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Background. Although 40% of people with panic attacks never seek care for their attacks, those who do may use medical settings or mental health settings, or both. The purpose of [...]

Objective: Little is known about the prevalence of panic symptoms that do not meet criteria for panic disorder. This study was conducted to determine the prevalence of panic disorder, panic attacks, and limited-symptom attacks in the general population. Method: The authors identified a community-based sample of 1,683 randomly selected adults in 18 census tracts in San Antonio, Tex.; 1,306 of these subjects agreed to be interviewed with the Structured Clinical Interview for DSM-III. Subjects were classified as having panic disorder if they met DSM-III-R criteria, as having panic attacks if they had attacks of four or more panic symptoms but did not have panic disorder, and as having limited-symptom attacks if they had attacks of fewer than four symptoms but no full-blown panic attacks. Results: The crude lifetime prevalence rates were 3.8% for panic disorder, 5.6% for panic attacks, and 2.2% for limited symptom attacks. Women had higher rates of panic disorder and panic attacks than men, but the difference between men and women was not statistically significant for limited-symptom attacks. No statistically significant differences in rates between Hispanic and either non-Hispanic white or black subjects were found. Non-Hispanic white subjects had higher rates of limited-symptom attacks than black subjects. Conclusions: The prevalence of limited-symptom attacks in this community-based study was 2.2%; black subjects had lower rates than non-Hispanic white subjects. Panic attacks appear to be at least as common as DSM-III-R panic disorder and, like panic disorder, are more common among women. (Am J Psychiatry 1993; 150:246-249)

Background. Epidemiologic studies link oral contraceptive use with several cardiovascular events, but the literature is difficult to summarize, and potential biases remain poorly addressed. This study uses meta-analysis to summarize study results and to analyze the influence of study characteristics, including susceptibility to bias, on study outcome. Methods. Forty-seven case-control and cohort studies of oral contraceptives and four cardiovascular events were coded for relative risk (RR) and study characteristics, including adherence to 14 bias-control standards. Key RRs were pooled to summarize findings for each disease type. Univariate determinants of the magnitude of the relative risks were identified, and partial correlation analysis was performed for each disease type. Results. Relative risks were significantly greater than 1.0 for venous thromboembolism (RR = 2.8, CI = 2.4 to 3.2), stroke (RR = 1.8, CI = 1.6 to 2.0), and myocardial infarction (RR = 1.6, CI = 1.4 to 1.8), but not for death due to any cardiovascular cause (RR = 1.0, CI = 0.8 to 1.3). Study characteristics were diverse, and potential biases were frequently uncontrolled. For three of ten study characteristics identified as independently influencing relative risk, methodologically stronger studies of venous thromboembolism tended to have higher RRs. The RRs for stroke and myocardial infarction were lower in studies that were methodologically stronger with regard to variables identified as important. In studies of cardiovascular death, bias-control standards identified as important were generally well addressed by the studies. Conclusions. Oral contraceptive use does not appear to increase overall cardiovascular mortality. The associations noted with stroke and myocardial infarction may be due to methodologic flaws in the studies, while the association with venous thromboembolism is more likely to be valid., Numerous epidemiologic studies of the relationship between the use of oral contraceptives and cardiovascular disease have been published. Although several reviews of this vast literature have been published,[1-4] it is [...]