Early-onset fearful panic attack: a possible prodrome of early-onset severe psychopathology.

To determine whether early-onset panic attack (< or =20 years) with fear at onset represents a possible prodrome of early-onset severe psychopathology, we drew data from the National Comorbidity Survey (N = 8,098), a probability sample drawn from respondents age 18 to 54 in the 48 contiguous United States. Multivariate logistic regression analyses were used to determine differences in age of onset of comorbid mental disorders, familial psychopathology, and lethality of suicide attempts between those with early-onset panic attacks with fear at onset compared with individuals with panic attacks that do not meet this criteria. Logistic regression analyses revealed that respondents with early-onset panic attack with fear at onset (n = 86) had significantly earlier onset of almost every comorbid mental disorder, higher rates of familial psychopathology, and increased risk and lethality of suicide attempt compared with those with other panic attacks (n = 336). These findings provide preliminary evidence to suggest that early-onset fearful panic attack may be a marker of risk of a lengthy course of severe psychopathology, which is predicted by familial mental illness, and is characterized by early onset and increased risk of serious suicidal behavior. Replication of these findings in other epidemiologic and clinical samples is needed.