A Comprehensive Model of Predictors of Recurrence or Persistence in Individuals With Panic Disorder: Results From a National 3-Year Prospective Study.

Multiple factors may influence the risk of recurrence or persistence of panic disorder, suggesting the need to combine them into an integrative model to develop more effective prevention strategies. In this report, we sought to build a comprehensive model of the 3-year risk of recurrence or persistence in individuals with panic disorder using a longitudinal, nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2002; Wave 2, 2004-2005). We used structural equation modeling to simultaneously examine the effects of 5 broad groups of clinical factors previously identified as potential predictors of recurrence or persistence in adults with a past-year diagnosis of panic disorder (n = 775): (1) severity of panic disorder, (2) severity of comorbidity, (3) family history of psychiatric disorders, (4) sociodemographic characteristics, and (5) treatment-seeking behavior. The 3-year rates of persistence and recurrence were 13.0% and 27.6%, respectively. A general psychopathology factor, representing the shared effect of all comorbid psychiatric disorders, panic disorder liability, a lower physical health-related quality of life, a greater number of stressful life events, and the absence of treatment-seeking behavior at baseline, significantly and independently predicted recurrence or persistence of symptoms between the two waves (all  < .05). This integrative model could help clinicians to identify individuals at high risk of recurrence or persistence of panic disorder and provide content for future research.