazepines (12.1%); Psychosocial treatment (33.2%)

Berntsen et al. (2012) [38]

Posttraumatic Stress Disorder Checklist (PCL)

Symptoms assessed pre-deployment; during the 6-month deployment; 1–3 weeks after return; 2–4 months after return; and 7–8 months after return

No explicit definition of recovery – latent class growth modelling revealed trajectories which showed ‘temporary beneficial effects associated with deployment’, i.e. ‘high or moderate levels of PTSD symptoms at pre-deployment [which] decreased either at deployment, return from deployment, or approximately 3 months after return’

No explicit definition of recurrence – latent class growth modelling revealed trajectories where temporary reductions in symptoms associated with deployment later ‘increased again after 3 or 7 months following return’

Not reported

Boe et al. (2010) [15]

Structural Clinical Interview for DSM-IV axis I Disorders (SCID-I)

Symptoms measured 5.5 months, 14 months, 5 years and 27 years after the disaster

Not reported

Either fulfilling all DSM-IV diagnostic criteria or sub-syndromal cases of PTSD, referred to as ‘reactivated PTSD’

Not reported

Chopra et al. (2014) [39]

PTSD assessment schedule based on DSM-IV criteria of PTSD

Symptoms assessed at baseline, 3 months and 6 months

Participants ‘denied any reexperiencing symptoms’

Meeting DSM-IV criteria for PTSD

Participants were attending primary care clinics – unclear what treatment was provided

Davidson et al. (2005) [40]

Clinical Global Impressions of Severity (CGI-S); Short PTSD Rating Interview (SPRINT); Davidson Trauma Scale

Baseline, 1-week, 2-week, 4-week and then monthly follow-ups over 1 year

CGI scores of 1 (very much improved), 2 (much improved) or 3 (moderately improved)

CGI score reverted back to no improvement relative to baseline or worse (i.e. scores of 4 or greater), or which had increased by at least 2 points relative to improvement status at Week 24; a participant was also considered relapsed if an ‘untoward clinical event’ occurred such as psychiatric hospitalisation, suicidality, or the patient dropping out because they did not feel progress had been sustained

Randomised trial – 30 participants received a placebo and 27 received fluoxetine; medication and support were provided as the ‘only form of intervention’

DenVelde et al. (1996) [41]

28-item Dutch self-rating scale based on the DSM-III criteria for PTSD; participants rated PTSD symptoms as ‘none’, ‘mild’, ‘moderate’, ‘severe’ or ‘very severe’

Participants gave complete life-history data at one timepoint (exact date not provided; sometime between 1985–1994)

Participants self-reported whether their PTSD symptoms were chronic/progressive, lasted for less than 5 years, or entailed ‘remissions and exacerbations’

See previous column

Not reported

Fan et al. (2015) [42]

Posttraumatic Stress Disorder Self-Rating Scale

6, 12, 18 and 24 months post-earthquake

‘Relapsing/remitting’ group characterised by PTSD symptoms fluctuating and showing a cyclical course across the follow-up period

See previous column

Not reported

Gonçalves et al. (2011) [43]

Posttraumatic Stress Diagnostic Scale (PDS)

T1: beginning of cancer treatment; T2: 6–8 weeks later; T3: 15 weeks after T1; T4: 27 weeks after T1

Not meeting the full criteria for PTSD case diagnosis

Meeting criteria for PTSD diagnosis (one reexperiencing symptom, three avoidance symptoms, two arousal symptoms, duration of symptoms for at least 1 month and impairment in at least one area of functioning)

Of those with PTSD diagnoses, 5% reported current psychological help, 16% reported past psychological help and 30% reported use of antidepressants

Gross et al. (2022) [44]

PCL-5

Admission to residential treatment, discharge (mean length of stay 51 days, range 3-322), and follow-up (4 months post-discharge)

Significant decrease in PTSD symptoms over the course of treatment

Not defined

All participants were admitted to residential rehabilitation treatment programmes although the length of time they stayed varied

Hansen et al. (2017) [45]

Norwegian version of the Posttraumatic Stress Disorder Checklist-Specific (PCL-S)

10, 22 and 34 months post-bombing

Not meeting the criteria for symptom-defined PTSD at T2

Meeting the criteria for PTSD at T3

Not reported

Hepp et al. (2008) [46]

Impact of Events Scale; Clinician Administered PTSD Scale for DSM (CAPS)

2 weeks, 6 months, 12 months and 36 months post-accident

N/A

‘Secondary increase of the CAPS score above 30 later on’

6 patients at T4 (7%) reported psychopharmacological and/or psychotherapeutic treatment related to the accident

Holliday et al. (2020) [47]

PCL-5

Admission to treatment, discharge (length of treatment not reported), 4-month follow-up

