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Lifetime co-morbidity of panic attacks and major depression in a population-based study: age of onset

  • L. Andrade (a1), W. W. Eaton (a1) and H. D. Chilcoat (a1)

We used survival analysis to test for a suspected effect of co-morbidity of DIS/DSM-III major depression and panic attack on the age of onset of each of these disorders, in a population-based sample from four sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (N = 12668). The possible effects of gender and presence of a co-morbid disorder on age of onset of the single disorders were analysed using the Cox proportion-hazard model, with gender as an explanatory variable and the co-morbid disorders as time-dependent covariates. The disorders begin earlier in life when they are co-morbid than when they occur singly. The occurrence of one disorder increases the chance of occurrence of the other. Females have from 1·7 to almost twice the risk for developing panic and/or depression compared with men, even if the co-morbid disorder precedes the index disorder or is lifetime co-morbid. These findings are compatible with a hypothesis of a higher severity in co-morbid cases when compared with a single disorder.

Corresponding author
1Address for correspondence: Dr Laura Andrade Instituto de PsiquiatriaHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloCaixa Postal 8091CEP 01065–970São PauloBrazil.
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Andrade, L., Eaton, W. W. & Chilcoat, H. (1994). Lifetime comorbidity of panic attacks and major depression in a population-based study: symptom profiles. British Journal of Psychiatry 165, 363369.
Angst, J., Vollrath, M., Merikangas, K. R. & Ernst, C. (1990). Comorbidity of anxiety and depression in the Zurich Cohort Study of Young Adults. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J. D. and Cloninger, C. R.), pp. 123137. American Psychiatric Press: Washington, DC.
Barlow, D. H. (1991). The nature of anxiety: anxiety, depression and emotional disorders. In Chronic Anxiety: General Anxiety and Mixed Anxiety-Depression (ed. Rapee, R. M. and Barlow, D. H.), pp. 128. Guilford Press: New York.
Boyd, J. H., Burke, J. D., Gruenberg, E., Holzer-III, C. E., Rae, D. S., George, L. K., Karno, M., Stoltzman, R., McEvoy, L. & Nestadt, G. (1984). Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry 41, 983989.
Boyd, J. H., Robins, L. N., Holzer-III, C. E., Von Korff, M., Jordan, K. B. & Escobar, J. I. (1985). Making diagnosis from DIS data. In Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program (ed. Eaton, W. W. and Kessler, L. G.), pp. 209231. Academic Press: Orlando.
Breier, A., Charney, D. S. & Heninger, G. R. (1984). Major depression in patients with agoraphobia and panic disorder. Archives of General Psychiatry 41, 11291135.
Breier, A., Charney, D. S. & Heninger, G. R. (1985). The diagnostic validity of anxiety disorders and their relationship to depressive illness. American Journal of Psychiatry 142, 787797.
Breier, A., Charney, D. S. & Heninger, G. R. (1986). Agoraphobia with panic attacks: development, diagnostic stability, and course of illness. Archives of General Psychiatry 43, 10291036.
Buller, R., Maier, W. & Benkert, O. (1986). Clinical subtypes in panic disorder: their descriptive and prospective validity. Journal of Affective Disorders 11, 105114.
Christie, K. A., Burke, J. D., Regier, D. A., Rae, D. S., Boyd, J. H. & Locke, B. Z. (1988). Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. American Journal of Psychiatry 145, 971975.
Eaton, W. W. & Chilcoat, H. (1992). The latent structure of anxiety and depression in treated and untreated samples of two US populations. In Primary Health Care and Psychiatric Epidemiology (ed. Cooper, B. and Eastwood, R.), pp. 307318. Routledge: London.
Eaton, W. W. & Kessler, L. G. (1985). Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Academic Press: New York.
Eaton, W. W. & Keyl, P. M. (1995). The epidemiology of panic. In Panic Disorder: Clinical, Biological and Treatment Aspects (ed. Asnis, G. M. and van Praag, H. M.), pp. 5065. Wiley: New York.
Eaton, W. W., Dryman, A. & Weissman, M. (1991). Panic and phobia. In Psychiatric Disorders in America: the Epidemiologic Catchment Area Study (ed. Robins, L. N. and Regier, D. A.), pp. 155179. Free Press: New York.
EGRET (1991). Epidemiological Graphics, Estimation, and Testing Package, version 0.26.6.
Frances, A., Widiger, T. & Fyer, M. R. (1990). The influence of classification methods in comorbidity. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J. D. and Cloninger, C. R.), pp. 439462. American Psychiatric Press: Washington, DC.
Hetch, H., von Zerssen, D., Krieg, C., Possl, J. & Wittchen, H. U. (1989). Anxiety and depression: comorbidity, psychopathology, and social functioning. Comprehensive Psychiatry 30: 420433.
Klerman, G. L., Weissman, M. M., Ouellette, R., Johnson, J. & Greenwald, S. (1991). Panic attacks in the community: social morbidity and health care utilization. Journal of the American Medical Association 265, 742746.
Kovacs, M., Gatsonis, C., Paulauskas, S. & Richards, C. (1989). Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Archives of General Psychiatry 46, 776782.
Lesser, I. M., Rubin, R. T., Pecknold, J. C., Rifkin, A., Swinson, R. P., Lydiard, R. B., Burrows, G. D., Noyes, R. & Dupont, R. L. (1988). Secondary depression in panic disorder and agoraphobia. Archives of General Psychiatry 45, 437443.
Noyes, R., Reich, J., Christiansen, J., Suelzer, M., Pfohl, B. & Coryell, W. (1990). Outcome in panic disorder: relation to diagnostic subtypes and comorbidity. Archives of General Psychiatry 47, 809818.
Price, R. A., Kidd, K. K. & Weissman, M. M. (1987). Early onset (under age 30 years) and panic disorder as markers for etiologic homogeneity in major depression. Archives of General Psychiatry 44, 434440.
Robins, L. N., Helzer, J. E., Orvaschel, H., Anthony, J. C., Beazer, D. G., Burman, A. & Burke, J. (1985). The diagnostic Interview Schedule. In Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program (ed. Eaton, W. W. and Kessler, L. G.), pp. 143170. Academic Press: Orlando.
SAS Institute (1991). Uses Guide: Statistics. Version 6. SAS Institute Inc.: Cary, NC.
Stravakaki, C. & Vargo, B. (1986). The relationship of anxiety and depression: a review of the literature. British Journal of Psychiatry 149, 716.
Van Valkenburg, C., Akiskal, H. S., Puzantian, V. & Rosenthal, T. (1984). Anxious depression: clinical, family history, and naturalistic outcome: comparisons with panic and major depressive disorders. Journal of Affective Disorders 6, 6782.
von Korff, M. R., Eaton, W. W. & Keyl, P. (1985). The epidemiology of panic attacks and panic disorder: result of three community surveys. American Journal of Epidemiology 122, 970981.
Wittchen, H. U. & Essau, C. A. (1989). Comorbidity of anxiety and depression: does it affect course and outcome? Psychiatry and Psychobiology 4, 315323.
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Psychological Medicine
  • ISSN: 0033-2917
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