Lifetime prevalence of panic disorder is about 5% in the USA
Q How common is panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without a history of panic disorder in the USA?
Cross sectional study.
General population, USA; 2001–02.
43 093 community dwelling adults aged over 18 years.
Participants were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version (AUDADIS-IV). People with organic or substance induced disorders were excluded.
Diagnosis of panic disorder with agoraphobia, panic disorder without agoraphobia, or agoraphobia without panic disorder.
The overall 12 month and lifetime prevalence rates for panic disorder (with or without agoraphobia) were 2.1% and 5.1%. The 12 month and lifetime prevalence rates for panic disorder with agoraphobia were 0.6% and 1.1%, while the corresponding rates for panic disorder without agoraphobia were 1.6% and 4.0%. Agoraphobia without panic disorder was uncommon (12 month prevalence 0.05%; lifetime prevalence 0.17%). Panic disorder with or without agoraphobia was more common in women, middle-aged people, people with low incomes, and those who were widowed, separated or divorced (see http://www.ebmentalhealth.com/supplemental for table). Panic disorders were more common in Native Americans, and less common in Hispanic, black, or Asian/Pacific Islanders than in white people.
About one in 20 people in the USA have a lifetime diagnosis of panic disorder. Panic disorder is more common in women, Native Americans, the middle-aged, people with low incomes, and people who are widowed, separated, or divorced.
- O Joseph Bienvenu, MD, PhD
The National Epidemiologic Survey on Alcohol and Related Conditions involves a huge representative US sample, with assessment of many common Axis I conditions and several personality disorders. Grant et al capitalised on these unique strengths to make important observations regarding panic disorder with and without agoraphobia in the general population. For example, the results indicate that panic disorder is substantially more common in Native Americans, compared to whites, and less common in blacks, Asians, and Hispanics. This information is particularly important for clinicians and healthcare planners who work in settings with large Native American communities. It was also observed that avoidant and dependent personality disorders are extremely common in people with panic and agoraphobia—this is not an artefact of ascertainment in clinical settings. Since the study was cross sectional, we should not assume a particular longitudinal relation between the conditions.
One unfortunate aspect of the study was the definition of agoraphobia without a history of panic disorder. The authors laudably attempted to overcome a limitation of previous large epidemiologic studies of agoraphobia—that is, those studies did not adequately address the nature of fears in typical agoraphobic situations (for example, crowds, tunnels/bridges, public transportation). The unfortunate part is that the authors chose to follow the definition of agoraphobia implied in DSM-IV:1 for this study, the nature of agoraphobic fear did not just relate to incapacitation, difficulty escaping, etc, but to developing panic/anxiety itself. In order to meet criteria for agoraphobia without a history of panic disorder, participants had to avoid typical agoraphobic situations for fear of panic, yet not meet criteria for panic disorder. Given this, it is not surprising that the prevalence of agoraphobia without a history of panic disorder was exceedingly low. The authors’ reasoning that their data supports Klein’s2 contention regarding panic as the cause of agoraphobia appears tautological.
For correspondence: Bridget F Grant PhD, Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, MS 9304, 5635 Fishers Lane, Bethesda, MD 20892-9304, USA;
Sources of funding: National Institute on Alcohol Abuse and Alcoholism, and National Institute of Drug Abuse, USA.