Psychometric Analysis for fear of COVID-19 Scale (FCV-19S) and its association with depression in patients with diabetes: A cross sectional study from a Tertiary Care Centre in Karachi, Pakistan

BACKGROUND AND AIMS

To assess the psychometric properties of the Fear of COVID-19 (FCV-19S) scale and to determine its associated factors among the Pakistani patients with diabetes.

METHODS

This observational study was conducted in 24-h helpline service, a department of Baqai Institute of Diabetology and Endocrinology (BIDE). Study duration was from August to September 2020. The target population was registered adult patients with type 2 diabetes aged >16 years. Baseline demographic details were obtained from hospital management system of BIDE. Forward-backward translation method was used to translate the existing Fear scale (FCV-19S). Symptoms of depressive disorder were assessed through Patient Health Questionnaire (PHQ9).

RESULTS

Total of 380 participants with mean age 51.93 ± 12.03 years contributed in the study. Three factors loading and item correlation of fear COVID-19 explained 96% of total variance having unidimensional Cronbach's alpha of 0.881. All demographic indicators that showed significance in univariate model were included in multivariate model. Females had more fear for COVID-19 compared to males (OR = 1.73, 95% CI (1.15-2.6)), whereas current smokers had also showed 4 times more fear than non-smokers (OR = 4.19, 95% CI (1.18-14.83). Depression assessed by PHQ9 showed maximum fear of COVID-19 in participants with moderate depression.

CONCLUSION

FCV-19S had adequate psychometric properties for assessing effects of pandemic in people with diabetes attending tertiary care center.

An Investigation of Various Machine and Deep Learning Techniques Applied in Automatic Fear Level Detection and Acrophobia Virtual Therapy

In this paper, we investigate various machine learning classifiers used in our Virtual Reality (VR) system for treating acrophobia. The system automatically estimates fear level based on multimodal sensory data and a self-reported emotion assessment. There are two modalities of expressing fear ratings: the 2-choice scale, where 0 represents relaxation and 1 stands for fear; and the 4-choice scale, with the following correspondence: 0—relaxation, 1—low fear, 2—medium fear and 3—high fear. A set of features was extracted from the sensory signals using various metrics that quantify brain (electroencephalogram—EEG) and physiological linear and non-linear dynamics (Heart Rate—HR and Galvanic Skin Response—GSR). The novelty consists in the automatic adaptation of exposure scenario according to the subject’s affective state. We acquired data from acrophobic subjects who had undergone an in vivo pre-therapy exposure session, followed by a Virtual Reality therapy and an in vivo evaluation procedure. Various machine and deep learning classifiers were implemented and tested, with and without feature selection, in both a user-dependent and user-independent fashion. The results showed a very high cross-validation accuracy on the training set and good test accuracies, ranging from 42.5% to 89.5%. The most important features of fear level classification were GSR, HR and the values of the EEG in the beta frequency range. For determining the next exposure scenario, a dominant role was played by the target fear level, a parameter computed by taking into account the patient’s estimated fear level.

Fear Level Classification Based on Emotional Dimensions and Machine Learning Techniques

There has been steady progress in the field of affective computing over the last two decades that has integrated artificial intelligence techniques in the construction of computational models of emotion. Having, as a purpose, the development of a system for treating phobias that would automatically determine fear levels and adapt exposure intensity based on the user’s current affective state, we propose a comparative study between various machine and deep learning techniques (four deep neural network models, a stochastic configuration network, Support Vector Machine, Linear Discriminant Analysis, Random Forest and k-Nearest Neighbors), with and without feature selection, for recognizing and classifying fear levels based on the electroencephalogram (EEG) and peripheral data from the DEAP (Database for Emotion Analysis using Physiological signals) database. Fear was considered an emotion eliciting low valence, high arousal and low dominance. By dividing the ratings of valence/arousal/dominance emotion dimensions, we propose two paradigms for fear level estimation—the two-level (0—no fear and 1—fear) and the four-level (0—no fear, 1—low fear, 2—medium fear, 3—high fear) paradigms. Although all the methods provide good classification accuracies, the highest F scores have been obtained using the Random Forest Classifier—89.96% and 85.33% for the two-level and four-level fear evaluation modality.

Sixteen-Item Anxiety Sensitivity Index

The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.

