Cross-national Epidemiology of Panic Disorder and Panic Attacks in the World Mental Health Surveys

Peter de Jonge, Annelieke Roest, Carmen Lim, Silvia Florescu, Evelyn Bromet, Dan Stein, Meredith Harris, Vladimir Nakov, Jose-Miguel Caldas-de-Almeida, Daphna Levinson, Al-Hamzawi Ali, Josep-Maria Haro, Maria Carmen Viana, Gui Borges, Siobhan O'Neill, Giovanni diGirolamo, Koen Demyttenaere, Oye Gurege, Noboru Iwata, Sing LeeChiyi Hu, Aimee Karam, Jacek Moskalewicz, Viviane Kovess-Masfety, Fernando Navarro-Mateu, Mark Oakley-Browne, Maria Piazza, Jose Posada-Vila, Yolanda Torres, Margaret Ten-Have, Ronald Kessler, Kate Scott

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129 Citations (Scopus)
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Context: The scarcity of cross-national reports and the changes in DSM-5 regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population.Objective: To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions.Design and Setting: Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0.Participants: Respondents (n=142,949) from 25 high, middle and lower-middle income countries across the world aged 18 years or older.Main Outcome Measures: PD and presence of single and recurrent PAs.Results: Lifetime prevalence of PAs was 13.2% (s.e. 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; s.e. 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (s.e. 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. Conclusions: We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.
Original languageEnglish
JournalDepression and Anxiety
Early online date24 Oct 2016
Publication statusPublished online - 24 Oct 2016


  • panic disorder
  • panic attack
  • mental health


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