CITATION: Isensee, B,
Hans-Ulrich, W., et al. (2003). Smoking increases
the risk of panic: Findings from a prospective community study Archives of General
Psychiatry. Chicago: Vol. 60, Iss. 7; pg. 692
We examined prospectively
determined bidirectional associations between smoking and panic and
anxiety disorders and their temporal ordering of onset in a
community sample of adolescents and young adults.
follow-up data were used from the Early Developmental Stages of
Study, a prospective longitudinal study of adolescents and young adults
in Munich, Germany. We assessed smoking (occasional and regular),
dependence, panic attacks, panic disorder, other anxiety disorders, and
other mental disorders using the Munich-Composite International
attacks and panic disorder were strongly associated with occasional and
regular smoking and nicotine dependence (odds ratio [OR] range,
In the prospective analyses, we found increased risk for new onset of
attacks with prior regular smoking (OR, 2.9; 95% confidence interval
1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior
dependence increased also the risk for onset of panic disorder (OR,
95% CI, 1.0-10.5), whereas preexisting panic was not associated with
smoking or nicotine dependence. When using COX regression with
covariates, prior nicotine dependence was confirmed to be related to
panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic
(hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that
prior panic attacks/disorder might also have an effect on secondary
of nicotine dependence.
prospective analyses revealed a fairly unique and specific,
relationship between prior smoking and increased risk for subsequent
attacks/disorder. However, we could not exclude the existence of a
less frequent, reverse pathway of prior panic and secondary nicotine
1. Breslau N, Kilbey
P. Nicotine dependence, major depression, and anxiety in young adults.
Arch Gen Psychiatry. 1991;48:1069-1074.
2. Breslau N, Kilbey
Andreski P. Nicotine dependence and major depression: new evidence from
a prospective investigation. Arch Gen Psychiatry. 1993;50:31-35.
3. Breslau N, Kilbey
Andreski P. DSM-III-R nicotine dependence in young adults: prevalence,
correlates and associated psychiatric disorders. Addiction.
4. Brown RA, Lewinsohn
Seeley JR, Wagner EF. Cigarette smoking, major depression, and other
disorders among adolescents. J Am Acad Child Adolesc Psychiatry.
5. Fergusson DM,
MT, Horwood LJ. Comorbidity between depressive disorders and nicotine
in a cohort of 16-year-olds. Arch Gen Psychiatry. 1996;53:1043-1047.
6. Glassman AH, Helzer
Covey LS, Cottler LBL, Stettner F, Tipp JE, Johnson J. Smoking, smoking
cessation, and major depression. JAMA. 1990;264:1546-1549.
7. Hughes JR, Hatsukami
Mitchell JE, Dahlgren LA. Prevalence of smoking among psychiatric
Am J Psychiatry. 1986;143:993-997.
8. Kendler KS, Neale
MacLean CJ, Heath AC, Eaves LJ, Kessler RC. Smoking and major
a causal analysis. Arch Gen Psychiatry. 1993;50:36-43.
9. Kashani JH, Beck NC,
EW, Fallahi C, Corcoran CM, McAllister JA, Rosenberg TK, Reid JC.
disorders in a community sample of adolescents. Am J Psychiatry.
10. Sonntag H, Wittchen
Hofler M, Kessler RC, Stein MB. Are social fears and DSM-IV social
disorder associated with smoking and nicotine dependence in adolescents
and young adults? Eur Psychiatry. 2000;15:67-74.
11. Pohl R, Yeragani
Balon R, Lycaki H, McBride R. Smoking in patients with panic disorder.
Psychiatry Res. 1992;43:253-262.
12. Amering M, Bankier
Berger P, Griengl H, Windhaber J, Katschnig H. Panic disorder and
smoking behavior. Compr Psychiatry. 1999;40:35-38.
13. Himle J, Thyer BA,
DJ. Prevalence of smoking among anxious outpatients. Phobia Pract Res
14. Klein DF. False
alarms, spontaneous panics, and related conditions: an integrative
Arch Gen Psychiatry. 1993;50:306-317.
15. Klein DF. Testing
suffocation false alarm theory of panic disorder. Anxiety. 1994;1:1-7.
16. Breslau N, Klein
Smoking and panic attacks: an epidemiologic investigation. Arch Gen
17. Johnson JG, Cohen
Pine DS, Klein DF, Kasen S, Brook JS. Association between cigarette
and anxiety disorders during adolescence and early adulthood. JAMA.
18. Dilsaver SC.
and panic attacks. Am J Psychiatry. 1987;144:1245-1246.
19. Wittchen H-U,
A, Lachner G, Nelson CB. Early developmental stages of psychopathology
study (EDSP): objectives and design. Eur Addict Res. 1998;4:18-27.
20. Lieb R, Isensee B,
Sydow K, Wittchen H-U. The Early Developmental Stages of
Study (EDSP): a methodological update. Eur Addict Res. 2000;6:170-182.
21. Wittchen H-U,
H, eds. DIA-X-Interviews: Manual fur Screening-Verfahren und Interview;
Interviewheft Langsschnittuntersuchung (DIA-X-Lifetime); Erganzungsheft
(DIA-X-Lifetime): Interviewheft Querschnittuntersuchung (DIA-X-12
Erganzungsheft (DIA-X-12 Monate); PC-Programm zur Durchfuhrung des
(Langs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt,
Swets & Zeitlinger; 1997.
22. World Health
Composite International Diagnostic Interview (CIDI). Geneva,
World Health Organization, Division of Mental Health; 1990.
23. Reed V, Gander F,
H, Steiger A, Sonntag H, Treknwalder C, Hundt W, Wittchen H-U. To what
degree does the Composite International Diagnostic Interview (CIDI)
identify DSM-IV disorders? testing validity issues in a clinical
Int J Methods Psychiatr Res. 1998;7:142-155.
24. Wittchen H-U,
G, Wunderlich U, Pfister H. Test-retest reliability of the computerized
DSM-IV version of the Munich-Composite International Diagnostic
(M-CIDI). Soc Psychiatry Psychiatr Epidemiol. 1998;33:568-578.
25. Lachner G, Wittchen
Perkonigg A, Holly A, Schuster P, Wunderlich U, Turk D, Garczynski E,
H. Structure, content and reliability of the Munich-Composite
Diagnostic Interview (M-CIDI): substance use sections. Eur Addict Res.
26. Wittchen H-U.
and validity studies of the WHO-Composite International Diagnostic
(CIDI): a critical review. J Psychiatr Res. 1994;28:57-84.
Association. Diagnostic and Statistical Manual of Mental Disorders,
Edition. Washington, DC: American Psychiatric Association; 1994.
28. Wittchen H-U, Reed
Kessler RC. The relationship of agoraphobia and panic in a community
of adolescents and young adults. Arch Gen Psychiatry. 1998;55:1017-1024.
29. Wittchen H-U,
CB, Lachner G. Prevalence of mental disorders and psychosocial
in adolescents and young adults. Psychol Med. 1998;28:109-126.
30. Perkonigg A,
RC, Storz S, Wittchen H-U. Traumatic events and posttraumatic stress
in the community: prevalence, risk factors and comorbidity. Acta
31. Wittchen H-U, Stein
Kessler RC. Social fears and social phobia in a community sample of
and young adults: prevalence, risk factors and co-morbidity. Psychol
32. StataCorp. Stata
Software: Release 7.0. College Station, Tex: Stata Corp; 2001.
33. Royall RM. Model
confidence intervals using maximum likelihood estimators. Int Stat Rev.
34. McCullagh P, Neider
Generalized Linear Models. 2nd ed. New York, NY: Chapman & Hall;
35. Cox DH. Some
on overdispersion. Biometrics. 1983;70:269-274.
36. Grambsch TM,
PM. Modelling survival data: extending the Cox model. New York, NY:
Publishing Co Inc; 2000.
37. Nelson CB, Wittchen
Smoking and nicotine dependence: results from a sample of 14- to
in Germany. Eur Addict Res. 1998;4:42-49.
38. Reed V, Wittchen
DSM-IV panic attacks and panic disorder in a community sample of
and young adults: how specific are panic attacks? J Psychiatr Res.
39. Clark DM. A
approach to panic. Behav Res Ther. 1986;24:461-470.
40. Ehlers A, Margraf
Roth WT. Selective information processing, interoception, and panic
In: Hand I, Wittchen H-U, eds. Panic and Phobias. Vol 2. New York, NY:
Springer Publishing Co Inc; 1988:129-148.
41. Sheikh JI, Leskin
Klein DF. Gender differences in panic disorder: findings from the
Comorbidity Survey. Am J Psychiatry. 2002;159:55-58.