Lifetime panic–depression comorbidity in the National Comorbidity Survey: Association with symptoms, impairment, course and help-seeking
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Background: Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses. Aims: General population data were used to study the association of lifetime and recent (12 months) panic–depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS). Method: The NCS is a nationally representative survey of the prevalences and correlates of major DSM–III–R disorders in the US household population. Results: Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary. Conclusions: Both lifetime and current panic–depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary–secondary distinction were important moderators of these associations.
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Many people with depression or anxiety disorders do not seek professional help.
“Despite the severity of these consequences, it is estimated that up to one-half of those with depression [16-18] and only one third to one-half of those affected by anxiety disorders [8,16] seek professional help.”
From A systematic review of help-seeking interventions for depression, anxiety and general psychological distress (2012) · cites this paper as [18]
Table 3 (Discussion; page not given in our copy) reports past-year service use of 35.5% for major depression alone and 34.4% for panic disorder alone, supporting the point that many people in those groups did not seek help. The paper examines panic disorder, not anxiety disorders generally, and reports 55.2% service use among people with both conditions. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPatients with panic disorder frequently suffer from depressive symptoms in addition to panic symptoms.
“Patients with panic disorder frequently suffer from depressive symptoms in addition to panic symptoms.19”
From Impact of mindfulness-based cognitive therapy on intolerance of uncertainty in patients with panic disorder (2016) · cites this paper as [19]
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“…levels of co-morbidity of non-psychotic disorders, particularly anxiety disorders, in adult depression (Blazer et al. 1994; Kessler et al. 1994; Roy-Byrne et al. 2000; Rapaport, 2001) but few subjects developed schizoaffective disorder, schizophrenia or bipolar affective disorder during…”
BackgroundHelp-seeking behaviour in patients with anxiety disorder and depression
Roness, A., Mykletun, A., & Dahl, A. A. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00433.x · Cited by 197 · see citing works
Rotondo, A., Mazzanti, C. M., Dell’Osso, L., Rucci, P., Sullivan, P. F., Bouanani, S., Gonnelli, C., Goldman, D. A., & Cassano, G. B. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.23 · Cited by 162 · see citing works
Whisman, M. A., & Uebelacker, L. A. (2006) · Journal of Family Psychology · doi:10.1037/0893-3200.20.3.369 · Cited by 161 · see citing works
“First, prior investigators have operationalized distress in terms of perceived health (e.g., Kessler et al., 1999) and suicide behavior (e.g., Roy-Byrne et al., 2000).”
BackgroundComorbid Bipolar Disorder and Panic Disorder in Families With a High Prevalence of Bipolar Disorder
MacKinnon, D. F., Zandi, P. P., Cooper, J., Potash, J. B., Simpson, S. G., Gershon, E. S., Nürnberger, J. I., Reich, T., & DePaulo, J. R. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.30 · Cited by 158 · see citing works
Textbook of Psychiatric Epidemiology
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Avoidance mediates the relationship between anxiety and depression over a decade later
Jacobson, N. C., & Newman, M. G. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.03.007 · Cited by 149 · see citing works
Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V
Craske, M. G., Kircanski, K., Epstein, A., Wittchen, H.-U., Pine, D. S., Lewis-Fernández, R., Hinton, D., Anxiety, D. V., Spectrum, O., & Posttraumatic and Dissociative Disorder Work Group (2010) · Depression and Anxiety · doi:10.1002/da.20654 · Cited by 147 · see citing works
Muntingh, A. D., van der Feltz-Cornelis, C. M., van Marwijk, H. W., Spinhoven, P., Penninx, B. W., & van Balkom, A. J. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-66 · Cited by 147 · see citing works
Panic Attack as a Risk Factor for Severe Psychopathology
Goodwin, R. D., Lieb, R., Hoefler, M., Pfister, H., Bittner, A., Beesdo‐Baum, K., & Wïttchen, H. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.12.2207 · Cited by 147 · see citing works
“0%), and this finding is consistent with results from cross-sectional studies among adults (9, 10, 16).”
BackgroundResultKircanski, K., LeMoult, J., Ordaz, S. J., & Gotlib, I. H. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.006 · Cited by 148 · see citing works
“This form of co-occurrence is associated with a more severe and protracted clinical course, greater disability, and higher risk for suicide than is either category of disorder alone (Ballenger et al., 2001; Bruce et al., 2005; Fava et al., 2006; Kessler et al., 1999; Lamers et al., 2011; Roy-Byrne et al., 2000; Seo et…”
BackgroundEpidemiology and natural history of schizophrenia
Bromet, E. J., & Fennig, S. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00153-5 · Cited by 144 · see citing works
Gardenswartz, C. A. R., & Craske, M. (2001) · Behavior Therapy · doi:10.1016/s0005-7894(01)80017-4 · Cited by 157 · see citing works
Wïttchen, H., Lieb, R., Pfister, H., & Schuster, P. (2000) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(00)80018-8 · Cited by 131 · see citing works
“There is a substantial and significant co-occurrence of diagnoses both within and between major classes of disorders, with particularly high lifetime and current comorbidity rates between anxiety and depressive disorders.(7-13) Additional data on the age of first onset have allowed the incidence of various diagnoses t…”
BackgroundDavidson, J. R. T., Meoni, P., Haudiquet, V., Cantillon, M., & Hackett, D. (2002) · Depression and Anxiety · doi:10.1002/da.10045 · Cited by 131 · see citing works
“…it is associated with a worse prognosis and poorer outcome [Van Valkenburg et al., 1984; Grunhaus, et al., 1988] and with increased incidences of suicide, social distress, and alcohol and drug abuse [Fawcett and Kravitz, 1983; Fawcett, 1992; Roy-Byrne et al., 2000; Vollrath and Angst, 1989].”
BackgroundBruce, S. E., Vasile, R. G., Goisman, R. M., Salzman, C., Spencer, M., Machan, J. T., & Keller, M. B. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.8.1432 · Cited by 127 · see citing works
Halbreich, U., & Kahn, L. S. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.09.023 · Cited by 133 · see citing works
Norton, P. J., Barrera, T. L., Mathew, A. R., Chamberlain, L. D., Szafranski, D. D., Reddy, R., & Smith, A. H. (2013) · Depression and Anxiety · doi:10.1002/da.22018 · Cited by 121 · see citing works
de Graaf, R., Bijl, R., ten Have, M., Beekman, A., & Vollebergh, W. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.03.001 · Cited by 133 · see citing works
Cairney, J., Corna, L., Veldhuizen, S., Herrmann, N., & Streiner, D. L. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000300627.93523.c8 · Cited by 120 · see citing works
Depression in primary care: part 1—screening and diagnosis
Ferenchick, E. K., Ramanuj, P., & Pincus, H. A. (2019) · BMJ · doi:10.1136/bmj.l794 · Cited by 118 · see citing works
Nuyen, J., Volkers, A., Verhaak, P., Schellevis, F., Groenewegen, P., & van den Bos, G. V. D. (2005) · Psychological Medicine · doi:10.1017/s0033291705004812 · Cited by 132 · see citing works
Urinary biomarker panel for diagnosing patients with depression and anxiety disorders
Chen, J., Bai, S., Li, W., Zhou, C., Zheng, P., Fang, L., Wang, H., Liu, Y., & Xie, P. (2018) · Translational Psychiatry · doi:10.1038/s41398-018-0245-0 · Cited by 112 · see citing works
Determinants of help-seeking behavior in depression: a cross-sectional study
Boerema, A. M., Kleiboer, A., Beekman, A. T. F., van Zoonen, K., Dijkshoorn, H., & Cuijpers, P. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0790-0 · Cited by 110 · see citing works
Combination Treatment With Benzodiazepines and SSRIs for Comorbid Anxiety and Depression
Dunlop, B. W., & Davis, P. G. (2008) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.v10n0307 · Cited by 107 · see citing works
Relation between depression and anxiety in dystonic patients: implications for clinical management
Moraru, E., Schnider, P., Wimmer, A., Wenzel, T., Birner, P., Griengl, H., & Auff, E. (2002) · Depression and Anxiety · doi:10.1002/da.10039 · Cited by 101 · see citing works
The 12-Month Prevalence and Trends in DSM-IV Alcohol Abuse and Dependence
Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. P., Dufour, M. C., & Pickering, R. P. (2006) · Cited by 102 · see citing works
Mellman, T. A., Miller, A. L., Weissman, E. M., Crismon, M. L., Essock, S. M., & Marder, S. R. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.5.619 · Cited by 102 · see citing works
Evidence-Based Hypnotherapy for Depression
Alladin, A. (2010) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140903523194 · Cited by 101 · see citing works
“The comorbidity of anxiety and depression is associated with an increased severity of symptoms, psychological distress, overall impairment ( Roy-Byrne et al, 2000 ), and an increased suicide rates ( Lecrubier, 1998 ).”
Assessment of anxiety and depression among substance use disorder patients: a case-control study
Mohamed, I., Ahmad, H. E. K., Hassaan, S. H., & Hassan, S. M. S. (2020) · Middle East Current Psychiatry · doi:10.1186/s43045-020-00029-w · Cited by 102 · see citing works
Long-term work disability and absenteeism in anxiety and depressive disorders
Hendriks, S. M., Spijker, J., Licht, C. M. M., Hardeveld, F., de Graaf, R., Batelaan, N. M., Penninx, B. W. J. H., & Beekman, A. T. F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.03.004 · Cited by 101 · see citing works
Psychometric Properties of Two Brief Versions of the Hopkins Symptom Checklist: HSCL-5 and HSCL-10
Schmalbach, B., Zenger, M., Tibubos, A. N., Kliem, S., Petrowski, K., & Brähler, E. (2021) · Assessment · doi:10.1177/1073191119860910 · Cited by 107 · see citing works
“This can partly be explained by the high comorbidity of not only depression and anxiety disorders (Brady & Kendall, 1992; Roy-Byrne et al., 2000) but also the high comorbidity with other diseases, such as coronary heart disease and diabetes, as well as others (Anderson, Freedland, Clouse, &…”
BackgroundDSM–IV pain disorder in the general population
Fröhlich, C., Jacobi, F., & Wïttchen, H. (2005) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-005-0625-3 · Cited by 97 · see citing works
Predicting Panic Disorder Among Patients With Chest Pain: An Analysis of the Literature
Huffman, J. C., & Pollack, M. H. (2003) · Psychosomatics · doi:10.1176/appi.psy.44.3.222 · Cited by 97 · see citing works
Regulation of the Hypothalamic–Pituitary–Adrenocortical System in Patients with Panic Disorder
Erhardt, A., Ising, M., Unschuld, P. G., Kern, N., Lucae, S., Pütz, B., Uhr, M., Binder, E. B., Holsboer, F., & Keck, M. E. (2006) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301168 · Cited by 97 · see citing works
“%) clinical condition causing a high number of hospital admissions (Merikangas et al, 1996; Roy-Byrne et al, 2000).”
