The British Journal of Psychiatry (2006) 188: 432-438. doi: 10.1192/bjp.bp.105.010827
© 2006 The Royal College of Psychiatrists
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Agoraphobia in adults: incidence and longitudinal relationship with panic

O. JOSEPH BIENVENU, MD, PhD and CHIADI U. ONYIKE, MB, BS, MHS

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

MURRAY B. STEIN, MD, MPH

Departments of Psychiatry and Family and Preventive Medicine, University of California, San Diego, California

LI-SHIUN CHEN, MD, ScD

Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri

JACK SAMUELS, PhD and GERALD NESTADT, MB, BCh, MPH

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

WILLIAM W. EATON, PhD

Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

Correspondence: Dr O. J. Bienvenu, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287, USA. Tel: +1 410 614 9063; fax: +1 410 614 5913; e-mail: jbienven{at}jhmi.edu

Declaration of interest None.

Background Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.

Aims To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.

Method A sample of 1920 adultsin east Baltimore were assessed in 1981–1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS).Psychiatristdiagnoses were made in a subset of the sample at follow-up (n=816).

Results Forty-one new cases of DIS/DSM–III–R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM–III panic disorder predicted first incidence of agoraphobia (OR=12, 95% CI 3.2–45), as did younger age, femalegenderandother age, female gender and other phobias.Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI1.8–8.4).Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3–180; agoraphobia before panic OR=16, 95% CI 3.2–78).

Conclusions The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM–IV appears incorrect.


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