Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community

Abstract

BackgroundFew studies examined characteristics of initial fearful spells (FS) or panic attacks (PA) and their relation to DSM-IV PA and panic disorder (PD). MethodsA community sample of adolescents and young adults (N=3021) was followed up in 4 waves (T0–T3) over up to 10 years. FS, PA, and PD were assessed at each wave using the DSM-IV/M-CIDI. Characteristics of the initial FS/PA including perceived reasons/triggers, appraisal, duration, and behavioral/emotional consequences of the initial FS/PA were retrospectively assessed at T1 and T2 in those reporting the experience of lifetime FS or PA at these waves (N=363). Multinomial logistic regressions adjusted for sex and age were used to reveal associations of initial FS/PA characteristics (aggregated data from T1 and T2) with PA only (N=88) and PD (N=62; lifetime incidences cumulated across assessment waves) (reference group: No PA/PD). ResultsAlcohol consumption, drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with PA-only (OR 2.46−5.44), while feelings of depression, feelings of anxiety, and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, subsequent avoidance, and subsequent consumption of medication, alcohol, or drugs were associated with PD (OR 2.64−4.15). A longer duration until “feeling okay again” was associated with both PA-only (OR=1.29 per category) and PD (OR=1.63). LimitationsInitial FS/PA characteristics were necessarily assessed retrospectively by self-report only. Thus, our data might be subject to recall/evaluation biases. Aggregated data were used and strictly prospective-longitudinal studies are necessary that replicate our findings. ConclusionAssessing initial FS/PA characteristics might be useful to identify individuals at increased risk for more severe panic pathology.