Epidemiology of panic disorder and subthreshold panic symptoms in the Greek general population
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Panic disorder (PD) is a common anxiety disorder with severe social and health consequences in the lives of individuals who suffer from it. General population studies that attempt to measure the prevalence of this disorder across the world suggest that a 1.7% to 4.7 % of adults and adolescents suffer from Panic Disorder. In Greece, research analyzing the abovementioned matters is limited, and previous studies were put forward in small samples. The aim of the present study was to describe the prevalence and sociodemographic associations of panic disorder (PD) and related subthreshold panic symptoms in the general population of Greece and to appraise the comorbidity, use of services and impact on quality of life of these syndromes. This was a secondary analysis of the 2009-2010 psychiatric morbidity survey carried out in a representative sample of the Greek general population (4894 participants living in private households, 18-70 years, response rate 54%). Psychiatric disorders were assessed with the computerized version of the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D generic instrument. The utilization of health services was examined by making relevant questions. Finally, direct questions were used to assess sociodemographic and socioeconomic factors According to our findings, 1.87% of the participants (95% confidence interval [CI]: 1.50-2.26%) met criteria for PD and 1.61% met criteria for subclinical PD (95% CI: 1.26-1.96%). There was a clear female preponderance for both PD (p=0.001) and Sub-PD (p=0.01). In addition, 3.48% of the participants reported having experienced panic attacks during the past week (95% confidence interval [CI]: 2.98-4.01%). PD or subclinical PD was independently associated with a limited number of sociodemographic and socioeconomic variables especially after the adjusted analysis. Both panic related conditions involved significant reductions in quality of life and elevated utilization of health services for both medical and psychological reasons in comparison to healthy participants. In conclusion, PD and subclinical panic symptoms were common in the general Greek population with substantial comorbidity and impaired quality of life. The observed use of the general and psychological health services among adults with panic symptoms and its temporal and economic consequences calls for more efficient diagnostic and treatment policies.
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Greater anxiety symptom severity is associated with poorer quality of life in adolescents, adults, and older adults with anxiety.
“Specifically, anxiety symptom severity was inversely associated with QOL among adolescents with anxiety [12–14], adults with anxiety [15–21], and older adults with anxiety [22].”
From Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research (2021) · cites this paper as [19]
In “Comorbidity, quality of life and use of health services” (page unavailable), adults with full panic disorder had lower quality-of-life scores than those with subclinical panic disorder (0.52 versus 0.64), supporting the adult portion of the association. The paper compares panic-disorder categories rather than measuring anxiety symptom severity across anxiety disorders; it does not establish the association separately for adolescents or older adults. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIndividuals with panic disorder or subthreshold panic symptoms are more likely to use medical and psychological health services and report poorer quality of life than individuals without panic symptoms.
“Specifically, individuals with PD or subthreshold panic symptoms were more likely to utilize medical and psychological health services, and endorsed poorer QOL, compared to individuals without panic symptoms [19].”
From Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research (2021) · cites this paper as [19]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Kessler, R. C., & Üstün, T. B. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.168 · Cited by 4,771 · see citing works
Lewis, G., Pelosi, A. J., Araya, R., & Dunn, G. (1992) · Psychological Medicine · doi:10.1017/s0033291700030415 · Cited by 1,487 · see citing works
Preventive strategies for mental health
Arango, C., Díaz-Caneja, C. M., McGorry, P. D., Rapoport, J., Sommer, I. E., Vorstman, J. A., McDaid, D., Marín, O., Serrano-Drozdowskyj, E., Freedman, R., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30057-9 · Cited by 1,271 · see citing works
Full and partial posttraumatic stress disorder: findings from a community survey
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.8.1114 · Cited by 1,013 · see citing works
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., Shea, M. T., & Keller, M. B. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.6.1179 · Cited by 963 · see citing works
Quality-of-Life Impairment in Depressive and Anxiety Disorders
Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.6.1171 · Cited by 914 · see citing works
The Descriptive Epidemiology of Commonly Occurring Mental Disorders in the United States
Kessler, R. C., & Wang, P. S. (2008) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.29.020907.090847 · Cited by 888 · see citing works
Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.4.415 · Cited by 795 · see citing works
Personality and Major Depression: A Swedish Longitudinal, Population-Based Twin Study
Kendler, K. S., Gatz, M., Gardner, C. O., & Pedersen, N. L. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.10.1113 · Cited by 663 · see citing works
The epidemiology of DSM-III-R bipolar I disorder in a general population survey
Kessler, R. C., Rubinow, D. R., Holmes, C. A., Abelson, J. M., & Zhao, S. (1997) · Psychological Medicine · doi:10.1017/s0033291797005333 · Cited by 600 · see citing works
Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., Welton, N. J., Baxter, H., Kessler, D., Churchill, R., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30069-4 · Cited by 407 · see citing works
Self-citationNepon, J., Belik, S.-L., Bolton, J., & Sareen, J. (2010) · Depression and Anxiety · doi:10.1002/da.20674 · Cited by 374 · see citing works
Mild Disorders Should Not Be Eliminated From the DSM-V
Kessler, R. C., Merikangas, K. R., Berglund, P., Eaton, W. W., Koretz, D. S., & Walters, E. E. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.11.1117 · Cited by 348 · see citing works
The epidemiology of panic disorder and agoraphobia in Europe
Goodwin, R. D., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., & Wïttchen, H. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.006 · Cited by 243 · see citing works
de Jonge, P., Roest, A. M., Lim, C. C. W., Florescu, S. E., Bromet, E. J., Stein, D. J., Harris, M., Nakov, V., Caldas-de-Almeida, J. M., Levinson, D., et al. (2016) · Depression and Anxiety · doi:10.1002/da.22572 · Cited by 229 · see citing works
Aalto, M., Alho, H., Halme, J. T., & Seppä, K. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.02.013 · Cited by 182 · see citing works
Validity of the EuroQoL (EQ-5D) Instrument in a Greek General Population
Kontodimopoulos, N., Pappa, E., Niakas, D. A., Yfantopoulos, J., Dimitrakaki, C., & Tountas, Y. (2008) · Value in Health · doi:10.1111/j.1524-4733.2008.00356.x · Cited by 169 · see citing works
Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015
Guo, X., Meng, Z., Huang, G., Fan, J., Zhou, W., Ling, W., Jiang, J., Long, J., & Su, L. (2016) · Scientific Reports · doi:10.1038/srep28033 · Cited by 168 · see citing works
Reed, V., & Wittchen, H. (1998) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(98)00014-4 · Cited by 162 · see citing works
The Separation Anxiety Hypothesis of Panic Disorder Revisited: A Meta-Analysis
Kossowsky, J., Pfaltz, M. C., Schneider, S., Taeymans, J., Locher, C., & Gaab, J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12070893 · Cited by 159 · see citing works
Vermani, M., Marcus, M., & Katzman, M. A. (2011) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.10m01013 · Cited by 154 · see citing works
Skapinakis, P., Bellos, S., Koupidis, S. A., Grammatikopoulos, I. A., Theodorakis, P. N., & Mavreas, V. G. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-163 · Cited by 149 · see citing works
Self-citationPanic Disorder and Migraine: Comorbidity, Mechanisms, and Clinical Implications
Smitherman, T. A., Kolivas, E. D., & Bailey, J. (2012) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12004 · Cited by 107 · see citing works
Battaglia, M., Pesenti-Gritti, P., Medland, S., Ogliari, A., Tambs, K., & Spatola, C. A. M. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2008.513 · Cited by 107 · see citing works
Anxiety Disorders in Primary Care
Combs, H. L., & Markman, J. (2014) · Medical Clinics of North America · doi:10.1016/j.mcna.2014.06.003 · Cited by 88 · see citing works
Panic Disorder Comorbidity with Medical Conditions and Treatment Implications
Meuret, A. E., Kroll, J. L., & Ritz, T. (2017) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093044 · Cited by 88 · see citing works
Epidemiology of anxiety disorders
Michael, T., & Margraf, J. (2004) · Psychiatry · doi:10.1383/psyt.3.4.2.32909 · Cited by 87 · see citing works
CHILDHOOD SEPARATION ANXIETY DISORDER AND ADULT ONSET PANIC ATTACKS SHARE A COMMON GENETIC DIATHESIS
Roberson‐Nay, R., Eaves, L. J., Hettema, J. M., Kendler, K. S., & Silberg, J. L. (2012) · Depression and Anxiety · doi:10.1002/da.21931 · Cited by 73 · see citing works
Quality of life in panic disorder: looking beyond symptom remission
Davidoff, J., Christensen, S., Khalili, D. N., Nguyen, J., & IsHak, W. W. (2011) · Quality of Life Research · doi:10.1007/s11136-011-0020-7 · Cited by 68 · see citing works
Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder
Batelaan, N., de Graaf, R., van Balkom, A. V., Vollebergh, W., & Beekman, A. (2006) · Psychological Medicine · doi:10.1017/s0033291706009007 · Cited by 67 · see citing works
Shear, M. K. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.7.125 · Cited by 61 · see citing works
Busch, F. N., Cooper, A. M., Klerman, G. L., Penzer, R. J., Shapiro, T., & Shear, M. K. (1991) · Psychoanalytic Inquiry · doi:10.1080/07351699109533861 · Cited by 61 · see citing works
Clinical and subthreshold panic disorder
Bystritsky, A., Kerwin, L. E., Niv, N., Natoli, J. L., Abrahami, N., Klap, R. S., Wells, K. B., & Young, A. S. (2009) · Depression and Anxiety · doi:10.1002/da.20622 · Cited by 60 · see citing works
GENETIC AND ENVIRONMENTAL CONTRIBUTIONS TO SEPARATION ANXIETY: A META-ANALYTIC APPROACH TO TWIN DATA
Scaini, S., Ogliari, A. L., Eley, T. C., Zavos, H. M. S., & Battaglia, M. (2012) · Depression and Anxiety · doi:10.1002/da.21941 · Cited by 59 · see citing works
Botega, N. J., Pereira, W. A. B., Bio, M. R., Garcia, C., & Zomignani, M. A. (1995) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00802041 · Cited by 50 · see citing works
Health Care Use and Quality of Life Among Patients with Asthma and Panic Disorder
Feldman, J. M., Lehrer, P. M., Soo Borson, B., Hallstrand, T. S., & Siddique, M. I. (2005) · Journal of Asthma · doi:10.1081/jas-200054633 · Cited by 49 · see citing works
Skapinakis, P., Lewis, G., Davies, S., Brugha, T. S., Prince, M. J., & Singleton, N. (2010) · European Psychiatry · doi:10.1016/j.eurpsy.2010.06.004 · Cited by 48 · see citing works
Self-citationChou, K. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2424 · Cited by 39 · see citing works
Factores de riesgo de la conducta suicida asociados a trastornos depresivos y ansiedad
Baca‐García, E., & Aroca, F. (2014) · Salud Mental · doi:10.17711/sm.0185-3325.2014.044 · Cited by 38 · see citing works
Quality of life in early phases of panic disorder: Predictive factors
Carrera-Arce, M., Herrán, A., Ayuso‐Mateos, J. L., Sierra‐Biddle, D., RAMIREZ, M., Ayestarán, A., Hoyuela, F., Rodríguez‐Cabo, B., & Vázquez‐Barquero, J. L. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.03.006 · Cited by 38 · see citing works
Ages of Onset of Mood and Anxiety Disorders in Fragile X Premutation Carriers
Seritan, A. L., Bourgeois, J. A., Schneider, A., Mu, Y., Hagerman, R. J., & Nguyen, D. V. (2013) · Current Psychiatry Reviews · doi:10.2174/157340013805289662 · Cited by 36 · see citing works
Carta, M. G., Moro, M. F., Aguglia, E., Balestrieri, M., Caraci, F., Dell’Osso, L., Sciascio, G. D., Drago, F., Hardoy, M. C., d’Aloja, E., et al. (2015) · International Journal of Social Psychiatry · doi:10.1177/0020764015573848 · Cited by 35 · see citing works
Prevalence and treatment of common mental disorders in the English national population, 1993–2007
Spiers, N. A., Qassem, T., Bebbington, P., McManus, S., King, M., Jenkins, R., Meltzer, H., & Brugha, T. S. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.174979 · Cited by 35 · see citing works
Health Care Use and Quality of Life Among Patients with Asthma and Panic Disorder
Feldman, J. M., Lehrer, P. M., Borson, S., et al. (2005) · Journal of Asthma · doi:10.1081/jas-54633 · Cited by 31 · see citing works
Panic Disorder and Agoraphobia in OCD patients: Clinical profile and possible treatment implications
Torres, A. R., Ferrão, Y. A., Shavitt, R. G., Diniz, J. B., Costa, D. L. C., do Rosário, M. C., Miguel, E. C., & Fontenelle, L. F. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.11.017 · Cited by 22 · see citing works
Panic disorder and subthreshold panic in the light of comorbidity: a follow-up study
Oral, E., Aydın, N., Güleç, M., & Oral, M. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.01.009 · Cited by 12 · see citing works
Bipolar disorder and anxiety disorders.
