PANIC AND DEPRESSION - A WORLDWIDE PRIMARY-CARE PERSPECTIVE

The World Health Organization Collaborative Study on Psychological Pro blems in General Health Care examined the form and frequency of, and d isability associated with, psychiatric disorders in primary care atten ders in 14 countries worldwide. This large multicenter study showed th at psychiatric disorders are frequent (24%) among primary healthcare a ttenders and that significant disability is associated with the mental illness. We present further data from this study, focusing on the com orbidity of psychiatric disorders and the relevance of panic attacks i n the primary care setting. Panic disorder is frequently comorbid with depression and this comorbid condition represents a severe form of me ntal illness. Patients diagnosed with both panic disorder and depressi on are more likely to have a long-lasting disorder that has an increas ed severity, results in higher disability levels and is associated wit h increased suicidality. Panic attacks are indicative of the presence of a depressive disorder, an anxiety disorder or a subthreshold diagno sis in 99% of patients with current panic attacks. A high symptomatic severity and disability, and increased suicide risk mere found in subt hreshold cases, particularly if associated with depressive episodes. T hus, panic attacks, which are readily recognized, are characteristic o f psychiatric illness and should indicate a high probability that trea tment is needed. (C) 1998 Lippincott-Raven Publishers.