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The British Journal of Psychiatry (2000) 176: 229-235
© 2000 The Royal College of Psychiatrists

Lifetime panic-depression comorbidity in the National Comorbidity Survey

Association with symptoms, impairment, course and help-seeking

PETER P. ROY-BYRNE, MD

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine

PAUL STANG, PhD

Department of Epidemiology, University of North Carolina, and Smith-Kline-Beecham

HANS-ULRICH WITTCHEN, PhD

Department of Clinical Psychology, Max Planck Institute of Psychiatry Clinical Institute

BEDIRHAN USTUN, MD

World Health Organization

ELLEN WALTERS, MS and RONALD C. KESSLER, PhD

Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

Declaration of interest Funding received from the National Institute of Mental Health, the National Institute of Drug Abuse, the W.T.Grant Foundation and SmithKline Beecham Pharmaceuticals.

{dagger} Address comments or questions about the NCS data set to:R.C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. Tel: (617) 432-3587; fax: (617) 432-3588. See Acknowledgements for instructions on how to obtain a complete list of NCS documents and a copy of the NCS public use data tape from the Internet.

Correspondence: Peter Roy-Byrne, Professor and Vice-Chairman, Department of Psychiatry, University of Washington at Harborview Medical Center, 325 9th Avenue, Box 35911, Seattle, WA 98104, USA. Tel: (206) 731-3404; fax: (206) 731-3236

Background Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses.{dagger}

Aims General population data were used to study the association of lifetime and recent (12 months) panic-depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS).

Method The NCS is a nationally representative survey of the prevalences and correlates of major DSM-III-R disorders in the US household population.

Results Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary.

Conclusions Both lifetime and current panic-depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary-secondary distinction were important moderators of these associations.




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