Disability and Comorbidity: Diagnoses and Symptoms Associated with Disability in a Clinical Population with Panic Disorder

Abstract

Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study

“…Many researchers have reported that comorbidity strongly aggravated the disability of patients ( 30 ). Amongst ADs patients, the presence of comorbid other mental disorders, such as depression, indicates a more chronic course with worse prognosis ( 31 ), which may increase the difficulty of treatments and the possibility of recurrence ( 31 , 32 ). Another finding from the study was the comorbidity of physical diseases predicted the disability at the follow-up.…”

“…AGP is more associated with a chronic course than other anxiety disorders and the chronic course is associated with more disability ( 36 ). Besides, in patients with AGP, the symptom of agoraphobic avoidance makes the largest contribution to the disability among all types of ADs ( 31 ). Consistent with a previous study ( 37 ), GAD patients had higher disability during the follow-up.…”

Factors differentiating panic disorder with and without comorbid symptoms of depression

“…(Carrera et al, 2006; Davidoff, Christensen, Khalili, Nguyen, & IsHak, 2012; Rufer et al, 2010). Several studies have found that both PD and depression are associated with disability (Bonham & Uhlenhuth, 2014; van der Leeuw et al, 2015), which ranges from moderate to severe on multiple domains (Davidoff et al, 2012). This disability increases considerably when both disorders are present (Davidoff et al, 2012).…”

“…Most published research has focused on elucidating the role played by variables such as somatization (Haug et al, 2004) in manifesting the close association among anxiety disorders—especially PD (Kircanski, Craske, Epstein, & Wittchen, 2009)—and the increase in this association when presenting with depressive disorder (Hassan & Ali, 2011). Similarly, research on the impact that these disorders have on disability (Bonham & Uhlenhuth, 2014; van der Leeuw et al, 2015) and QoL (Davidoff et al, 2012) is also extensive. However, little is known about the differences in cognitive profiles between patients with PD and those with PD and comorbid depressive disorder (PD + MDD).…”

A Diagnostic-Oriented Screening Scale for Anxiety Disorders: The Center for Epidemiologic Studies Anxiety Scale (CESA)

“…Grant et al (2006) found lifetime prevalence rates ranging from.05 to.17% in the United States general population. Despite having one of the lowest prevalences among anxiety disorders, agoraphobia is included in the CESA due to its high impairment and comorbidity with other anxiety disorders (Bonham and Uhlenhuth, 2014).…”