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Findings From a Prospective Community Study

Barbara Isensee, PhD; Hans-Ulrich Wittchen, PhD; Murray B. Stein, MD; Michael Höfler, DiplStat; Roselind Lieb, PhD

Arch Gen Psychiatry. 2003;60:692-700.

Background  We examined prospectively determined bidirectional associations between smoking and panic and other anxiety disorders and their temporal ordering of onset in a representative community sample of adolescents and young adults.

Methods  Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders using the Munich-Composite International Diagnostic Interview.

Results  At baseline, panic attacks and panic disorder were strongly associated with occasional and regular smoking and nicotine dependence (odds ratio [OR] range, 3.0-28.0). In the prospective analyses, we found increased risk for new onset of panic attacks with prior regular smoking (OR, 2.9; 95% confidence interval [CI], 1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior nicotine dependence increased also the risk for onset of panic disorder (OR, 3.3; 95% CI, 1.0-10.5), whereas preexisting panic was not associated with subsequent smoking or nicotine dependence. When using Cox regression with time-dependent covariates, prior nicotine dependence was confirmed to be related to subsequent panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic disorder (hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that prior panic attacks/disorder might also have an effect on secondary development of nicotine dependence.

Conclusions  In young adults, prospective analyses revealed a fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. However, we could not exclude the existence of a second, less frequent, reverse pathway of prior panic and secondary nicotine dependence.

From the Clinical Psychology and Epidemiology Unit, Max-Planck-Institute of Psychiatry, Munich, Germany (Dr Isensee, Wittchen, and Lieb and Mr Höfler); the Department of Psychiatry, University of California–San Diego, La Jolla (Dr Stein); and the Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany (Dr Wittchen and Mr Höfler).

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