Risk Factors for Suicidality in Patients With Panic Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression

Background: Subjects with panic disorder are nearly 4 times as likely to attempt suicide as compared to subjects without this condition. The current meta-analysis aims to determine factors associated with suicide ideation, suicide attempt and suicide in panic disorder. Methods: We searched Pubmed, Web of Science and EMBASE from Jan 1, 1960 to May, 15, 2017. Articles were included if they reported a dichotomous sample of patients with panic disorder with suicidal ideation, attempted suicide, or suicide compared to patients with panic disorder and no suicidal behavior. Review articles and pre-clinical studies were excluded. Outcomes: A total of 10 studies with 1301 participants were included in our analysis. Comorbid depression (p<0·0001), depressive symptoms (p=0·0030), older age (p<0·0001), younger age of panic disorder onset (p=0·0226), and history of alcohol dependence (p=0·0322) were each associated with suicide attempt in panic disorder. Symptoms of depression (p<0·0001), symptoms of anxiety (p=0·0004), longer illness duration (p<0·0001), comorbid depressive disorder (p=0·0019), and younger age of onset (p=0·0348) were associated with suicidal ideation in panic disorder. Due to the paucity of literature on the subject, we were unable to perform a meta-analysis of studies on completed suicide in panic disorder. Interpretation: Our findings provide a framework for the development of suicide prevention strategies in this population. Future studies may also combine these risk factors by using multivariate predictive analysis techniques to objectively stratify risk of suicide in panic disorder. Funding Statement: The authors state: "None." Declaration of Interests: All authors report no competing interests. Ethics Approval Statement: Missing.