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

Background: Panic 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. Methods: A 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. Results: In 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. Limitations: No strictly prospective analytical approach was used. Time intervals between some risk factors and their retrospective assessment were relatively long. Conclusions: Findings 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. (C) 2016 Published by Elsevier B.V.