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      Weekly and Holiday-Related Patterns of Panic Attacks in Panic Disorder: A Population-Based Study

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          Abstract

          Background

          While chronobiological studies have reported seasonal variation in panic attacks (PA) episodes, information on the timing of PA by week-days may enable better understanding of the triggers of PA episodes and thereby provide pointers for suitable interventional approaches to minimize PA attacks. This study investigated weekly variation in potential PA admissions including associations with holidays using a population-based longitudinal, administrative claims-based dataset in an Asian population.

          Methods

          This study used ambulatory care data from the “Longitudinal Health Insurance Database 2000. We identified 993 patients with panic disorder (PD), and they had 4228 emergency room (ER) admissions for potential PA in a 3-year period between 1 January 2009 and 31 December 2011. One-way analysis of variance (ANOVA) was used to examine associations between the potential PA admissions and holidays/weekend days/work-days of the week.

          Results

          The daily mean number of potential PA admissions was 3.96 (standard deviation 2.05). One-way ANOVA showed significant differences in potential PA admissions by holiday and day of the week ( p<0.001). Daily frequencies showed a trough on Wednesday-Thursday, followed by a sharp increase on Saturday and a peak on Sunday. Potential PA admissions were higher than the daily mean for the sample patients by 29.4% and 22.1%, respectively on Sundays and holidays. Furthermore, the weekly variations were similar for females and males, although females always had higher potential PA admissions on both weekdays and holidays than the males.

          Conclusions

          We found that potential PA admissions among persons with PD varied systematically by day of the week, with a significant peak on weekends and holidays.

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          Most cited references27

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          Work stress precipitates depression and anxiety in young, working women and men.

          Maria Melchior, Avshalom Caspi, Stephen Milne … (2007)
          Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1.90 [95% confidence interval (CI) 1.22-2.98] in women, and 2.00 (95% CI 1.13-3.56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.
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            The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.

            Ronald C Kessler, Wai Tat Chiu, Robert Jin … (2006)
            Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. English-speaking respondents (N=9282) 18 years or older. Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.
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              The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings.

              M. Kushner (2000)
              It is generally agreed that problems related to alcohol use and anxiety tend to occur within the same individual ("comorbidity"); however, the cause of this association remains controversial. Three prominent perspectives are that anxiety disorder promotes pathological alcohol use, that pathological alcohol use promotes anxiety disorder and that a third factor promotes both conditions. We review laboratory, clinical, family, and prospective studies bearing on the validity of these explanatory models. Findings converge on the conclusion that anxiety disorder and alcohol disorder can both serve to initiate the other, especially in cases of alcohol dependence versus alcohol abuse alone. Further, evidence from clinical studies suggests that anxiety disorder can contribute to the maintenance of and relapse to pathological alcohol use. Relying heavily on pharmacological and behavioral laboratory findings, we tentatively propose that short-term anxiety reduction from alcohol use, in concert with longer-term anxiety induction from chronic drinking and withdrawal, can initiate a vicious feed-forward cycle of increasing anxiety symptoms and alcohol use that results in comorbidity.
              Article 0 comments Cited 124 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Robert Stewart: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 9 July 2014
                Volume: 9
                Issue: 7
                Electronic Location Identifier: e100913
                Affiliations
                [1 ]Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
                [2 ]Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
                [3 ]Arnold School of Public Health, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, United States of America
                [4 ]Taipei Medical University Hospital, Department of Psychiatry, Taipei, Taiwan
                [5 ]Taipei Medical University, School of Medicine, Department of Psychiatry, Taipei, Taiwan
                [6 ]Taipei Medical University, School of Health Care Administration, Taipei, Taiwan
                [7 ]Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
                [8 ]Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
                [9 ]School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
                Institute of Psychiatry, United Kingdom
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LTK SX KHC SPL HCL SDC. Analyzed the data: LTK SX HCL. Wrote the paper: LTK SX KHC SPL HCL SDC. Critical revision: LTK SX SPL HCL SDC.

                ¶ These authors also contributed equally to this work.

                Article
                Publisher ID: PONE-D-14-00064
                DOI: 10.1371/journal.pone.0100913
                PMC ID: 4090070
                PubMed ID: 25006664
                SO-VID: e5a98910-33e0-435a-81dc-9c13c649e549
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 1 January 2014
                Date accepted : 1 June 2014
                Page count
                Pages: 5
                Funding
                These authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Chronobiology
                Subject: Psychology
                Subject: Emotions
                Subject: Anxiety
                Subject: Clinical Psychology
                Subject: Psychological Stress
                Subject: Social Psychology
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Epidemiology
                Subject: Clinical Epidemiology
                Subject: Social Epidemiology
                Subject: Health Care
                Subject: Health Services Research
                Subject: Health Statistics
                Subject: Psychological and Psychosocial Issues
                Subject: Medical Humanities
                Subject: Medical Sociology
                Subject: Mental Health and Psychiatry
                Subject: Anxiety Disorders
                Subject: Mood Disorders
                Subject: Public and Occupational Health
                Subject: Behavioral and Social Aspects of Health
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Longitudinal Studies
                Subject: Social Sciences
                Subject: Anthropology
                Subject: Psychological Anthropology

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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