Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study

Objectives: Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD. Methods: We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities. Results: PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11–1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59–3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98–1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32–5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25–7.96]) than in men (MRR, 3.77 [99% CI, 3.14–4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59–4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29–17.85]) causes. Conclusion: PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.