Describing temperament in an ungulate: a multidimensional approach

Studies on animal temperament have often described temperament using a one-dimensional scale, whereas theoretical framework has recently suggested two or more dimensions using terms like “valence” or “arousal” to describe these dimensions. Yet, the valence or assessment of a situation is highly individual. The aim of this study was to provide support for the multidimensional framework with experimental data originating from an economically important species (Bos taurus). We tested 361 calves at 90 days post natum (dpn) in a novel-object test. Using a principal component analysis (PCA), we condensed numerous behaviours into fewer variables to describe temperament and correlated these variables with simultaneously measured heart rate variability (HRV) data. The PCA resulted in two behavioural dimensions (principal components, PC): novel-object-related (PC 1) and exploration-activity-related (PC 2). These PCs explained 58% of the variability in our data. The animals were distributed evenly within the two behavioural dimensions independent of their sex. Calves with different scores in these PCs differed significantly in HRV, and thus in the autonomous nervous system’s activity. Based on these combined behavioural and physiological data we described four distinct temperament types resulting from two behavioural dimensions: “neophobic/fearful – alert”, “interested – stressed”, “subdued/uninterested – calm”, and “neoophilic/outgoing – alert”. Additionally, 38 calves were tested at 90 and 197 dpn. Using the same PCA-model, they correlated significantly in PC 1 and tended to correlate in PC 2 between the two test ages. Of these calves, 42% expressed a similar behaviour pattern in both dimensions and 47% in one. No differences in temperament scores were found between sexes or breeds. In conclusion, we described distinct temperament types in calves based on behavioural and physiological measures emphasising the benefits of a multidimensional approach.

Fear of death and good death among the young and elderly with terminal cancers in Taiwan

Fear of death is a common characteristic among palliative care patients. We might think that the elderly display a higher degree of acceptance of the inevitability and less fear in the face of death. This study was aimed at investigating the relationship between the death fear level and the good-death scale in two age groups. The study was conducted in 224 patients with terminal cancers admitted to the Palliative Care Unit in National Taiwan University Hospital during the period of January 1 through October 31, 2001. The mean age was 62.13 +/- 15.47 years. The duration of admission in the elderly group was shorter than that of the younger group (P < 0.05). The severity of death fear decreased gradually in both groups after being admitted to the hospice (P < 0.05). However, the elderly (> or = 65 years of age) displayed higher levels of death fear than the younger group at two days before death (P < 0.05). A significant negative correlation was observed between the degree of death fear and the total good death score in both groups at two days before death (P < 0.05). The comprehensive care in the palliative care unit might relate to the relief of the death fear of terminal cancer patients. There is a need for psychological and spiritual care in elderly patients.

Predicting anxiety in magnetic resonance imaging scans

This study evaluated a brief screening instrument for predicting psychological distress in patients undertaking magnetic resonance imaging (MRI) scans. The scale is adapted from Wolpe and Lang's (1964) Fear Survey Schedule (FSS; see Lukins, Davan, & Drummond, 1997). Noise and/or confinement were identified as the most unpleasant feature of the MRI by 48.3% of 118 outpatients. The MRI-FSS (Lukins et al., 1997; 9 items) significantly predicted the number of panic attack symptoms and state anxiety experienced during MRI scan better than a range of other measures. There was a significant increase in MRI-FSS scores from prescan to postscan among those who experienced high levels of anxiety during the scan. The MRI-FSS appears to be a useful indicator of likely adverse psychological reactions in the MRI scan that is sensitive to the sequelae of the MRI procedure.

[Neural organization of different types of fear: implications for the understanding of anxiety]

The dangerous stimuli may be potentially dangerous, distal or proximal and the recognition by the animals of each one of these conditions is determinant for the nature of the fear responses. In the present article a parallel with this particular process is drawn taking into account that different fear responses are generated by light, tones and contexts used as conditioned stimuli and by unconditioned stimulation of the dorsal periaqueductal gray (dPAG). In this review we summarize the efforts that have been made to characterize the neural circuits recruited in the organization of defensive reactions to the conditioned and unconditioned aversive stimulations, particularly evidence linking the brain's defense response systems to the concept of fear-stress-anxiety. The dPAG constitute the main neural substrates for the integration of aversive states in response to proximal aversive stimuli. In fact, panic-like behaviors often result when this structure is electrically or chemically stimulated. On the other hand, successful preparatory processes of danger-orientation and preparedness to flee seem to be linked to anxiety. The pre-frontal and cingulate cortex, median raphe nucleus, septum and hippocampus seem to be implicated in the elaboration and organization of these responses. As a working hypothesis, it is advanced that increasing the intensity and proximity of the danger may lead to an emotional shift. When the animals are submitted to this gradual increase in aversiveness there is a switch from the neural circuits responsible for the production of the orientated and organized motor patterns of appropriate defensive response to a conditioned stimulus towards the incomplete and uncoordinated defense responses related to panic attacks. The circuits in the amygdala and the medial hypothalamus responsible for the organization of the defense reaction may well subserve to this switch process.

