title: Smoking increases the risk of panic: findings from a prospective community study.
abstract: BACKGROUND
  We examined prospectively determined bidirectional associations between smoking and panic and other anxiety disorders and their temporal ordering of onset in a representative community sample of adolescents and young adults.
  
  
  METHODS
  Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders using the Munich-Composite International Diagnostic Interview.
  
  
  RESULTS
  At baseline, panic attacks and panic disorder were strongly associated with occasional and regular smoking and nicotine dependence (odds ratio [OR] range, 3.0-28.0). In the prospective analyses, we found increased risk for new onset of panic attacks with prior regular smoking (OR, 2.9; 95% confidence interval [CI], 1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior nicotine dependence increased also the risk for onset of panic disorder (OR, 3.3; 95% CI, 1.0-10.5), whereas preexisting panic was not associated with subsequent smoking or nicotine dependence. When using Cox regression with time-dependent covariates, prior nicotine dependence was confirmed to be related to subsequent panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic disorder (hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that prior panic attacks/disorder might also have an effect on secondary development of nicotine dependence.
  
  
  CONCLUSIONS
  In young adults, prospective analyses revealed a fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. However, we could not exclude the existence of a second, less frequent, reverse pathway of prior panic and secondary nicotine dependence.
authors.affiliation: Clinical Psychology and Epidemiology Unit, Max-Planck-Institute of Psychiatry, Munich, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Isensee
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012494:Sampling Studies; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology; D014029:Tobacco Use Disorder / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology