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An Epidemiologic Investigation

Naomi Breslau, PhD; Donald F. Klein, MD

Arch Gen Psychiatry. 1999;56:1141-1147.

Background  Epidemiologic studies have reported a lifetime association between smoking and panic disorder. In this study, we examine potential explanations for this association.

Methods  Analysis was conducted on data from 2 epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007) and the National Comorbidity Survey Tobacco Supplement (n = 4411). Cox proportional hazards models with time-dependent covariates were used to estimate the risk for onset of panic attacks associated with prior smoking and vice versa, controlling for history of major depression. The role of lung disease in the smoking–panic attacks association was explored.

Results  Daily smoking signaled an increased risk for first occurrence of panic attack and disorder; the risk was higher in active than past smokers. No significant risk was detected for onset of daily smoking in persons with prior panic attacks or disorder. Exploratory analyses suggest that lung disease might be one of the mechanisms linking smoking to panic attacks.

Conclusions  The evidence that the association between smoking and panic disorder might result primarily from an influence in one direction (ie, from prior smoking to first panic attack) and the possibility of a higher risk in active than past smokers suggest a causal hypothesis for the smoking–panic attacks relationship.

From the Departments of Psychiatry, Henry Ford Health System, Detroit, Mich, University of Michigan School of Medicine, Ann Arbor, and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Breslau); and the College of Physicians and Surgeons, Columbia University, and the New York State Psychiatric Institute, New York (Dr Klein).

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