Mental disorders and total mortality after 20 years in an adult general population sample.

BACKGROUND: General population data on associations between mental disorders and total mortality are rare. The aim was to analyze whether the number of mental disorders, single substance use, mood, anxiety, somatoform or eating disorders during the lifetime and whether treatment utilization may predict time to death 20 years later in the general adult population. METHODS: We used data from the Composite International Diagnostic Interview, which includes DSM-IV diagnoses for substance use, mood, anxiety, somatoform, and eating disorders, for a sample of 4,075 residents in Germany who were 18-64 years old in 1996. Twenty years later, mortality was ascertained using the public mortality database for 4,028 study participants. Cox proportional hazards models were applied for disorders that existed at any time in life before the interview. RESULTS: The data revealed increased hazard ratios (HRs) for number of mental disorders (three or more; HR 1.4; 95% confidence interval [CI] 1.1-1.9) and for single disorders (alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis), with the reference group being study participants who had not suffered from any of the mental disorders analyzed and with adjustments made for age, sex, and education. Among individuals with any mental disorder during their lifetimes, having been an inpatient in treatment for a mental disorder was related to a higher HR (2.2; CI 1.6-3.0) than was not having been in any treatment for a mental disorder. CONCLUSIONS: In this sample of adults in the general population, three or more mental disorders, alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis were related to premature death.

Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database.

AIMS: To determine the risk of coronary heart disease (CHD), acute myocardial infarction (MI), and CHD-related mortality in patients with panic attacks/disorder. METHODS AND RESULTS: We conducted a cohort study using 650 practices in the 'General Practice Research Database'. We selected all 57 615 adults diagnosed with panic attacks/disorder and a random sample of 347 039 unexposed, frequency matched for sex/age, and measured incidence of CHD, MI, and CHD-related mortality rate. There was a significantly higher incidence of MI following new onset panic in people under 50 years of age, but not in older age groups. There was a higher incidence of CHD for all ages, more marked in those under 50 years, but no significant differences in CHD mortality. Fully adjusted models showed panic attacks/disorder were associated with a significantly increased hazard of MI in those under 50 years (HR 1.38, 95% CI 1.06-1.79) and CHD at all ages (<50 years, HR 1.44, 95% CI 1.25-1.65; > or =50 years, HR 1.11, 95% CI 1.03-1.20), but no increased hazard of MI over 50 years (HR 0.92, 95% CI 0.82-1.03), and a slightly reduced CHD-mortality at all ages (HR 0.76, 95% CI 0.66-0.88). CONCLUSION: New onset panic attacks/disorder were associated with increased hazard of subsequent CHD/MI diagnosis in younger people, but with less effect in people over 50, and a slightly reduced hazard of CHD-related mortality. This may be due to initial misdiagnosis of CHD as panic attacks or an underlying increased risk of CHD with panic attacks/disorder in younger people.

Association between short sleep and suicidal ideation and suicide attempt among adults in the general population.

OBJECTIVE: To determine the association between sleep, mental disorders, and suicidal ideation (SI) and suicide attempt (SA) among adults in the community. DESIGN: Cross-sectional. SETTING: National Comorbidity Survey (n = 8098). PARTICIPANTS: A representative sample of adults in the United States. MEASUREMENTS AND RESULTS: Multiple logistic regression analyses were used to determine the association between usual number of hours of sleep during a 24-h period and SI and SA (past 12 months and lifetime). Analyses were adjusted for differences in demographic characteristics and comorbid mental disorders. Additional analyses examined the relationship between hours of sleep and the odds of SA among adults with SI, compared with SI without SA. Short sleep was associated with significantly increased odds of SI (OR 2.5, 95% CI: 1.6-3.9) and SA (OR 3.0, 95% CI: 1.4-6.4), and with SA among those with SI (past 12 months). These associations persisted after adjusting for differences in demographic characteristics and mental disorders, though the links between short sleep and SA among those with SI were no longer statistically significant after adjusting for panic, mood, and substance use disorders. CONCLUSIONS: Short sleep appears to be associated with increased likelihood of SI and SA, independent of the effects of comorbid mental disorders, among adults in the community. Among adults with SI, short sleep is associated with increased odds of SA, and this association seems largely related to the presence of panic attacks, mood, and substance use disorders. Future studies should investigate the nature of these relationships, and whether and how mental health problems may play a role.

