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Moreno-Peral P, Conejo-Cerón S, Motrico E, Rodríguez-Morejón A, Fernández A, García-Campayo J, Roca M, Serrano-Blanco A, Rubio-Valera M, Bellón JÁ. Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: a systematic review of cohort studies. J Affect Disord 2014; 168:337-48. [PMID: 25089514 DOI: 10.1016/j.jad.2014.06.021] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND We aimed to assess available evidence on risk factors associated with the onset of panic disorder (PD) and/or generalised anxiety disorder (GAD) in cohort studies in the general adult population. METHODS Systematic review using MEDLINE, PsycINFO and Embase. Search terms included panic disorder, generalised anxiety disorder, cohort studies and risk factors. RESULTS We finally selected 21 studies, involving 163,366 persons with a median follow-up of 5 years. 1) Sociodemographic factors: PD was associated with age, female gender, and few economic resources. GAD was associated with age, non-Hispanics and Blacks, being divorced or widowed, and few economic resources. 2) Psychosocial factors: PD was associated with smoking and alcohol problems. GAD was associated with stressful life events in childhood and adulthood, and personality. 3) Physical and mental health factors: PD was associated with the number of physical diseases suffered and the joint hypermobility syndrome. PD was also associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected. GAD was associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected, plus already having received psychiatric care. LIMITATIONS Few studies examined the same risk factors. CONCLUSIONS Sociodemographic, psychosocial and mental-physical health risk factors were determinant for the onset of PD and GAD in the general adult population. These findings could be useful for developing preventive interventions in PD and GAD.
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Affiliation(s)
- Patricia Moreno-Peral
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Sonia Conejo-Cerón
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Emma Motrico
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain; Departamento de Psicología, Sociología y Trabajo Social. Universidad Loyola Andalucía, Sevilla, Spain
| | - Alberto Rodríguez-Morejón
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Spain
| | - Anna Fernández
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute University of Sydney, Australia; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Javier García-Campayo
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Servicio de Psiquiatría, Hospital Miguel Servet, Instituto Aragonés Ciencias de la Salud, Zaragoza, Spain
| | - Miquel Roca
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Antoni Serrano-Blanco
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Maria Rubio-Valera
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain; School of Pharmacy, Universitat de Barcelona, Spain
| | - Juan Ángel Bellón
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Centro de Salud El Palo, Servicio Andaluz de Salud, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Campus de Teatinos, 29071 Málaga, Spain.
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Moreno-Peral P, Luna JDD, Marston L, King M, Nazareth I, Motrico E, GildeGómez-Barragán MJ, Torres-González F, Montón-Franco C, Sánchez-Celaya M, Díaz-Barreiros MÁ, Vicens C, Muñoz-Bravo C, Bellón JÁ. Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study. PLoS One 2014; 9:e106370. [PMID: 25184313 PMCID: PMC4153639 DOI: 10.1371/journal.pone.0106370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023] Open
Abstract
Background There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.
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Affiliation(s)
- Patricia Moreno-Peral
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Juan de Dios Luna
- Departamento de Bioestadística, Universidad de Granada, Granada, Spain
| | - Louise Marston
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Michael King
- Mental Health Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Irwin Nazareth
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Emma Motrico
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Universidad Loyola Andalucía, Sevilla, Spain
| | | | | | - Carmen Montón-Franco
- Centro de Salud Casablanca, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
| | - Marta Sánchez-Celaya
- Directora Continuidad Asistencial Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Miguel Ángel Díaz-Barreiros
- Centro de Salud Vecindario, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas, Spain
| | - Catalina Vicens
- Centro de Salud son Serra-La Vileta, Unidad Docente de Medicina Familiar y Comunitaria de Mallorca, Instituto Balear de la Salud, Palma de Mallorca, Illes Balears, Spain
| | - Carlos Muñoz-Bravo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
| | - Juan Ángel Bellón
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
- Centro de Salud El Palo, Servicio Andaluz de Salud, Málaga, Spain
- * E-mail:
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King M, Bottomley C, Bellón-Saameño JA, Torres-Gonzalez F, Švab I, Rifel J, Maaroos HI, Aluoja A, Geerlings MI, Xavier M, Carraça I, Vicente B, Saldivia S, Nazareth I. An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA. Psychol Med 2011; 41:1625-1639. [PMID: 21208520 DOI: 10.1017/s0033291710002400] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes. METHOD Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile. RESULTS There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724-0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837-1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654-0.809) in Estonia, 0.811 (95% CI 0.736-0.886) in The Netherlands and 0.707 (95% CI 0.671-0.742) in Chile. CONCLUSIONS PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.
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Affiliation(s)
- M King
- Department of Mental Health Sciences, UCL Medical School, UK.
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Feldner MT, Zvolensky MJ, Babson K, Leen-Feldner EW, Schmidt NB. An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy. J Anxiety Disord 2008; 22:1227-43. [PMID: 18281190 PMCID: PMC2666044 DOI: 10.1016/j.janxdis.2008.01.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 12/31/2007] [Accepted: 01/04/2008] [Indexed: 11/17/2022]
Abstract
Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.
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