Lifetime Panic-Depression Comorbidity in the National Comorbidity Survey

Harvard University, Cambridge, Massachusetts, United States
Archives of General Psychiatry (Impact Factor: 14.48). 10/1998; 55(9):801-8. DOI: 10.1001/archpsyc.55.9.801
Source: PubMed


The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population.
Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression.
Strong associations were found between the lifetime prevalences of panic and major depressive episodes (odds ratios: for panic attacks with depression, 6.2; for panic disorder with depression, 6.8). These associations were not significantly influenced by the inclusion or exclusion of respondents with mania. Temporally primary depression predicted a first onset of subsequent panic attacks but not of panic disorder. Temporally primary panic attacks, with or without panic disorder and whether or not the panic was persistent, predicted a first onset of subsequent major depression. The associations between panic attack and depression were attenuated in models that controlled for prior traumatic life experiences and histories of other DSM-III-R disorders.
Lifetime panic-depression comorbidity characterizes most community respondents with panic disorder and a substantial few of those with major depression. The absence of a dose-response relationship suggests that primary panic attack is a marker, rather than a causal risk factor, of subsequent depression. Primary depression, in comparison, appears to be a genuine risk factor for secondary panic attacks. That primary depression predicts panic attacks but not panic disorder suggests that secondary panic is a severity marker of depression rather than a comorbid condition. These results are far from definitive because they are based on retrospective reports, lay-administered diagnostic interviews, and only 1 survey. However, they raise important questions that could lead to a fundamental rethinking of panic-depression comorbidity if they are replicated in future epidemiological and clinical studies.

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Available from: Tevfik Bedirhan Ustun, Aug 19, 2015
    • "In a retrospective analysis of longitudinal data, in individuals who had met criteria for both GAD and major depressive episode (Wittchen et al. 2003b), the depression diagnosis followed that of GAD in 52% of individuals and preceded GAD in only 29%. In a further study which relied on participants' recall in a population who had experienced depression and panic attacks, a first depressive episode was recalled as occurring after the first panic attack in 43% of cases and preceding it in 31% (Kessler et al. 1998). However, in a subsample who had had a diagnosis of panic disorder, which has a higher threshold, 22% recalled that panic disorder preceded the first depressive episode whereas 48% reported that a depressive episode began first. "
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    ABSTRACT: Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years. Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data. In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker. Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
    Psychological Medicine 08/2015; -1:1-13. DOI:10.1017/S003329171500149X · 5.94 Impact Factor
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    • "On the other hand, the other findings of this study showed that experience of childhood emotional maltreatment predicted internalized symptoms (depression and anxiety) in adulthood. This finding is supported by previous studies (Kessler.,et al, 1998; Mineka, Watson and clark, 1998; Sachs-Ericsson .,et al, 2006). That shows the importance of fear and helplessness as long term consequence of emotional maltreatment (Gibb,2003; Hankin, 2005)."
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    ABSTRACT: Objective: This study aimed to investigate the mediating role of maladaptive schemas between childhood emotional maltreatment and psychological distress among college students. Methods: This was a descriptive-correlative and after the fact study. A total of 315 students were selected with multistage cluster sampling from students of Tehran universities. The participants completed the lifetime of experiences questionnaire (LEQ), Young’s schema questionnaire short form with 90-item (YSQ-SF-3), and the trauma symptom checklist-40 (TSC-40). Data were analyzed by path analysis using SPSS 16. Results: The results indicated that perception of childhood emotional maltreatment was associated with later psychological distress and mediated through schema of defectiveness/ shame, vulnerability to harm, self-sacrifice, and entitlement. Conclusion: In this study, our findings suggested that childhood emotional maltreatment is contributed to later psychological distress by developing cognitive vulnerability of children through maladaptive schemas. These schemas are rigid and extreme cognitive structures that negatively filter and bias cognitive and emotional information.
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    • "Seventy-three percent of persons with major depression have comorbid lifetime anxiety disorders, whereas 27–77% of those with a principal diagnosis of an anxiety disorder develop a lifetime diagnosis of depression (Brown, Campbell, Lehman, Grisham, & Mancill, 2001). In comparison to those with pure diagnoses, individuals with comorbid anxiety and depressive disorders experience greater chronicity and severity of each diagnosis; poorer work and psychosocial functioning; lower perceived quality of life; and a heightened risk of suicide (Brown, Schulberg, Madonia, Shear, & Houck, 1996; Kessler et al., 1998; Olfson et al., 1997; Pfeiffer, Ganoczy, Ilgen, Zivin, & Valenstein, 2009; Sherbourne, Wells, Meredith, Jackson, & Camp, 1996). Hence, a greater understanding of the mechanisms behind this comorbidity is imperative. "
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    ABSTRACT: Anxiety and depression are often highly correlated with each other. To explain this connection, the present study examined the longitudinal relationship between earlier anxiety and later depression, using avoidance as a mediator and trauma as a moderator. Participants (N = 6,504 adolescents) completed baseline measures of anxiety and depression, a measure of avoidance one year later, a measure of trauma six to eight years later, and a measure of depression 12 to 14 years later. Analyzed with structural equation models, the results showed that anxiety predicted later depression, and this relationship was partially mediated by avoidance. The relationship between avoidance and depression was not moderated by trauma. Together, these findings suggest that anxiety may influence later depression through avoidance, and this relationship remains unaffected by experiencing a traumatic experience.
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