Clinically meaningful change in PTSD symptoms from admission to discharge

Not defined

All participants were admitted to residential rehabilitation treatment programmes although only around three-quarters completed the programme

Karstoft et al. (2015) [48]

PTSD Checklist, civilian version (PCL-C)

Pre-deployment, during deployment, on return from deployment, + 3 months, + 7 months, + 2.5 years

Moderate initial symptom level that ‘decreased somewhat during deployment’

Moderate initial symptom level that ‘decreased somewhat during deployment’ and then increased drastically after deployment

Some participants had received psychological or psychiatric help before deployment

Liang et al. (2019) [49]

Liang et al. (2021) [50]

20-item section of the UCLA PTSD reaction index for DSM-IV (Steinberg et al., 2004)

4, 16, 29, 40 and 52 months post-earthquake

Relapsing trajectory: High PTSD score at T1 which decreased to a low level until T3 but then increased again at T4

Relapsing trajectory: High PTSD score at T1 which decreased to a low level until T3 but then increased again at T4

Not reported, although one of the two schools is described as having ‘better psychological intervention and peer social support networks’

Madsen et al. (2014) [51]

PCL-C

6 weeks pre-deployment; during deployment; at homecoming; and 3 months, 7 months and 2.5 years post-deployment

‘Relieved-worsening’ trajectory is not clearly defined

See previous column

Not reported

Markowitz et al. (2018) [52]

CAPS; Structured Clinical Interview for DSM-IV; “other measures”

T1: start of treatment

T2: 14 weeks later

T3: 26 weeks from baseline

Response to treatment defined as: ≥30% decrement from baseline CAPS score and remission as CAPS score < 20

Relapse defined as: <30% reduction from baseline CAPS score after having met response criteria at week 14

10 weekly 90-minute sessions, over 14 weeks, of prolonged exposure helping the patient to reconstruct a narrative of the trauma, understand the rationale for facing reminders of the trauma, constructing a hierarchy of fears, and undergoing imaginal and in vivo exposure

Or

14 weekly 50-minute sessions of individual psychotherapy focusing on the interpersonal consequences of trauma and using affect as a guide to handling interpersonal encounters

Or

9 weekly 90-minute sessions of relaxation therapy where therapists induced muscle and mental relaxation

Martenyi et al. (2002) [53]

Pre-treatment: Structured Clinical Interview for DSM-IV Axis I Disorders for Patients, Investigator Version (SCID-I modified); Clinician-Administered PTSD Scale, Current Diagnostic Version (CAPS-DX)

Follow-ups: TOP-8 scale; CGI-S scale; CAPS-DX; Clinical Global Impression of Improvement (CGI-I); Davidson Trauma Scale

12 weeks after treatment, 36 weeks after treatment (unclear how long after trauma exposure)

‘Responding to treatment’ defined as: 50% decrease in the eight-item Treatment Outcome PTSD (TOP-8) score from baseline; CGI-S score of 2 or less; and failing to meet DSM-IV diagnostic criteria for PTSD

Relapse criteria: 40% increase in TOP-8 score, increase in CGI-S score of 2 + from week 12; or the ‘clinical judgement of the investigator’

12 weeks double-blind treatment with fluoxetine or placebo followed by 24-week relapse prevention (re-randomised to either fluoxetine or placebo) for those who responded to treatment

Murphy & Smith (2018) [54]

Impact of Events Scale-Revised (IES-R)

Intake, end of six-week treatment, and then 6 weeks, 6 months, and 12 months after the end of treatment

Latent class growth analysis identified a ‘response-remit’ trajectory, with significant reductions in PTSD observed post-treatment

Latent class growth analysis identified a ‘response-remit’ trajectory, with PTSD severity scores returning to pre-treatment levels ‘at the first follow-up point 6 weeks later and at subsequent timepoints’

All participants had been admitted to a residential intervention

Osenbach et al. (2014) [55]

PCL-C

Baseline measures completed in hospital; follow-up assessment 1–3 weeks after injury; additional follow-up measures at 1, 3, 6, 9 and 12 months post-injury

The relapsing/remitting trajectory showed ‘moderate symptoms that varied slightly across time, but stayed relatively moderate’

See previous column

96/194 received a series of interventions focused on early, sustained care of posttraumatic symptoms, beginning with motivational interviewing and behavioural activation and then ‘stepped up’ to higher-intensity care (pharmacotherapy)

Osofsky et al. (2017) [56]

PCL-C

Intake and at 1, 3, 6, 12 and 18 month follow-up intervals

‘Initial declines’ – not reported whether this meant eradication of symptoms or not meeting the threshold

‘Increasing symptoms’ – again, not reported what this means; not clear whether those in the increasing group did have clinically significant PTSD scores

Participants were receiving ‘integrated services’ at health clinics but it is not clear what this means

Perconte et al. (1991) [57]

