A new 'comprehensive' model integrating a variety of factors may help flag individuals at risk for recurrence or persistence of panicdisorder, new research suggests.
PD is a disabling disorder with a"chronic course" — and a recurrence rate ranging from 25% to 50%, the investigators note. "Because of the heterogeneous course of PD, there is a need to develop a comprehensive predictive model of recurrence or persistence," they write.
This could"help practitioners adapt therapeutic strategies and develop prevention strategies in high-risk individuals." Most previous studies that have investigated risk factors for PD recurrence and persistence have relied on clinical samples, often with limited sample sizes. Moreover, each risk factor, when considered individually, accounts for only a"small proportion" of the variance in risk, the researchers note. The co-occurrence of these risk factors"suggests the need to combine them into a broad multivariable model." However, currently proposed integrative models do not identify independent predictors or mitigate the influence of confounding variables. To fill this gap, the investigators conducted a study using structural equation modeling"to take into account multiple correlations across predictors." They drew on data from 775 participants in the National Epidemiologic Survey on Alcohol and Related Conditions . For the current analysis, they examined two waves of NESARC to"build a comprehensive model" of the 3-year recurrence or persistence of PD. The researchers used a"latent variable approach" that simultaneously examined the effect of the following five groups of potential predictors of recurrence or persistence:Treatment-seeking behavior They also distinguished between risk factors responsible for recurrence and those responsible for persistence. Psychiatric diagnoses were determined on the basis of the AUDADIS-IV . Participants also completed Version 2 of the Short Form 12-Item Health Survey, which assesses both mental and physical QOL over the previous 4 weeks.Among participants with a 12-month diagnosis of PD at wave 1, 13% had persistent PD and 27.6% had recurrent PD during the 3-year period. The mean duration of illness was 9.5 years. A greater number of lifetime panic attacks, the presence of any Axis I or II comorbid disorder, and any Axis I disorder, especially social, were significantly associated with 3-year risk for recurrence and for persistence. Sweating, choking, paresthesias, the comorbid disorders of mania/hypomania and general anxiety disorder, nicotine dependence, lower mental and physical QOL scores, and exposure to a greater number of stressful life events in the previous year were all significantly associated with 3-year risk for recurrence.value were statistically significant,"with thePersistence vs Remission OR
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