title: Lifetime panic-depression comorbidity in the National Comorbidity Survey.
abstract: BACKGROUND
  The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population.
  
  
  METHODS
  Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression.
  
  
  RESULTS
  Strong associations were found between the lifetime prevalences of panic and major depressive episodes (odds ratios: for panic attacks with depression, 6.2; for panic disorder with depression, 6.8). These associations were not significantly influenced by the inclusion or exclusion of respondents with mania. Temporally primary depression predicted a first onset of subsequent panic attacks but not of panic disorder. Temporally primary panic attacks, with or without panic disorder and whether or not the panic was persistent, predicted a first onset of subsequent major depression. The associations between panic attack and depression were attenuated in models that controlled for prior traumatic life experiences and histories of other DSM-III-R disorders.
  
  
  CONCLUSIONS
  Lifetime panic-depression comorbidity characterizes most community respondents with panic disorder and a substantial few of those with major depression. The absence of a dose-response relationship suggests that primary panic attack is a marker, rather than a causal risk factor, of subsequent depression. Primary depression, in comparison, appears to be a genuine risk factor for secondary panic attacks. That primary depression predicts panic attacks but not panic disorder suggests that secondary panic is a severity marker of depression rather than a comorbid condition. These results are far from definitive because they are based on retrospective reports, lay-administered diagnostic interviews, and only 1 survey. However, they raise important questions that could lead to a fundamental rethinking of panic-depression comorbidity if they are replicated in future epidemiological and clinical studies.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Mass 02115, USA. kessler@hcp.med.harvard.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
authors.forename: P E
authors.initials: PE
authors.lastname: Stang
authors.forename: H U
authors.initials: HU
authors.lastname: Wittchen
authors.forename: T B
authors.initials: TB
authors.lastname: Ustun
authors.forename: P P
authors.initials: PP
authors.lastname: Roy-Burne
authors.forename: E E
authors.initials: EE
authors.lastname: Walters
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D015897:Comorbidity; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016584:Panic Disorder / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology