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Does Panic Disorder Increase the Risk for Suicide?

The seminal analysis by Weissman et al. of the large Epidemiologic Catchment Area (ECA) study (NEJM 1989; 321:1210) demonstrated that the risk of suicide in patients with panic disorder was 18 times higher than the risk among people without psychiatric illness. This elevated risk was substantially lowered, but not eliminated, by controlling for other comorbid psychiatric conditions known to be associated with suicide. However, subsequent clinical studies have failed to confirm the increased risk after controlling for comorbid mood, substance abuse, and psychotic and personality disorders.

This study reanalyzed the ECA data, controlling for comorbid disorders in the aggregate (rather than one at a time as Weissman et al. did) including schizophrenia. (Weissman et al. did not control for schizophrenia despite the fact that 40% of suicidal panic subjects met criteria for schizophrenia.)

In the reanalysis, panic disorder was not associated with a significantly increased risk of suicide attempt (odds ratio, 1.2). The risk of suicide was highest for schizophrenia (OR, 4.5) and bipolar illness (OR, 4.0), followed by substance abuse (OR, 3.6) and major depression (OR, 2.7). Furthermore, panic disorder did not increase the risk of suicide attempt beyond that associated with other comorbid disorders.

Comment: This reanalysis calls into question the notion that uncomplicated panic disorder is associated with suicide risk, a notion that clashes with the experience of many clinicians. Because too few suicidal patients with panic disorder in the ECA sample had panic uncomplicated by any other disorder (only 3 of 50), analysis of data from more recent surveys such as the National Comorbidity Survey is needed to resolve the controversy.

— P Roy-Byrne

Published in Journal Watch Psychiatry September 1, 1995

Citation(s):

Hornig CD; McNally RJ. Panic disorder and suicide attempt: a reanalysis of data from the Epidemiologic Catchment Area study. Br J Psychiatry 1995 167 76-80.

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