Childhood separation anxiety and the risk of subsequent psychopathology: Results from a community study.
OBJECTIVE
To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia.


METHODS
The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14-24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders.


RESULTS
Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6-58.7), specific phobia (HR = 2.7, 95% CI = 1.001-7.6), generalized anxiety disorder (HR = 9.4, 95% CI = 1.8-48.7), obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7-66.1), bipolar disorder (HR = 7.7, 95% CI = 2.8-20.8), pain disorder (HR = 3.5, 95% CI = 1.3-9.1), and alcohol dependence (HR = 4.7, 95% CI = 1.7-12.4). Increased hazard rates for PDAG (HR = 4.2, 95% CI = 1.4-12.1), bipolar disorder type II (HR = 8.1, 95% CI = 2.3-27.4), pain disorder (HR = 1.9, 95% CI = 1.01-3.5), and alcohol dependence (HR = 2.1, 95% CI = 1.1-4.) were also found for subjects fulfilling subthreshold SAD.


CONCLUSIONS
Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.
Brückl
Tanja M
TM
Department of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany. brueckl@mpipsykl.mpg.de
Wittchen
Hans-Ulrich
HU
Höfler
Michael
M
Pfister
Hildegard
H
Schneider
Silvia
S
Lieb
Roselind
R
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology; D001010:Anxiety, Separation / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D002675:Child, Preschool; D003156:Community Mental Health Services; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology*; D016584:Panic Disorder / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies