Childhood separation anxiety and the risk of subsequent psychopathology:: Results from a community study

Objective: To examine the association between separation anxiety disorder ( SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia. Method: The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14-24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders. Results: Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6-58.7), specific phobia ( HR = 2.7, 95% CI = 1.001-7.6), generalized anxiety disorder ( HR = 9.4,95% CI = 1.8-48.7), sessive-compulsive disorder (HR = 10.7, 95% CI = 1.7-66.1), bipolar disorder ( HR = 7.7, 95% CI = 2.8-20.8), pain disorder ( HR = 3.5, 95% CI = 1.3-9.1), and alcohol dependence ( HR = 4.7, 95% CI = 1.7-12.4). Increased hazard rates for PDAG ( HR = 4.2, 95% CI = 1.4-12.1), bipolar disorder type II ( HR = 8.1, 95% CI = 2.3-27.4), pain disorder ( HR = 1.9, 95% CI = 1.01-3.5), and alcohol dependence ( HR = 2.1,95% CI = 1.1-4.) were also found for subjects fulfilling subthreshold SAD. Conclusions: Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD. Copyright (c) 2007 S. Karger AG, Basel.