BackgroundMason, W. A., Kosterman, R., Hawkins, J. D., Herrenkohl, T. I., Lengua, L. J., & McCauley, E. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200403000-00012 · Cited by 96 · see citing works
Mental Disorder Comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey
Scott, K. M., McGee, M. A., Browne, M. A. O., & Wells, J. E. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2006.01906.x · Cited by 95 · see citing works
Hatzenbuehler, M. L., Keyes, K. M., Narrow, W. E., Grant, B. F., & Hasin, D. S. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0711 · Cited by 94 · see citing works
Corticotropin-releasing factor, vasopressin and receptor systems in depression and anxiety
Keck, M. E. (2006) · Amino Acids · doi:10.1007/s00726-006-0333-y · Cited by 92 · see citing works
Cameron, O. G., Huang, G., Nichols, T. E., Koeppe, R. A., Minoshima, S., Rose, D. S., & Frey, K. A. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.7.793 · Cited by 90 · see citing works
Association of polymorphisms in P2RX7 and CaMKKb with anxiety disorders
Erhardt, A., Lucae, S., Unschuld, P. G., Ising, M., Kern, N., Salyakina, D., Lieb, R., Uhr, M., Binder, E. B., Keck, M. E., et al. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.11.016 · Cited by 87 · see citing works
The prediction of nonresponse to pharmacotherapy in panic disorder: A review
Slaap, B. R., & den Boer, J. A. (2001) · Depression and Anxiety · doi:10.1002/da.1053 · Cited by 88 · see citing works
NEURONAL NETWORK OF PANIC DISORDER: THE ROLE OF THE NEUROPEPTIDE CHOLECYSTOKININ
Zwanzger, P., Domschke, K., & Bradwejn, J. (2012) · Depression and Anxiety · doi:10.1002/da.21919 · Cited by 87 · see citing works
Heldt, E., Manfro, G. G., Kipper, L., Blaya, C., Maltz, S., Isolan, L., Hirakata, V. N., & Otto, M. W. (2002) · Psychotherapy and Psychosomatics · doi:10.1159/000067188 · Cited by 87 · see citing works
Hovland, A., Pallesen, S., Hammar, Å., Hansen, A. L., Thayer, J. F., Tarvainen, M. P., & Nordhus, I. H. (2012) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2012.10.004 · Cited by 86 · see citing works
Marijuana use and depression among adults: testing for causal associations
Harder, V. S., Morral, A. R., & Arkes, J. A. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01545.x · Cited by 84 · see citing works
Lazareck, S., Robinson, J. A., Crum, R., Mojtabai, R., Sareen, J., & Bolton, J. (2012) · Journal of Clinical Psychiatry · doi:10.4088/jcp.11m07345 · Cited by 67 · see citing works
Correlates of Generalized Anxiety and Panic Attacks in Dystonia and Parkinson Disease
Lauterbach, E. C., Freeman, A., & Vogel, R. L. (2003) · Cognitive and Behavioral Neurology · doi:10.1097/00146965-200312000-00004 · Cited by 82 · see citing works
Mechanisms of comorbidity, continuity, and discontinuity in anxiety-related disorders
McNaughton, N., & Corr, P. J. (2016) · Development and Psychopathology · doi:10.1017/s0954579416000699 · Cited by 80 · see citing works
“…as depression comorbid with anxiety but where both sets of symptoms are generated by a common underlying dysfunction that is more chronic and severe than those giving rise to anxiety or depression, separately, and which is accompanied by a higher suicide risk (Roy-Byrne et al., 2000).”
Background
- Authors
- Roy-Byrne, P. P., Stang, P., Wittchen, H.-U., Ustun, B., Walters, E. E., & Kessler, R. C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Harvard University (US)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2000-03
- Volume
- 176
- Issue
- 3
- Pages
- 229-235
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2004030076
- Cited by
- 446
- References
- 29
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 27 · 2021: 14 · 2020: 13 · 2019: 15 · 2018: 14 · 2017: 16 · 2016: 15 · 2015: 19 · 2014: 25 · 2013: 22 · 2012: 26
- FWCI
- 28.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Funders
- National Institutes of Health (5r01mh052861-04)
- National Institute of Mental Health (MH52861, R01 MH52861, K05 MH 00507, R01MH046376, MH 00507, MH-49098, R01 MH46376, MH 46376, 90135190, R01-MH49098, R01MH049098)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- panic disorder, depression, comorbidities, symptom severity, role impairment, suicidality, help-seeking, clinical course, National Comorbidity Survey
- MeSH terms
- Adolescent, Adult, Depression, Female, Health Surveys, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Severity of Illness Index, United States, Comorbidity, Prevalence, Panic Disorder, Age of Onset
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