Unemployment and Emergency Room Visits Predict Poor Treatment Outcome in Primary Care Panic Disorder
J Clin Psychiatry 2003;64(4):383-389
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: To complement existing data on
predictors of treatment response in groups of "pure"
panic disorder patients studied in clinical trials or in poorly
controlled naturalistic follow-up, we sought to elucidate
predictors of treatment response over 1 year in a diagnostically
heterogeneous and comorbidly ill group of primary care patients
with panic disorder participating in a randomized effectiveness
Method: Patients with DSM-IV panic disorder (N =
115), mostly without agoraphobia, were recruited from 3 primary
care clinics in Seattle, Wash., and randomly assigned to an
on-site collaborative care intervention (N = 57), in which
psychiatrists provided education, 2 visits, follow-up phone
calls, and paroxetine, or to usual care by their primary care
physician (N = 58). Predictors of response at 3-month intervals
over 1 year were determined using logistic regression analysis.
Results: Patients with consistent response over
the year (response at the majority of available timepoints) were
significantly (p < .05) more likely to be white, employed, in
higher income strata, and in the intervention group and had less
medical comorbidity and phobia severity, fewer recent
hospitalizations and emergency room visits, and higher reported
Medical Outcomes Study 36-Item Short Form physical and role
functioning. The final regression model indicated that responders
were more likely to be in the intervention group, be employed,
and lack a recent emergency room visit.
Conclusion: While some of the univariate
findings partially replicate previous results linking greater
illness severity with poorer response, univariate findings
linking medical comorbidity and low socioeconomic status with
poor response, as well as multivariate findings that unemployment
and recent emergency room use are the most potent predictors of
poor response, have not been previously reported.