Abstract
BackgroundPanic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence.MethodThis study is part of the TRacking Adolescents’ Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10–12). At age 18–20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10–20 years, using survival analysis in univariate and multivariate models.ResultsThere were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset.ConclusionRisk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.
Highlights
The DSM-IV [1] classification includes clinical criteria for both panic attacks and panic disorder
When comparing the T1 sample with participants who provided T4 outcome data, we found that T1 predictors of not providing outcome data were male gender (T1 49.2% vs. T4 46.0%), low socio-economic status (T1 25.2% vs. T4 19.6%), ethnic minority background (T1 10.6% vs. T4 7.6%), one-parent family (T1 15.5% vs. T4 13.5%), and a Total Problem score of the Child Behavior Checklist (CBCL/6– 18) [23] in the clinical range at baseline (T1 16.1% vs. T4 13.9%)
The mean age of onset of panic attacks was 15.8 years and the age of onset did not differ between girls and boys, F(1) = .837, p =
Summary
The DSM-IV [1] classification includes clinical criteria for both panic attacks and panic disorder. Panic attacks may occur in the context of multiple anxiety disorders. They are considered to be amongst the most debilitating psychiatric conditions [2] and are associated with high level of mental health treatment seeking [3]. While it is known that early identification and subsequent intervention can reduce deleterious outcomes of psychiatric disorders [4], including panic disorder and panic attacks, research on risk factors for the onset of panic attacks is scarce. Some recent studies have identified panic attacks as a risk factor for other anxiety [4,5,6] and mood disorders [4,5], independent of comorbid internalizing psychopathology. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence
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