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.