Clinician diagnosis according to DSM-III criteria; Minnesota Multiphasic Personality Inventory (MMPI), including the PTSD subscale

Pre-treatment, termination of treatment, and 18-month follow-up

Obtaining at least a 1-point improvement on the BHPRS Global Pathology Index

Being hospitalised at least once since termination of treatment

Partial hospitalisation programme which involved group psychotherapy, flooding/desensitisation techniques, problem-solving and stress management, social skills and assertiveness training, substance abuse counselling, individual counselling, vocational counselling, recreational activities

Veterans attended treatment 3 days per week for 4–6 h

Sakuma et al. (2020) [58]

Japanese version of the PTSD Checklist Specific Version (PCL-S)

14, 30, 43 and 54 months post-earthquake

‘Fluctuating course’ defined as: cyclical course moving above and below the diagnostic threshold

‘Fluctuating course’ defined as: cyclical course moving above and below the diagnostic threshold

Not reported

Solomon & Mikulincer (2006) [59]

PTSD Inventory based on the DSM-III

1, 2, 3 and 20 years post-war

Not meeting criteria for PTSD

No formal definition was provided. However, a recurrent trajectory could be seen as some participants met the criteria for PTSD at one time-point, then did not meet the criteria, then met the criteria again at a later time-point

All participants in the combat stress reaction group had undergone at least some treatment

Solomon et al. (1987) [60]

Clinician’s diagnosis, confirmed by the authors using DSM-III criteria

Time-points unclear – analysis of ‘case histories’ between 1973 and 1982

‘Completely dormant or resolved episode of combat stress’

Reactivation of a dormant/resolved episode or exacerbation of residual symptoms of combat stress reaction

Not reported, but it is clear from the case studies provided as examples that some had been ‘referred for psychiatric treatment’

Solomon et al. (2018) [61]

PTSD-Inventory, a 17-item self-report scale corresponding to DSM PTSD criteria

T1: 1991

T2: 2003

T3: 2008

T4: 2014

Observed trajectories included “recovery followed by delayed-onset PTSD” and “recovery followed by delayed-onset PTSD followed by recovery”; unclear what this means or what the criteria for meeting these trajectories were

See previous column

Not reported

Solomon et al. (2021) [62]

PTSD-Inventory, a 17-item self-report scale corresponding to DSM PTSD criteria

18, 30, 35, 42 and 47 years post-war

Participants who ‘endorsed PTSD criteria’ in earlier waves but not later waves

‘Reactivated PTSD’ group: participants who initially had PTSD, recovered, then had a ‘reactivation’ of PTSD at a later measurement; the parameters of reactivation are not defined

Not reported

Sørensen et al. (2016) [63]

PCL-C

6 weeks pre-deployment; during deployment; at homecoming; and 3 months, 7 months and 2.5 years after deployment

‘Relieved-worsening’ trajectory had initial decreasing PTSD symptoms followed by a steep increase in symptoms post-deployment

See previous column

Not reported

Sungur & Kaya (2001) [64]

Diagnosis based on the presence of each symptom of PTSD criteria for DSM-III-R

1 month, 6 months, 12 months and 18 months post-disaster

‘Acute recurrent’ group defined as: symptomatic at T1, no symptoms at T2, symptomatic again at T3 and/or T4

‘Acute recurrent’ group defined as: symptomatic at T1, no symptoms at T2, symptomatic again at T3 and/or T4

Some participants took antidepressants but most did not seek treatment

Zanarini et al. (2011) [65]

Structured Clinical Interview for DSM-III-R Axis I disorders

Baseline, 2-year follow-up, 4-year follow-up, 6-year follow-up, 8-year follow-up

‘Remission’ defined as any 2-year period in which the criteria for PTSD were no longer met

Any 1-month period in which the criteria for PTSD were met after a 2-year remission

All participants were in inpatient treatment at the start of the study; around 90% were in individual therapy and taking psychotropic medications at baseline and around 70% were in therapy or taking medications at follow-ups

Zlotnick et al. (1999) [66]

Baseline: Structured Clinical Interview for the DSM-III-R Patient Version (SCID-P; Spitzer et al., 1988)

Follow-ups: Longitudinal Interval Follow-up Evaluation to collect data on the course of illness. Participants were assigned weekly Psychiatric Status Ratings corresponding to the number and frequency of PTSD symptoms experienced during the week

6-month intervals for the first 2 years and yearly thereafter, until 5 years after intake

‘Remission’ defined as ‘minimal or no symptoms of PTSD for at least 8 consecutive weeks’

Participants described as having a ‘re-occurrence of PTSD at follow-up’ but no definition is provided

Participants described as ‘in treatment at intake’ but type of treatment is not specified and the authors report that they did not obtain information on whether the treatment was specifically for PTSD