Heart rate variability in coronary artery disease patients with and without panic disorder.

Panic disorder (PD) and coronary artery disease (CAD) often co-occur, and CAD patients with comorbid PD suffer greater cardiovascular morbidity and mortality relative to CAD patients without PD. However, the mechanisms underlying these associations are still unknown. Reduced heart rate variability (HRV), a non-invasive measure of cardiac autonomic modulation, is an important predictor of adverse cardiac events. Interestingly, reduced HRV has been observed in patients with panic-like anxiety and PD, as well as in various CAD populations. However, the extent to which HRV is altered in patients with both PD and CAD is unknown. This study evaluated HRV in 42 CAD patients with (n=20) and without (n=22) PD. Patients underwent 48-h electrocardiographic monitoring. Power spectral analysis of HRV indicated that CAD patients with PD exhibited significantly lower LF/HF ratios, which may reflect lower sympathetic modulation, compared with non-PD patients. Additionally, total power in PD patients was made up of a significantly higher proportion of HF power and a significantly lower proportion of VLF power than in non-PD patients. No other significant differences in HRV indices were observed. Results suggest that contrary to what has been observed in the majority of PD-only and CAD-only populations; patients with both PD and CAD appear to exhibit lower sympathetic modulation during ordinary daily life conditions. Though preliminary, these findings suggest that changes in HRV may not be the mechanism underlying greater cardiovascular morbidity and mortality among CAD patients with PD.

Cardiovascular death from panic disorder and panic-like anxiety: a critical review of the literature.

Several symptoms of panic disorder mimic those of cardiovascular diseases and patients with this disorder frequently consult physicians with the fear of dying from a heart attack. The salient question is: Can the patient with panic disorder die from the cardiovascular consequences of his/her panic attacks? We critically review the six studies that have examined the association between panic disorder (or panic-like anxiety) and cardiovascular mortality or complications associated with the cardiovascular system. We then briefly review the evidence by which mechanisms panic may be linked to cardiovascular mortality and conclude with proposed guidelines for patient management.

Mortality of anxiety syndromes in a normal population. The Lundby Study.

The mortality of anxiety syndromes between 1972 and 1992 was investigated in a prospective study of a normal population, the 1947 Lundby cohort. 121 persons with anxiety according to the Lundby definition (Anx), and 74 persons with panic disorder with/without agoraphobia (PD-Ag) according to the DSM-III-R, all of them developing their first episode between 1947 and 1972, were analyzed with regard to general mortality and special cause of death. Sex- and age-specific mortality rates for these groups were calculated and compared with the corresponding rates of the cohort's 1,877 remaining subjects without first episodes of Anx/PD-Ag. In contrast to the females, the annual rates of general mortality in males with Anx/PD-Ag were 1.9/2.2 times higher in the age group 65-84 years, compared with the rates of the non-Anx/PD-Ag groups. They also had an increase in death due to circulatory disorders, most pronounced in males with PD-Ag before the age of 65. There were no suicides in any of the Anx/PD-Ag groups during the observation period.

Suicidal behavior in patients with panic disorder: retrospective and prospective data.

This paper examines factors associated with suicidal behavior in patients with anxiety disorders. HARP is a naturalistic, prospective, longitudinal follow-up study. This paper examines 527 subjects with panic disorder (with or without agoraphobia). 9% of the subjects reported past suicidal behavior. Factors associated with suicidal behavior were depressive disorders, substance abuse, eating disorders, PTSD and personality disorders as well as having early onset of the first anxiety or depressive disorder. Subjects had a 4.5% P of suicidal behavior during the first 30 months of follow-up. All prospectively recorded suicidal behavior occurred in subjects with depressive disorders. In these panic disorder patients, suicidal behavior rarely occurred in the absence of affective disorders. Certain nondepressive disorders also substantially increased the risks of suicide attempts/gestures.