Agoraphobia in adults: incidence and longitudinal relationship with panic.
BACKGROUND
Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.


OBJECTIVE
To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.


METHODS
A sample of 1920 adults in east Baltimore were assessed in 1981-1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatrist diagnoses were made in a subset of the sample at follow-up (n = 816).


RESULTS
Forty-one new cases of DIS/DSM-III-R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR = 12, 95% CI 3.2-45), as did younger age, female gender and other age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3-180; agoraphobia before panic OR=16, 95% CI 3.2-78).


CONCLUSIONS
The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV appears incorrect.
Bienvenu
O Joseph
OJ
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA. jbienven@jhmi.edu
Onyike
Chiadi U
CU
Stein
Murray B
MB
Chen
Li-Shiun
LS
Samuels
Jack
J
Nestadt
Gerald
G
Eaton
William W
WW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000379:Agoraphobia / Q000453:epidemiology*; D015142:Baltimore / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology*; D010698:Phobic Disorders / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors