Lifetime panic-depression comorbidity in the National Comorbidity Survey.

Department of Health Care Policy, Harvard Medical School, Boston, Mass 02115, USA.
Archives of General Psychiatry (Impact Factor: 13.75). 10/1998; 55(9):801-8. DOI: 10.1001/archpsyc.55.9.801
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    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.
    Psychiatry journal. 01/2014; 2014:619727.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Presented is a model suggesting that the right hemisphere (RH) directly mediates the identification and comprehension of positive and negative emotional stimuli, whereas the left hemisphere (LH) contributes to higher level processing of emotional information that has been shared via the corpus callosum. RH subcortical connections provide initial processing of emotional stimuli, and their innervation to cortical structures provides a secondary pathway by which the hemispheres process emotional information more fully. It is suggested that the LH contribution to emotion processing is in emotional regulation, social well-being, and adaptation, and transforming the RH emotional experience into propositional and verbal codes. Lastly, it is proposed that the LH has little ability at the level of emotion identification, having a default positive bias and no ability to identify a stimulus as negative. Instead, the LH must rely on the transfer of emotional information from the RH to engage higher-order emotional processing. As such, either hemisphere can identify positive emotions, but they must collaborate for complete processing of negative emotions. Evidence presented draws from behavioral, neurological, and clinical research, including discussions of subcortical and cortical pathways, callosal agenesis, commissurotomy, emotion regulation, mood disorders, interpersonal interaction, language, and handedness. Directions for future research are offered.
    Frontiers in Human Neuroscience 04/2014; 8:230. · 2.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objetivo: A etiologia do transtorno do pânico (TP) é provavelmente multifatorial, incluindo fatores genéticos, biológicos, cognitivo-comportamentais e psicossociais que contribuem para o aparecimento de sintomas de ansiedade, muitas vezes durante a infância. O objetivo deste estudo foi avaliar a relação entre história de trans- tornos de ansiedade na infância e transtorno do pânico na vida adulta. Métodos: Foram avaliados retrospectivamente 84 pacientes adultos com transtorno do pânico quanto à presença de história de transtornos de ansiedade na infância, por meio de uma entrevista estruturada (K-SADS-E e DICA- P). A presença de comorbidades com outros transtornos de ansiedade e de humor foi avaliada por uma revisão de registros médicos. Resultados: Observou-se que 59,5% dos pacientes adultos com TP apresentavam história de ansiedade na infância. Encontrou-se uma associação significativa entre a presença de história de transtorno de ansiedade generalizada na infância e a presença de comorbidades com o TP na vida adulta, como agorafobia (p=0,05) e depressão (p=0,03). Conclusões: Este estudo sugere que a história de transtorno de ansiedade na infância pode ser considerada um preditor de maior gravidade para o transtorno do pânico na vida adulta. Ansiedade da separação. Adulto. Criança. Transtorno de pânico. Depressão. Objective: The etiology of panic disorder is probably multifactorial, involving genetic, biological, cognitive- behavioral and psychosocial factors that may contribute to the onset of anxiety symptoms in childhood. The aim of this study is to analyze the relationship between past history of anxiety disorder in childhood and panic disorder in adult life. Methods: Using a structured interview (K-SADS-E and DICA-P), 84 panic disorder adult patients were inter- viewed and childhood anxiety disorder was retrospectively investigated. A review of medical registers was performed to assess comorbidities with other anxiety and mood disorders. Results: Of the patients studied, 59,5% had past history of childhood anxiety disorders. There was a significant association between generalized anxiety disorder history during childhood and panic disorder in adult life and its comorbidities such as agoraphobia (p=0,05) and depression (p=0,03). Conclusion: This study suggests that childhood anxiety disorder may be a predictor of the severity of panic disorder in adult life. Anxiety, separation. Adult. Child. Panic disorder. Depression.
    Revista Brasileira de Psiquiatria 03/2002; 24(1):26-29. · 1.64 Impact Factor


Available from