Quality of life in early phases of panic disorder: Predictive factors

Abstract

Objective

To analyse the quality of life (QoL) of patients with panic disorder of recent onset and to find related clinical variables.

Method

Panic disorder patients with and without agoraphobia (N = 125) in the first stages of the disorder (median of 8 months since the first panic attack) were compared with a community control group. Quality of life was evaluated by 36-item Short-Form Health Survey (SF-36) and by a single-item scale evaluating subjective well-being.

Results

Panic disorder patients had worse scores than the general population in all of the dimensions of the SF-36. Anxiety and depressive symptoms, age, frequency of panic attacks and agoraphobic avoidance accounted for 18–42% of the variance in QoL scores. Frequency of panic attacks and agoraphobic avoidance were variables accounting for poor QoL in physical functioning and mental health respectively. However, unspecific factors in addition to panic symptomatology, particularly depressive and anxiety symptoms, significantly contribute to the worse QoL of these patients.

Conclusion

Panic disorder of recent onset is a deteriorating condition. Clinical variables do not equally affect mental health and physical functioning, and unspecific factors in addition to panic contribute to the poor QoL.

Introduction

Anxiety disorders are among the most prevalent of all psychiatric illnesses (Kessler et al., 1994), and the negative effect of these disorders on physical and emotional health is well documented (Mogotsi et al., 2000, Mendlowicz and Stein, 2000, Quilty et al., 2002). In addition, they are associated with reduced labour force participation, degraded employment trajectories and worse work performance compared to people with disabilities or long term health conditions, and they influence subjective well-being, contact with friends, and self-realization; such as two recent studies have reported (Waghorn et al., 2005, Cramer et al., 2005). For these reasons, it is surprising that little attention has been paid to the role of quality of life (QOL) in the anxiety disorders compared to “severe” psychiatric disorders such as schizophrenia and bipolar disorder (Mogotsi et al., 2000).

In the last years one of the most studied anxiety disorder is panic disorder (PD). With a generally chronic and recurrent course (Liebowitz, 1997, Katsching and Amering, 1998), and high prevalence rates (Gago, 1992, Kessler et al., 1994, Eaton et al., 1994, Eaton, 1995), it is expected to cause a major impact on quality of life (QoL). Data regarding quality of life in panic disorder derive from two types of sources: community studies and clinical studies (Mendlowicz and Stein, 2000). Epidemiological studies like the Epidemiological Catchment Area (ECA) or the National Comorbidity Survey (NCS) are significant sources of data regarding the impact of panic disorder on quality of life and offer results from unselected populations free of selection biases. In the ECA study persons with lifetime panic disorder had poorer physical and mental health compared to subjects with no disorder, and a similar QoL compared to individuals with major depression (Mendlowicz and Stein, 2000). Moreover, community samples of individuals with PD report a high frequency of public financial assistance, substance abuse, suicide attempts and occupational and marital difficulties (Markowitz et al., 1989, cited in: Quilty et al., 2002). Finally, in a recent epidemiological study, PD is the second reason of QoL loss, at the back of neurological problems and in front of somatic ones (cardiac, respiratory and diabetes) and mental diseases (depressive episode, phobias etc.) when lost work days due to the disorder are considered (Alonso et al., 2004).

On the other hand, clinical samples of PD also report poor physical and emotional health (Sherbourne et al., 1996, Hollifield et al., 1997, Candilis et al., 1999, Simon et al., 2002). This kind of study offers the possibility of a more detailed assessment of clinical variables accounting for the loss of QoL. Hollifield et al. (1997) found that comorbidity with major depression, increasing neuroticism and age, and less education accounted for 48–77% of the variance in QoL scores. Mogotsi et al. (2000) also found that comorbid depression, worry, severity of chest pain, quality of social support and disability at baseline predicted poorer QOL.

However, both epidemiological and clinical samples include patients in different stages of the disorder. Even in clinical studies patients in diverse stages of the disorder are included, and bad prognosis or resistant cases could be over-represented. In that case, we can ask ourselves; is QoL also affected in first stages of panic disorder? Is QoL also affected in unselected clinical cases of PD and not only in cases referred to specialized centres?

To overcome these limitations we studied a sample of never treated patients in the initial phases of PD. The current study had two primary aims. The first was to compare quality of life in PD with a community control group. The second was to identify variables predicting a poor QoL in early phases of panic disorder.