Panic disorder, comorbidity, and suicide attempts.

In a previous report, we demonstrated a strong association between panic disorder and suicide attempts based on data from the Epidemiologic Catchment Area study (a probability sample of more than 18,000 adults living in five US communities). In these analyses, although we controlled statistically for comorbidity of panic disorder with other psychiatric disorders, we did not directly estimate the risk of suicide attempts in persons with uncomplicated panic disorder (ie, without any other Axis I disorders) compared with those with comorbid conditions. Persons with uncomplicated panic disorder represent fewer than a third of persons with panic disorder. However, the lifetime rates of suicide attempts in persons with uncomplicated panic disorder (7%) were consistently higher than for persons with no psychiatric disorder (1%). Similar findings on the rate of suicide attempts in persons with uncomplicated major depression (7.9%) emerged. We conclude that suicide attempts are associated with panic disorder in its uncomplicated or its comorbid form and that the risks are comparable with those of major depression, comorbid and uncomplicated. These epidemiologic findings are discussed within a clinical perspective to explain why these associations may not appear obvious in clinical practice.