Separating emotion and motivational direction in fear and anger: effects on frontal asymmetry

State effects on frontal alpha electroencephalograph asymmetry (ASY) are thought to reflect approach and withdrawal motivational tendencies. Although this motivational direction model has inspired a large body of research, efforts to disentangle influences of emotion (EMO) and motivational direction (MOT) on ASY are rare. The authors independently manipulated EMO (fear and anger) and MOT (approach and withdrawal) in a between-subjects design. Irrespective of MOT, anger led to greater changes toward relative left frontal activation (LFA) than did fear. Conversely, higher ratings of negative valence were associated with greater changes toward LFA in withdrawal but with greater changes toward relative right frontal activation in approach. Results are discussed within a model based on behavioral inhibition system-behavioral activation system theory.

Anxiety and fear level in patients after myocardial infarction over five years of rehabilitation

The aim of the study was to characterise the structure of anxiety and fear in patients after myocardial infarction observed during their five-year rehabilitation. The study group comprised 114 men aged 24-63 years treated at the Chair and Department of Cardiology, Medical University of Lublin with recent myocardial infarction diagnosed according to generally accepted clinical criteria. Besides basic clinical examinations the patients were performed echocardiography and psychological examination. After completion of the first clinical therapy a five-year post-infarct outpatient rehabilitation was organised for the patients. To assess the level of anxiety and fear Cattell's IPAT Self-Analysis was used. The method lets find out that: 1. In every study period the level of general anxiety was close to the neurotic level. 2. During the whole period of five-year rehabilitation in about 60% of patients the normal level of internal integration was observed. 3. In all study periods about 30% of patients showed emotional instability. 4. In the structure of anxiety and fear about 60% of patients always showed high level of inner tension associated with a conflict between superego demands and impulsive sphere. 5. Observation of patients after myocardial infarction lasting many years has shown that the study group is not homogenous as for personality traits. The use of agglomerate analysis allowed distinguishing 7 groups of patients with the most similar personality characteristics. Individual groups of patients significantly differed from one another with regard to the structure of anxiety and fear.

The genetic epidemiology of irrational fears and phobias in men

BACKGROUND

Much of our knowledge of the role of genetic factors in the etiology of phobias comes from one population-based sample of female twins. We examined the sources of individual differences in the risks for phobias and their associated irrational fears in male twins.

METHODS

In personal interviews with both members of 1198 male-male twin pairs (707 monozygotic [MZ] and 491 dizygotic [DZ]) ascertained from a population-based registry, we assessed the lifetime history of agoraphobia and social, animal, situational, and blood/injury phobias as well as their associated irrational fears. Twin resemblance was assessed by means of probandwise concordance, odds ratios, tetrachoric correlations, and univariate and multivariate biometrical model fitting.

RESULTS

The suggestive results obtained by analysis of phobias only were supported by analyzing both fears and phobias. All 5 phobia subtypes aggregate within twin-pairs. This aggregation is due largely or solely to genetic factors with heritability of liabilities ranging from 25% to 37%. Multivariate analysis revealed a common genetic factor, genetic factors specific to each subtype, and a common familial-environmental factor.

CONCLUSIONS

In male subjects, genetic risk factors, which are partially common across all subtypes and partially subtype specific, play a moderate role in the etiology of phobias and their associated irrational fears. Family environment probably has an impact on risk for agoraphobia and social phobia. The genetic liability to blood/injury phobias is not distinct from those of the more typical phobias.

Confirmatory factor analysis of the Fear Questionnaire in injured workers with chronic pain

In an effort to extend the validity of the Fear Questionnaire (FQ) in a sample of patients with high levels of blood/injury phobia, the FQ responses of 255 injured workers with chronic pain were subjected to confirmatory factor analysis. Results indicated that an intercorrelated three-factor model of the FQ provided a better fit to the data than unidimensional, two-factor, hierarchical three-factor, or categorical three-factor models. These findings provide further support for the factorial validity of the FQ and the corresponding multidimensional theory of fear.

Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) [24] suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data [21] revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Dental fear in children--a proposed model

Over the past eleven years, we have worked together to treat children who are dentally phobic. This has enabled us to develop an understanding of how children come to be dentally fearful. We have constructed a model of child dental fear which helps us in our work. It is important to acknowledge that fear is a normal phenomenon when any of us are exposed to threat. Helping dentally fearful children appraise or evaluate threat, face their fear and build upon their strengths is the task facing dentists and, occasionally, psychologists. The consequences for children of not doing so are extreme difficulty with accepting and ultimately total avoidance of treatment. Both of these can persist into adulthood. First, we propose to discuss the normality of fear in children, placing dental fear within a developmental context. We will then outline a model for assessing and treating dental fear which identifies five discrete but interrelated factors. Each of the factors and its treatment is illustrated with examples.

