Department of Psychology, University of Illinois at Chicago, 1007 West Harrison Street (M/C 285), Chicago, IL, 60607-7137, USA.
Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2019 May;54(5):639-647. doi: 10.1007/s00127-018-1559-1. Epub 2018 Jul 12.
Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults.
Participants were community-dwelling adults (62.6% women; M = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder.
PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207-1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597-1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = - 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women.
Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.
创伤后应激障碍（PTSD）常与惊恐障碍（PD）共病，一些病因学模型假设惊恐反应在 PTSD 发病中的因果作用；然而，缺乏关于这些情况时间顺序的数据。本研究旨在检查创伤后暴露的全国代表性流行病学样本中 PD 和 PTSD 之间的双向关联。
参与者为社区居住的成年人（62.6%为女性；M=48.9，SD 16.3），他们在一生中经历了 DSM-IV PTSD 标准 A 创伤暴露，这些创伤来自 2001/2 年全国酒精相关情况和条件流行病学调查（NESARC），并在 2004/5 年重新接受采访（N=12467）。使用具有时变协变量的 Cox 离散时间比例风险模型来研究 PD 和 PTSD 之间的双向关联，同时考虑人口统计学特征、创伤负荷以及一生中的重度抑郁症、广泛性焦虑症和社交焦虑症病史。
PD 与随后发生的 PTSD 显著相关（HR 1.210，95%CI=1.207-1.214，p<0.001），而 PTSD 与 PD 的发生显著相关（HR 1.601，95%CI 1.597-1.604，p<0.001）。与 PTSD 相比，PD 与随后发生 PD 的关联强度更大（Z=-275.21，p<0.01）。与女性相比，男性 PD 和 PTSD 之间的关联更强。
结果与风险的双向途径一致，即 PD 显著增加了 PTSD 发病的风险，而 PTSD 显著增加了 PD 的风险。鉴于 PTSD 与随后发生 PD 的关联，尤其是在男性中，临床医生可能会考虑在 PTSD 治疗中补充惊恐特异性干预措施，例如内感受暴露，以预防或治疗这种致残性共病。
