Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys

Abstract

Context The scarcity of cross-national reports and the changes in DSM-5 regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. Objective To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. Design and Setting Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. Participants Respondents (n=142,949) from 25 high, middle and lower-middle income countries across the world aged 18 years or older. Main Outcome Measures PD and presence of single and recurrent PAs. Results Lifetime prevalence of PAs was 13.2% (s.e. 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; s.e. 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8–2.2) and their course (OR 1.3; 95% CI 1.2–2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9–1.3 and OR 0.7; 95% CI 0.6–0.8). Cross-national lifetime prevalence estimates were 1.7% (s.e. 0.0%) for PD with a median age of onset of 32 (IQR 20–47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. Conclusions We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.

A comparison of DSM ‐5 and DSM ‐IV agoraphobia in the World Mental Health Surveys

“…Several sociodemographic correlates of AG were identified, consistent with other studies of AG and PD (Andrews & Slade, 2002;de Jonge et al, 2016). Although some quantitative differences were found for associations between sociodemographic factors and diagnostic subgroups, the general patterns were comparable, with younger age, female gender, lower education, not being married, and unemployment being associated with AG.…”

Rejoinder to Commentary: “Panic, Self-Disorder, and EASE Research: Methodological Considerations”

“…This suggestion contradicts the best available epidemiological evidence, which indicates that PD, despite its comorbidities, is a stable diagnostic category [6] . We note also that our own sample is not (as they claim) "peculiar" in lacking comorbidities since it was intentionally selected on that very basis (with inclusion criterion "diagnosis of panic disorder and no other diagnoOur aim in this rejoinder is to reply to the comment by Parnas et al…”

“…Likewise, it is highly implausible to suggest that past and present panic attacks (defined as involving sudden physical and psychical anxiety with fear of losing control and help-seeking behavior) could be mistaken by trained psychiatrists, in a clinical setting, with actual psychotic episodes (delusions and hallucinations with possible disorganized speech and behavior). Also, the most recent epidemiological study (which includes Portuguese subjects in its sample) shows high comorbid diagnosis of PD with "other anxiety disorders (63.1%) and mood disorders (53.7%)" but not with psychosis [6] . The latter study also refutes the idea that PD precedes comorbid psychosis, given that it is rare for the PD diagnosis to precede the comorbid diagnosis (only 15.4% of this already rare subgroup) [6] .…”

“…Also, the most recent epidemiological study (which includes Portuguese subjects in its sample) shows high comorbid diagnosis of PD with "other anxiety disorders (63.1%) and mood disorders (53.7%)" but not with psychosis [6] . The latter study also refutes the idea that PD precedes comorbid psychosis, given that it is rare for the PD diagnosis to precede the comorbid diagnosis (only 15.4% of this already rare subgroup) [6] .…”

Longitudinal association between panic disorder and health care costs in older adults

“…The attacks are followed by worry about the occurrence of additional panic attacks or/and maladaptive behavior that seeks to avoid them (American Psychiatric Association, ). Cross‐national studies estimate the lifetime prevalence for PD to be about 1.7% (de Jonge et al, ), and about 1% of adults aged 65 and older are affected as well (Andreas et al, ).…”