Identification and medical utilization of newly diagnosed panic disorder: A Nationwide case–control study

• Published in: Journal of psychosomatic research 2019-10, Vol.125, p.109815-109815, Article 109815
• Main Authors: Chang, Hu-Ming, Pan, Chun-Hung, Chen, Pao-Huan, Chen, Yi-Lung, Su, Sheng-Shiang, Tsai, Shang-Ying, Chen, Chiao-Chicy, Kuo, Chian-Jue
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; Case-Control Studies; Cohort Studies; Comorbidity; Databases, Factual; Demography; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Depressive personality disorders; Diagnosis; Early Diagnosis; Emergency Service, Hospital - statistics & numerical data; Emergency services; Family physicians; Family Practice - statistics & numerical data; Female; General practice; Herbal medicine; Herbalism; Humans; Illnesses; Incidence; Logistic Models; Male; Medical diagnosis; Medical expenditure; Medical utilization; Mental depression; Middle Aged; Multivariate Analysis; Newly diagnosed; Panic attacks; Panic disorder; Panic Disorder - diagnosis; Panic Disorder - epidemiology; Panic Disorder - psychology; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Psychiatry; Taiwan - epidemiology
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2019.109815

Ascertaining comorbid illnesses and patterns of medical utilization early in the course of psychiatric illness can help identify patients with panic disorder. We investigated how such cases were diagnosed and the comorbidities associated with newly diagnosed panic disorder in a nationwide database. We enrolled a large representative cohort of the general population in Taiwan (N = 1000,000) and selected 9759 cases of panic disorder from January 1, 2000 to December 31, 2013. The distribution of the departments in which the cases were identified and the medical utilization 12 months before diagnosis were analyzed. Based on a nested case–control study, four controls were randomly selected for each case and matched for sex, age, and incidence year. Conditional logistic regression was used to explore the factors associated with newly-diagnosed panic disorder such as demographic factors, concomitant medications, and physical and psychiatric comorbidities. Most (58.5%) cases of panic disorder were diagnosed in the psychiatry department, whereas only 3.7% were identified in the emergency department. Before diagnosis, the patients frequently visited the departments of internal medicine, family practice, and Chinese herbal medicine. A multivariate analysis revealed a higher number of physical and psychiatric comorbidities before diagnosis in the cases compared with the controls, especially depressive disorder and other anxiety disorders. Individuals with certain comorbidities and patterns of medical utilization are more likely to be diagnosed with panic disorder. We suggest providing more training to general practitioners and emergency physicians for the early diagnosis of panic disorder. •Patients with panic disorder utilized more medical resources before diagnosis.•Most cases of panic disorder were identified in the psychiatry department.•Specified illnesses were likely to be found before diagnosed as panic disorder.•Clinicians should improve detection, particularly in the emergency department.