The epidemiology of panic disorder and agoraphobia in Europe

Abstract

A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7-2.2) and 1.3% (0.7-2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.

Panic disorder in later life: results from a national survey of Canadians

“…PD is found to be frequently comorbid with other physical and psychiatric conditions, including affective, anxiety, and substance use disorders (Beekman et al, 2000;Birchall et al, 2000;Goodwin et al, 2005). For this reason, we included 12-month major depression, social phobia, mania, and agoraphobia in this analysis; there were not enough cases of substance use disorders to include this variable.…”

“…Several sociodemographic risk markers were selected based on previous work on PD in the general population (Eaton et al, 1994;Kessler et al, 1994;Wang et al, 2000;Carlbring et al, 2002;Goodwin et al, 2005). These included age, sex, marital status, education, income adequacy and language spoken (defined here as the first language learned and still understood).…”

“…Published estimates of 12-month PD in the general adult population range from 0.7% to 2.3%, and 6-month prevalence estimates from 0.6% to 1.0% (Myers et al, 1984;Bland et al, 1988a;Kessler et al, 1994). A number of studies have excluded older adults altogether or not provided prevalence estimates by age group (Eaton et al, 1994;Kessler et al, 1994;Carlbring et al, 2002;Goodwin et al, 2005). Using DSM-III criteria, Beekman et al (1998) reported 12-month estimates for the youngest (55-64 years: 0.8%), middle (65-74 years: 1.7%) and oldest old (75-85 years: 0.5%) in their survey of adults from the Netherlands.…”

“…While some studies indicate that low education and low income are risk markers for PD or anxiety disorders in general (Eaton et al, 1994;Beekman et al, 1998), many studies have not assessed measures of socioeconomic position as predictors of PD (Wittchen and Essau, 1993). Finally, PD is associated with a number of other psychiatric disorders, including agoraphobia and depression (Beekman et al, 2000;Goodwin et al, 2005). However, our present understanding of these and other potential risk markers in later life is limited because many epidemiological studies either do not examine a full range of sociodemographic variables (Eaton et al, 1994;Offord et al, 1996) or, as we have noted, exclude older adults altogether.…”

Panic Disorder and Agoraphobia Across the Lifespan

“…The 12-month prevalence of panic disorder ranges between 1% and 3% across the United States (Kessler et al, 2012(Kessler et al, , 2005 and Europe (Goodwin et al, 2005;De Graaf et al, 2012). The 12-month prevalence of agoraphobia is approximately 1.7% in adolescents and adults (Kessler et al, 2012;Wittchen et al, 2011).…”