Látalová, K., Praško, J. P., Grambal, A., Havlikova, P., Jelenova, D., Mainerová, B., Kamarádová, D., Ocisková, M., Sedlackova, Z., & Sandoval, A. (2013) · PubMed · Cited by 11 · see citing works
Psychiatric morbidity and social capital in rural communities of the Greek North Aegean islands
Tseloni, A., Zissi, A., & Skapinakis, P. (2010) · Journal of Community Psychology · doi:10.1002/jcop.20414 · Cited by 9 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 5
- Bystritsky A, Khalsa SS, Cameron ME, Schiffman J. Current Diagnosis and Treatment of Anxiety Disorders PT 2013, 8:30-57, PMID: 23599668
- Karelia J, Vala A, Parmar MC. A Study of Phenomenology of Panic Disorder & Assessment of Severity & Comorbidity of Panic Disorder: Phenomenology of Panic Disorder & Assessment of Severity. Natl J Integr Res Med [Internet]. 2018, 5:46-53, Available from: http://nicpd.ac.in/ojs-/index.php/njirm/ article/view/699
- Skapinakis P, Magklara K, Mpellos S, Gkatsa T, Mihalis G, Mavreas V. The association between socio-economic status and mental disorders in late adolescence: Cross-sectional sur- vey in the Northwestern part of Greece. Arch Hellen Med 2007, 24:19-29. Available from http://www.mednet.gr/archives/2007- sup/19abs.html
- Stylianidis S, Skapinakis P, Pantelidou S, Chondros P, Avgoustakis A, Ziakoulis M. Prevalence of common mental dis orders in an island area: needs assessment and planning of mental health actions. Arch Hellen Med 2010, 27:675-683 (in Greek). Available from http://mail.mednet.gr/archives/2010-4/ pdf/675.pdf
- Araya R, Rojas G, Fritsch R, Acuna J, Lewis G. Common mental disorders in Santiago, Chile: prevalence and socio- demographic correlates. Br J Psychiatry 2001, 178:228-233, PMID: 11230033
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Taguchi, K., Miyoshi, M., Seki, Y., Baba, S., & Shimizu, E. (2025) · JMIR Formative Research · doi:10.2196/63139 · Cited by 7 · see citing works
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- Authors
- Politis, S., Bellos, S., Hadjulis, M., Gournellis, R., Petrikis, P., Ploumpidis, D., & Skapinakis, P.
- Affiliations
- University of Ioannina (GR)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Skapinakis, P.
- Venue
- Psychiatriki
- Publisher
- Hellenic Psychiatric Association
- Published
- 2020-10-01
- Volume
- 31
- Issue
- 3
- Pages
- 201-215
- ISSN
- 1105-2333 (ISSN-L)
- OpenAlex
- W3093639960
- Cited by
- 10
- References
- 44
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 1 · 2021: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatriki (publishedVersion)
- PubMed (publishedVersion)
- 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, prevalence, sociodemographic factors, gender differences, quality of life, health care utilization, comorbidities, psychiatric morbidity
- MeSH terms
- Female, Greece, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Quality of Life, Risk Factors, Socioeconomic Factors, Comorbidity, Prevalence, Panic Disorder, Symptom Assessment
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