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

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.