Lifetime panic-depression comorbidity in the National Comorbidity Survey

被引:231
作者
Kessler, RC [1 ]
Stang, PE
Wittchen, HU
Ustun, TB
Roy-Burne, PP
Walters, EE
机构
[1] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[2] Univ N Carolina, Dept Epidemiol, Chapel Hill, NC USA
[3] SmithKline Beecham Pharmaceut, Philadelphia, PA USA
[4] Max Planck Inst Psychiat, Dept Clin Psychol, Inst Clin, D-80804 Munich, Germany
[5] WHO, CH-1211 Geneva, Switzerland
[6] Univ Washington, Dept Psychiat & Behav Sci, Sch Med, Seattle, WA 98195 USA
关键词
D O I
10.1001/archpsyc.55.9.801
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population. Methods: Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression. Results: 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. Conclusions: 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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收藏
页码:801 / 808
页数:8
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