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Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Robert Jin, MA; Ayelet Meron Ruscio, PhD; Katherine Shear, MD; Ellen E. Walters, MS

Arch Gen Psychiatry. 2006;63:415-424.

Context  Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD).

Objective  To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings.

Design and Setting  Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview.

Participants  English-speaking respondents (N=9282) 18 years or older.

Main Outcome Measures  Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG.

Results  Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only).

Conclusion  Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.

Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler and Ruscio, Messrs Chiu and Jin, and Ms Walters); and the Western Psychiatric Institute and Clinic, Pittsburgh, Pa (Dr Shear).

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