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Lifetime panic–depression comorbidity in the National Comorbidity Survey: Association with symptoms, impairment, course and help-seeking
Open accessAbstract
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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“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]
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“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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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
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 109
Glashouwer, K. A., & de Jong, P. J. (2010) · Psychological Medicine · doi:10.1017/s0033291709991371 · Cited by 111
“…is in accordance with current and previous observations that comorbid patients also report relatively severe symptoms (see also Hecht et al. 1990 ; Roy-Byrne et al. 2000 ; Bruce et al. 2005) and provides further evidence for the link between the strength of implicit self-associations and the…”
ResultDeterminants 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
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 113
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
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
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
Evidence-Based Hypnotherapy for Depression
Alladin, A. (2010) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140903523194 · Cited by 101
“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
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
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
“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 100
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
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 96
“%) 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
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 99
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 95
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 95
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 89
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 88
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
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
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
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 85
Marijuana use and depression among adults: Testing for causal associations.
Harder, V., Morral, A., & Arkes, J. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01545.x · Cited by 92
Lazareck, S., Robinson, J. A., Crum, R. M., Mojtabai, R., Sareen, J., & Bolton, J. M. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11m07345 · Cited by 87
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
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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