Link Between Separation Anxiety In Children And Subsequent Onset Of Panic Disorder In Adulthood, Testing The Hypothesis

There has been extensive discussion on the relationship between separation anxiety in children and subsequent onset of panic disorder in adulthood. The current issue of Psychotherapy and Psychosomatics for the first time tests the hypothesis by an epidemiological viewpoint.


The study was aimed to examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia. The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14-24 years at baseline in Munich, Germany.


The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview.


Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders.


Results: Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with:


-- agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6-58.7)

-- specific phobia (HR = 2.7, 95% CI = 1.001-7.6)

-- generalized anxiety disorder (HR = 9.4, 95% CI = 1.8-48.7)

-- obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7-66.1)

-- bipolar disorder (HR = 7.7, 95% CI = 2.8-20.8)

-- pain disorder (HR = 3.5, 95% CI = 1.3-9.1)

-- alcohol dependence (HR = 4.7, 95% CI = 1.7-12.4)


Increased hazard rates for:

-- PDAG (HR = 4.2, 95% CI = 1.4-12.1)

-- bipolar disorder type II (HR = 8.1, 95% CI = 2.3-27.4)

-- pain disorder (HR = 1.9, 95% CI = 1.01-3.5)

-- alcohol dependence (HR = 2.1, 95% CI = 1.1-4.)

were also found for subjects fulfilling subthreshold SAD. Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.


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