title: Panic disorder and suicidal ideation in primary care.
abstract: The purpose of this study was to ascertain whether panic disorder (PD) and suicidal ideation are associated in an inner-city primary care clinic and whether this association remains significant after controlling for commonly co-occurring psychiatric disorders. We surveyed 2,043 patients attending a primary care clinic using the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, a screening instrument that yields provisional diagnoses of selected psychiatric disorders. We estimated the prevalence of current suicidal ideation and of common psychiatric disorders including panic disorder and major depression. A provisional diagnosis of current PD was received by 127 patients (6.2%). After adjusting for potential confounders (age, gender, major depressive disorder [MDD], generalized anxiety disorder, and substance use disorders), patients with PD were about twice as likely to present with current suicidal ideation, as compared to those without PD (adjusted odds ratio [AOR] = 1.84; 95% confidence interval [CI]: 1.06-3.18; P = .03). After adjusting for PD and the above-mentioned potential confounders, patients with MDD had a sevenfold increase in the odds of suicidal ideation, as compared to those without MDD (AOR = 7.00; 95% CI: 4.42-11.08; P < .0001). Primary care patients with PD are at high risk for suicidal ideation, and patients with PD and co-occurring MDD are at especially high risk. PD patients in primary care thus should be assessed routinely for suicidal ideation and depression.
authors.affiliation: Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York, New York, USA. dp14@columbia.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pilowsky
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Gameroff
authors.forename: Priya
authors.initials: P
authors.lastname: Wickramaratne
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Adriana
authors.initials: A
authors.lastname: Feder
authors.forename: Raz
authors.initials: R
authors.lastname: Gross
authors.forename: Yuval
authors.initials: Y
authors.lastname: Neria
authors.forename: Myrna M
authors.initials: MM
authors.lastname: Weissman
mesh_terms: D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D013406:Suicide, Attempted / Q000523:psychology*; D011795:Surveys and Questionnaires