Panic agoraphobic spectrum in psychiatrically healthy subjects: impact on quality of life

Several studies have evaluated the quality of life (QOL) in patients with Panic Disorder (PD). For instance, the Epidemiological Catchment Area Study (ECA) assessed the quality of life (QoL) using the subjective evaluation of health, psychosocial functioning and financial status as parameters (Regier et al., 1984). Among the general population, people with PD or panic attacks reported a low level of physical health in 35% of cases and a low degree of mental health in 38% of cases, similarly to people suffering from Major Depressive Disorder (29% and 39% respectively), but more frequently than the in individuals not affected by any disorder (24% and 12% respectively). Furthermore, 27% of patients with PD were in need of some form of social or financial support in contrast to 16% of people suffering from depression and 12% of unaffected people. The National Comorbidity Survey (NCS) (Magee et al., 1996) found serious interference in activities in 27% of agoraphobic patients. For instance, the agoraphobic subjects reported an average of 1.1 days of work lost in the previous month due to their psychopathology. Several Authors have studied the relationship between PD and a worse quality of life and/or a worse ability to function. In a review on the topic, Mendlowicz & Stein (2000) provided an integrated view of the issue of quality of life in patients with anxiety disorders and concluded that the existing studies almost uniformly show a marked impairment of quality-of-life and psychosocial functioning in individuals with anxiety disorders. However, as noted by the Authors above, “despite the growing number of studies undertaken during the past 15 years, the investigation of quality of life in individuals with anxiety disorders is still in its infancy.” Rucci et al. (1993) evaluated the prevalence of subthreshold psychiatric disorders in primary care and their association with the patients health perception, disability in daily activities and psychological distress Subjects with subthreshold disorders reported levels of psychological distress, disability in daily activities and perceived health comparable to those of patients with full-fledged ICD-10 disorders. Despite the scientific and clinical importance of the topic, relatively few studies have evaluated the prevalence and impact of subthreshold affective disorders in general (Schotte & Cooper, 1999) and panic symptoms in particular (for instance Bellini & Galverni, 2003) in non psychiatric populations. Moreover, the literature on the relationship between sub-threshold or residual PD and quality of life is scant. To this end, we decided to investigate the impact of panic-agoraphobic “spectrum” on the quality of life of subjects who did not meet the criteria for a full blown PD. We adopted the definition of “spectrum” developed by Cassano and colleagues (Cassano & Pini, 2000; Rucci & Maser, 2000), which refers to a dimensional view of psychopathology that includes a broad array of manifestations of the target disorder, including its most severe symptoms as well as a range of more subtle features related to the core condition, which may include temperamental traits, prodromal indicators, or residual symptoms. Although they are frequently associated with specific DSM-IV disorders, these conditions are also found in individuals who have never met full DSM-IV diagnostic criteria. Our hypothesis for this study was that the presence of subthreshold panic-agoraphobic symptomatologies in otherwise healthy individuals would significantly impair the quality of life despite the absence of a full-blown PD diagnosis.