Risk factors for fearful spells, panic attacks and panic disorder in a community cohort of adolescents and young adults

- Data come from a 10-year prospective-longitudinal study in adolescents/ young adults.
- We examined risk factors for fearful spells, panic attacks and panic disorder.
- Similar risk factors predicted all three types of panic pathology.
- Strengths of associations tended to increase with panic severity.
- Fearful spells, panic attacks and panic disorder appear to be etiologically similar.

BackgroundPanic attacks (PA) and panic disorder (PD) as well as fearful spells only (FS-only, attacks of anxiety not meeting full criteria for PA or PD) increase the risk for various mental disorders. It is unclear so far whether FS-only, PA and PD share the same etiologies and risk factors.MethodsA representative community sample of adolescents and young adults (n=3021, aged 14-24 at baseline) was prospectively followed up over up to 10 years. Panic pathology and putative risk factors were assessed using the DSM-IV/M-CIDI and its embedded assessment modules and questionnaires.ResultsIn Cox regressions stratified by sex and age, female sex, parental anxiety and depression, behavioral inhibition, harm avoidance, lower coping-efficacy and parental rejection predicted the onset of FS-only, PA and PD (Hazard Ratios 1.2-3.0). Associations with other risk factors partially differed for FS-only, PA and PD and tended to be stronger for PA and PD than for FS-only.LimitationsNo strictly prospective analytical approach was used. Time intervals between some risk factors and their retrospective assessment were relatively long.ConclusionsFindings suggest that FS-only, PA and PD are etiologically similar and represent qualitatively equal, albeit differently severe forms of panic pathology that lie on different points of the same fear-panic dimension.