Panic disorder and suicide.

Background: Panic disorder (PD) may increase the likelihood of suicidal ideation and behaviors because of psychiatric comorbidities such as major depressive disorder (MDD). However, research has yet to demonstrate a direct relationship between PD and suicide mortality.

Method: Using data from Taiwan's National Health Insurance Research Database, we identified 171,737 individuals with PD and 686,948 age- and sex-matched individuals without PD during 2003-2017. We assessed the risk of suicide within the same period. Psychiatric comorbidities such as schizophrenia, bipolar disorder, MDD, obsessive-compulsive disorder (OCD), autism, alcohol use disorder (AUD), and substance use disorder (SUD) were also evaluated. Time-dependent Cox regression models were used to compare the risk of suicide in different groups after adjustment for demographic data and psychiatric comorbidities.

Results: Our Cox regression model revealed that PD was an independent risk factor for suicide (hazard ratio [HR] = 1.85, 95% confidence interval [CI] = 1.59-2.14), regardless of psychiatric comorbidities. Among all comorbidities, MDD with PD was associated with the highest risk of suicide (HR = 6.08, 95% CI = 5.48-6.74), followed by autism (HR = 4.52, 95% CI = 1.66-12.29), schizophrenia (HR = 3.34, 95% CI = 2.7-4.13), bipolar disorder (HR = 3.20, 95% CI = 2.71-3.79), AUD (HR = 2.99, 95% CI = 2.41-3.72), SUD (HR = 2.82, 95% CI = 2.28-3.47), and OCD (HR = 2.10, 95% CI = 1.64-2.67).

Discussion: PD is an independent risk factor for suicide. Psychiatric comorbidities (i.e. schizophrenia, bipolar disorder, MDD, OCD, AUD, SUD, and autism) with PD increase the risk of suicide.