Poor treatment response in panic disorder patients with suicide attempts and the symptom network characteristics

Background. Panic disorder (PD) is associated with suicidality. Depression has been suggested as a link between PD and suicide; however, this remains controversial. Comprehensive research on the history of suicide attempt (SA) in patients with PD is scarce. We investigated the clinical characteristics of SA in patients with PD using PD-related assessments and network approaches. Methods. A total of 1151 participants were enrolled, including 755 patients with PD (97 with SA (PD+SA) and 658 without SA (PD-SA)) and 396 healthy controls. The Scale for Suicide Ideation and Panic Disorder Severity, Anxiety Sensitivity Inventory, and other PD-related measures were also administered. We compared symptom severity and analyzed the pharmacological treatment response in patients with PD with and without SA. Network analysis was used to estimate the centrality, stability, and network structures of the nodes. Results. Our results revealed that the scores for panic and depressive symptoms, pathological worry, anxiety sensitivity, and the frequency of early trauma were significantly higher in the PD+SA group than in the PD-SA group. Multiple linear regression analysis revealed that short- and long-term pharmacological treatment responses were significantly poorer in the PD+SA group. Network analysis showed that fear of cognitive dyscontrol (FCD), as a cognitive aspect of anxiety sensitivity, was the central symptom through strength, expected influence (one and two steps), randomized shortest path betweenness, and eigenvector centrality measures in the PD+SA group. In contrast, depression was the central symptom of patients with PD-SA. Conclusion. Our study suggests that a history of SA could be associated with high panic-symptom severity and poor pharmacological treatment response in patients with PD and that FCD is the most central symptom in the PD+SA network. Central symptoms, such as cognitive aspects of AS in patients with PD+SA, may be clinically effective as potential targets for intervention in patients with PD at risk of or suffering from suicidality.