title: Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys.
abstract: The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population.
  
  
  
  To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions.
  
  
  
  Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0.
  
  
  
  Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older.
  
  
  
  PD and presence of single and recurrent PAs.
  
  
  
  Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder.
  
  
  
  We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.
authors: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Peter
authors: P
authors: de Jonge
authors: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Annelieke M
authors: AM
authors: Roest
authors: Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Carmen C W
authors: CC
authors: Lim
authors: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors: Silvia E
authors: SE
authors: Florescu
authors: Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors: Evelyn J
authors: EJ
authors: Bromet
authors: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
authors: Dan J
authors: DJ
authors: Stein
authors: School of Public Health, University of Queensland, Herston, QLD, Australia.
authors: Meredith
authors: M
authors: Harris
authors: Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.
authors: Vladimir
authors: V
authors: Nakov
authors: Chronic Diseases research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.
authors: Jose Miguel
authors: JM
authors: Caldas-de-Almeida
authors: Mental Health Services, Ministry of Health Israel, Israel.
authors: Daphna
authors: D
authors: Levinson
authors: College of Medicine, Al-Qadisiya University, Al Diwaniya City, Iraq.
authors: Ali O
authors: AO
authors: Al-Hamzawi
authors: CIBERSAM, Parc Sanitari Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain.
authors: Josep Maria
authors: JM
authors: Haro
authors: Department of Social Medicine, Federal University of Espirito Santo, Brazil.
authors: Maria Carmen
authors: MC
authors: Viana
authors: Instituo Nacional der Psiquiatria, Calzada Mexico Xochimilco, Mexico.
authors: Guilherme
authors: G
authors: Borges
authors: School of Psychology, University of Ulster, Londonderry, UK.
authors: Siobhan
authors: S
authors: O'Neill
authors: IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors: Giovanni
authors: G
authors: de Girolamo
authors: Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors: Koen
authors: K
authors: Demyttenaere
authors: Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria.
authors: Oye
authors: O
authors: Gureje
authors: Department of Psychology, Hiroshima International University, Hiroshima, Japan.
authors: Noboru
authors: N
authors: Iwata
authors: Department of Psychiatry, The Chinese University of Hongkong, Hongkong, China.
authors: Sing
authors: S
authors: Lee
authors: Institute of Mental Health, Peking University, Beijing, China.
authors: Chiyi
authors: C
authors: Hu
authors: Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
authors: Aimee
authors: A
authors: Karam
authors: Institute of Psychiatry and Neurology, Warsaw, Poland.
authors: Jacek
authors: J
authors: Moskalewicz
authors: Ecole des Hautes Estudies en Sante Pulbique, Paris Descartes University, Paris, France.
authors: Viviane
authors: V
authors: Kovess-Masfety
authors: Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca. Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP)-Murcia. Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain.
authors: Fernando
authors: F
authors: Navarro-Mateu
authors: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
authors: Mark Oakley
authors: MO
authors: Browne
authors: National Institute of Health, Peru, Universidad Cayetano Hereidia, St. Martin de Porres, Peru.
authors: Marina
authors: M
authors: Piazza
authors: El Bosque University, Bogota, Colombia.
authors: José
authors: J
authors: Posada-Villa
authors: Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
authors: Yolanda
authors: Y
authors: Torres
authors: Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
authors: Margreet L
authors: ML
authors: Ten Have
authors: Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA.
authors: Ronald C
authors: RC
authors: Kessler
authors: Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Kate M
authors: KM
authors: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009549:Nigeria / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D013020:South America / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: anxiety/anxiety disorders; assessment/diagnosis; epidemiology; international; panic attacks/agoraphobia