Panic disorder in completed suicide

Abstract

Background: Patients with panic disorder are reportedly at increased risk of suicidal behavior, but in psychological autopsy studies of completed suicides, a current diagnosis of panic disorder has been rare or absent. The comorbidity and other clinical characteristics of panic disorder among suicides are not known.

Method: On the basis of data from a psychological autopsy study of all suicides (N = 1397) in Finland occurring during 1 year, all victims with current DSM-III-R panic disorder were retrospectively identified and examined in terms of comorbidity, suicide methods, history of suicide attempts, treatment setting, and duration of panic disorder.

Results: Seventeen victims with current panic disorder, 1.2% of all suicides, were identified. The prevalence of panic disorder was higher among female (2.8%, 9 of 320) than male suicides (0.7%, 8 of 1077; p = .007). All victims with panic disorder suffered concurrent Axis I disorders, and 8 (47%) Axis II disorders. Major depression was diagnosed in 10 (59%), and substance dependence or abuse in 8 (47%) of the cases. The mean duration of panic disorder before suicide was 8 years. In most cases, the onset of panic disorder preceded comorbid Axis I disorders and previous suicide attempts. Most victims with panic disorder had a history of psychiatric treatment.

Conclusion: Current panic disorder, and noncomorbid panic disorder in particular, seem to be rare among completed suicides. Suicide in persons with panic disorder is associated with superimposed major depression and substance abuse, and with personality disorders. For recognizing panic disorder patients at risk of suicide, the assessment and monitoring of the overall psychopathology are essential.