Cross-cultural aspects of fears in African children and adolescents

The purpose of this study was to compare level and type of fears in Nigerian and Kenyan children using the Fear Survey Schedule for Children, Revised (FSSC-R; [Ollendick, T.H. (1983). Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R). Behaviour Research and Therapy, 21, 685-692]). A total of 852 males and females between the ages of 8 and 17 were surveyed. Results indicated that Nigerian children reported significantly higher total fear than Kenyan children and that scores from both countries were higher than those found in the United States, Australia and China. This suggests that the cultures of Kenya and Nigeria may share a common variable that makes reporting of fears greater than that reported by children of other world cultures. In addition, Christian children in both countries reported higher levels of fear on several factors than Muslim children, indicating that Islamic beliefs may encourage children to report less fear or to deal with their fears better than Christian beliefs. Finally, children between the ages of 8 and 12 reported greater fear of the unknown than children between 13 and 17 years of age. Overall, these findings suggest that important cultural, religious and age differences exist for levels of childhood fears reported in Nigeria and Kenya.

The convergent validity of the Phobia Origins Questionnaire (POQ): a review of the evidence

The Phobic Origins Questionnaire (POQ) [Ost, L.-G. & Hugdahl, K. (1981). Acquisition of phobias and anxiety response patterns in clinical patients. Behaviour Research and Therapy, 19, 439-447.] is the most commonly cited instrument for determining the origins of phobic anxiety and data obtained using this instrument strongly support the role of conditioning in the acquisition of fear reactions. The construct validity of the POQ in assessing episodes of conditioning has been questioned [e.g. Menzies, R. G. & Clarke, J. C. (1994). Retrospective studies of the origins of phobias: a review. Anxiety, Stress and Coping, 7, 305-318.] This paper examined the convergent validity of the POQ by comparing origins' classifications based on the POQ to classifications based on alternative instruments. The convergent validity of the POQ was found to be extremely poor. The POQ was consistently associated with a much greater likelihood of classifying the origin of fear reactions as due to direct conditioning episodes than was found using alternative instruments. The findings question the usefulness of the POQ in examining the origins of phobic anxiety.

The fear survey schedule for children-revised (FSSC-HI): ethnocultural variations in children's fearfulness

A revised Fear Survey Schedule for Children was used to examine the structure and developmental pattern of fearfulness in an ethnoculturally diverse sample of 385 Hawaii schoolchildren aged 7 to 16 years. The instrument's psychometric properties compared favorably with previous versions of the FSSC, and a 7-factor solution provided the best conceptual fit for the data. Six factors were similar to those described in previous versions of the FSSC, whereas the seventh was unique, reflecting children's social conformity fears. Between-group comparisons revealed significantly less fearfulness in children of Caucasian than of Asian, Filipino, and Hawaiian ethnocultural backgrounds. Gender and age differences were similar to previous reports in finding greater fearfulness in girl than boys, and in younger than older children on most factors. Results corroborate previous reports concerning gender and age trajectories of fearfulness and indicate that culture may mediate the expression of fears in culturally diverse populations.

Social phobia subtypes in the National Comorbidity Survey

OBJECTIVE

This article presents epidemiologic data on the distinction between social phobia characterized by pure speaking fears and that characterized by other social fears.

METHOD

The data come from the National Comorbidity Survey (N = 8,098). Social phobia was assessed with a revised version of the Composite International Diagnostic Interview.

RESULTS

Latent class analysis showed that the brief set of social fears assessed in the survey can be disaggregated into a class characterized largely by speaking fears and a second class characterized by a broader range of social fears. One-third of the people with lifetime social phobia exclusively reported speaking fears, while the other two-thirds also had at least one of the other social fears assessed. The vast majority of the latter had multiple social fears including, in most cases, both performance and interactional fears. The two subtypes were similar in age at onset distribution, family history, and certain sociodemographic correlates. However, the social phobia characterized by pure speaking fears was less persistent, less impairing, and less highly comorbid with other DSM-III-R disorders than was social phobia characterized by other social fears.

CONCLUSIONS

Further general population research assessing more performance and interaction fears is needed to determine whether social phobia subtypes can be refined and whether the subtypes are better conceptualized as distinct disorders. In the meantime, people who have social phobia with multiple fears, some of which are nonspeaking fears, appear to have the most impairment and should be the main focus of prevention and intervention efforts.

Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents

We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.

Fear of falling revisited

OBJECTIVE

To evaluate the measurement properties of an expanded version of the Falls Efficacy Scale (FES)-a measure of fear of falling. The original FES measures fear on almost exclusively indoor activities, which may limit the usefulness of the scale in identifying early stages of fear of falling in active community-dwelling older people.

DESIGN

Two-group convenience sample.

SETTING

An outpatient referral clinic, and community-dwelling older people recruited from various sources.

SUBJECTS

A volunteer sample of 111 healthy community-dwelling elderly (mean age 74.0 years) and a sample of 68 older people referred to a Falls and Balance Clinic (FBC) (mean age 79.2). Twenty-one subjects (9 healthy elderly and 12 FBC patients) were tested twice 1 week apart to investigate retest reliability.

MAIN OUTCOME MEASURES

A 14-activity questionnaire (the Modified Falls Efficacy Scale [MFES]) was used that incorporated the original 10-activity FES and four additional activities. Falls efficacy was rated on a 10-point visual analogue scale for each activity.

RESULTS AND CONCLUSIONS

The MFES demonstrated high internal consistency (Cronbach's alpha.95) and less skew than the original FES (-2.4 and -3.3, respectively). Factor analysis of the MFES revealed two factors accounting for 75% of the sample variance, grouping into an "indoor type activity" factor and an "outdoor type activity" factor. Retest reliability for the MFES was high (intraclass correlation coefficients = .93). Significant differences were evident between the FBC group and the healthy older group on all items of the MFES and on the total MFES score (p < .05). On the basis of these preliminary findings, the MFES appears to be a reliable and valid measure of falls self-efficacy, and could be a useful addition in the comprehensive assessment of older people with balance disturbance or falls.

The structure of fundamental fears

Reiss's expectancy theory states that panic attacks, phobias, and other fear reactions arise from three fundamental fears (sensitivities): anxiety sensitivity, fear of negative evaluation, and injury/illness sensitivity. The present study examined two central aspects of the theory: (1) the assumption that fundamental fears are factorially distinct, and (2) the proposition that fundamental fears account for variance in other forms of fear and in trait anxiety. Measures of fundamental fears, common fears, and trait anxiety were administered to 100 community volunteers. The results supported Reiss's theory; the fundamental fears were factorially distinct, minimally intercorrelated, and accounted for significant proportions of variance in measures of other fears and trait anxiety. Specific and conceptually meaningful links were found between fundamental fears and common fears.

Cross validation of a Brazilian version of the Dental Fear Survey

The Dental Fear Survey (DFS), a paper and pencil instrument for assessing dental fear and avoidance, has been widely used and validated in fear studies in the US. However, before such instruments are used in countries and cultures dissimilar to the one in which it was developed, they should be cross-validated in that culture. The present study is an examination of the DFS response characteristics in a group of 374 Brazilian university students. Factor analysis of the DFS revealed three factors essentially identical to those found among university students in the US and in Singapore, as well as among US adult dental patients. Higher DFS scores were significantly associated longer intervals since last dental visit. These results are taken as evidence that the DFS performs in this Brazilian sample very much as it does in other samples; and is thus, a valid indicator of dental fear at least among Brazilian university students.

Risk factors for the onset of panic disorder and other panic attacks in a prospective, population-based study

A total of 383 cases of incident panic attack were identified among 12,823 participants in the Epidemiologic Catchment Area Program over various 12-month periods in 1980-1983. These cases not phobia-stimulated were compared with 766 controls. Risk factors were examined for the onset of panic attacks, with attacks categorized as panic disorder, severe and unexplained panic attacks, or other panic attacks. Risk factors were also examined for the onset of attacks in which cardiovascular symptoms were experienced and those in which psychologic symptoms were experienced. Females were at greater risk than males for each category of attacks (relative odds ranged from 1.36 to 2.25). Persons aged 65 years or older were at lower risk than younger persons (relative odds, compared with 30- to 44-year-olds, ranged from 0.26 to 0.71). A history of cardiac symptoms, shortness of breath, depression or a major grief episode, drug abuse or dependence, alcohol abuse or dependence, and seizures were each strongly associated with panic attacks. A history of cardiac symptoms was more strongly associated with attacks in which cardiovascular symptoms were experienced than with attacks in which psychologic symptoms were experienced (relative odds, 8.36 vs. 2.23). A history of seizures was more strongly associated with attacks with psychologic symptoms than with attacks with cardiovascular symptoms (relative odds, 5.21 vs. 1.58).