Factors influencing care seeking for a self-defined worst panic attack

Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study

BACKGROUND

Although fearful spells (FS) and panic attacks (PA) increase the risk for various mental disorders, few studies have examined whether help-seeking in those with FS/PA attenuates the risk for incident psychopathology.

METHODS

A community sample of adolescents and young adults (N=2978, aged 14-24 at baseline) was followed up in up to 3 assessment waves over 10 years. FS, PA, psychopathology, and help-seeking were assessed using the DSM-IV/M-CIDI. Logistic regressions with interaction terms (adjusted for sex and age) were used to test interactions between FS/PA and help-seeking at baseline on predicting incident psychopathology at follow-up. Cases with panic disorder (PD) at baseline were excluded from all analyses.

RESULTS

FS/PA at baseline predicted the onset of any disorder, any anxiety disorder, PD, agoraphobia, generalized anxiety disorder, social phobia, and depression at follow-up (Odds Ratios, OR 1.62-5.80). FS/PA and help-seeking at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that FS/PA only predicted the respective disorders in individuals not seeking help at baseline. In those with FS/PA, a higher number of panic symptoms interacted with help-seeking on predicting incident PD (OR=0.63) in a way that a higher number of panic symptoms only increased the risk for PD in those without help-seeking at baseline.

LIMITATIONS

Help-seeking at baseline was not restricted to panic-specific interventions, but included treatment due to other psychological problems as well.

CONCLUSIONS

Findings suggest that early help-seeking might modify psychopathology trajectories and prevent incident disorders in high-risk individuals with FS/PA.

Psychological distress and professional help-seeking: a prospective national study

The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18-75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help-seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress.

Determinants of barriers to treatment for anxiety disorders

The objectives of this study were to evaluate perceived unmet need for mental healthcare, determinants of unmet need, and barriers to care in individuals with social anxiety (SA) or panic disorder with agoraphobia (PDA) in Quebec. Data from 206 participants diagnosed with SA or PDA were collected using an online questionnaire. Correlational analyses and binary stepwise logistic regressions were conducted to explore determinants of perceived unmet need. Of the 206 participants, 144 (69.9%) reported instances of unmet need for treatment. Perceived unmet need was correlated with variables related to the severity of the disorder, such as comorbid depression, avoidance, duration of worry, interference with functioning, and time lapsed between the appearance of first symptoms and first consultation. Depression and avoidance emerged as predictors for perceived unmet need in the regression analysis. The most common barriers to treatment reported were concern about the cost of services (63.9%), not knowing where to go to get help (63.2%), lack of health insurance coverage (52.4%), and appointment wait times (52.1%). The results of this study demonstrate the need to overcome barriers to treatment engendered by avoidance behaviors associated with anxiety. Potential methods for achieving this objective include Internet outreach, support groups, and increased accessibility to public services.

Power law relationships between health care utilization and symptom assessment among people with panic attacks

RATIONALE

Although people with panic attacks are high utilizers of health care, the role of symptom assessment in care-seeking is unclear. Previous studies suggest that symptom perceptions are linearly related to utilization but panic appraisal is not. The purpose of this study was to determine whether the relationships between symptom assessment and utilization are non-linear, displaying power law distributions.

METHODS

This community-based study of 97 subjects with panic attacks assessed utilization of family doctor offices, total ambulatory utilization, and hospitalizations as well as symptom perceptions and panic appraisals. Matrices of symptom assessment versus utilization were created, and log-log plots were constructed. To minimize the risk of overestimation of power law distributions, linear, quadratic and cubic regression models were computed.

RESULTS

None of the utilization versus symptom perceptions displayed power law distributions. However, all three measures of utilization showed power law relationships with panic appraisals, but in unique patterns.

CONCLUSIONS

Although power law relationships were not found between symptom perceptions and utilization, unique patterns of power laws were identified between panic appraisals and all three measures of utilization.

[A survey of panic symptoms in a primary care setting]

OBJECTIVE

To study the month-prevalence of any panic attacks (PA) among general practitioners' (GP) patients. To evaluate differences in terms of demographics, psychological distress and anxiety, between patients with and without PA.

DESIGN

One-stage cross-sectional study by the means of self-administered inventories.

SETTING

Waiting room at the GP's office at the San Andres Health Centre (Murcia, Spain).

SAMPLING

All consecutive patients attending for any reason the GP's office over one month period. 150 patients accepted to enter the study completing the assessment procedures (response rate of 60%).

MEASUREMENTS

Demographic characteristics, Goldberg's GHQ-12 (General Health Questionnaire) total score, STAI-Y (State and Trait Anxiety Inventory) scores, and PAAAS (Panic Attack and Anticipatory Anxiety Scale) scores. The subjects were included in the PA subgroup when showing one or more PA of any pattern (unexpected or situational, complete or subthreshold) over the last month.

RESULTS

The presence of PA over the last month is reported by 38% of our sample (95% IC, 30.14-45.86), with a higher rate in the age-group of 15-44 years. The PA subgroup showed State-Anxiety, Trait-Anxiety and GHQ-12 total-scores higher than those from the panicless subgroup (P<.0000); it appeared significantly younger as well.

CONCLUSIONS

Our study points out that any PA are a frequent issue among patients attending family-doctor's office, particularly affecting patients aged 15 to 44 years.