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Association between panic disorder and childhood adversities: a systematic review and meta-analysis

Published online by Cambridge University Press:  15 November 2021

Joyce Zhang Open the ORCID record for Joyce Zhang [Opens in a new window] ,
Patryja Wiecaszek ,
Saber Sami  and
Richard Meiser-Stedman
Joyce Zhang*
Affiliation:
Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
Patryja Wiecaszek
Affiliation:
Norfolk Community Health and Care, Norwich, UK
Saber Sami
Affiliation:
Dementia Research, Norwich Medical School, University of East Anglia, Norwich, UK
Richard Meiser-Stedman
Affiliation:
Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
*
Author for correspondence: Joyce Zhang, E-mail: y.zhang41@uea.ac.uk
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Abstract

Background

Adverse childhood experiences (ACEs) increase the risk of mental health difficulties in general, but the link to panic disorder (PD) has received comparatively little attention. There are no data for the magnitudes between ACEs and PD. This systematic review and meta-analysis estimated the overall, as well as the subgroups, odds ratio of having PD in adults who report ACEs, compared to adults who do not.

Methods

The study was pre-registered on PROSPERO [CRD42018111506] and the database was searched in June 2021. In order to overcome the violation of independent assumptions due to multiple estimations from the same samples, we utilized a robust variance estimation model that supports meta-analysis for clustered estimations. Accordingly, an advanced method relaxing the distributional and asymptotic assumptions was used to assess publication bias and sensitivity.

Results

The literature search and screening returned 34 final studies, comprising 192,182 participants. Ninety-six estimations of 20 types of ACEs were extracted. Pooled ORs are: overall 2.2, CI (1.82–2.58), sexual abuse 1.92, CI (1.37–2.46), physical abuse 1.71, CI (1.37–2.05), emotional abuse 1.61, CI (0.868–2.35), emotional neglect 1.53, CI (0.756–2.31), parental alcoholism 1.83, CI (1.24–2.43), and parental separation/loss 1.82, CI (1.14–2.50). No between-group difference was identified by either sociolegal classification (abuse, neglect, household dysfunction) or threat-deprivation dimensions (high on threat, high on deprivation and mixed).

Conclusions

There are links of mild to medium strength between overall ACEs and PD as well as individual ACEs. The homogeneous effect sizes across ACEs either suggest the effects of ACEs on PD are comparable, or raised the question whether the categorical or dimensional approaches to classifying ACEs are the definitive ways to conceptualize the impact of ACEs on later mental health.

Keywords

childhood adversitychildhood traumameta-analysispanic disorderrobust variance estimation
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 6 , April 2023 , pp. 2585 - 2595
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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