What are Panic Attacks and Panic Disorder
In the United States, over 7M people annually suffer from panic disorder (PD), a condition in which the patient has recurrent, unpredictable panic attacks followed by persistent fears about repeat attacks. Panic attacks and fear of potential attacks can have a profound impact on quality of life – resulting in avoidance behaviors such as missing work, not going out with friends, avoiding public places or fear of leaving the house.
Panic attacks are also a common component of other Anxiety Disorders (e.g., Post Traumatic Stress Disorder, Specific Phobias, Social Anxiety Disorder and Generalized Anxiety Disorder), and affect a total of 27M in the US per year. Women are 2-4 times more likely to suffer from PD than men and the most common age group for symptom onset is 25 – 44 years old. PD patients are more likely to commit suicide than depression patients [2,3] and over 25% of them abuse/misuse alcohol .
PD patients also consume significantly more healthcare resources than non-PD patients with similar health profiles. A recent analysis conducted by a health economics firm demonstrated that compared with age, gender and health risk-factor matched controls, PD patients:
- Are 5.4 times more likely to have an any-cause emergency room visit,
- Have 3.4 times more physician office visits,
- Have 6 times higher pharmacy claims,
- Are 5.6 times more likely to develop additional mental health disorders or substance abuse.
Current, evidence-based standards of care to treat PD include Cognitive Behavioral Therapy (CBT) and treatment with benzodiazepines and antidepressants. Limitations of CBT include cost, limited availability of CBT-trained therapists (only 12% of PD patients receive a formal CBT program), high dropout rates and fear of interoceptive exposure.
Medication limitations include side effects, especially of SSRI/SNRI, risk of abuse of benzodiazepine-class medications and relapse after discontinuation. Of note, 75% of patients say they do not want to take medications and 47% discontinue taking SSRI/SNRIs within 180 days (of these discontinuations, 84% are in the first 90 days).
A recent study published in the Journal of Clinical Psychiatry, reported that when treated with anti-depressants, chronically depressed patients with co-morbid panic disorder experienced greatly increased frequency and intensity of cardiac, gastrointestinal, neurological and genitourinary side effects vs. patients without the co-morbid panic. In addition, the subjects with depression and co-morbid panic showed a greater risk of worsening depressive symptoms associated with multiple side effects.
These limitations in treating panic with medication or CBT lead patients to continue misinterpreting their panic symptoms as serious medical events, driving increased emergency department and medical specialist visits.
The Impact of Panic on Employment
Studies have shown that while people suffering from PD and panic attacks may not necessarily miss work more often than employees with other chronic health conditions, productivity is severely negatively impacted. “Work impairment” is the term describing lost productively at work due to chronic health conditions, and refers to inefficiency on the job, or days at work cut short due to these health conditions. One study found that two mental disorders, General Anxiety Disorder (GAD) and Panic Disorder (PD) were among the top 6 of all chronic conditions in terms of work impairment days.
The level of work impairment for PD at 5.1 days per month is only slightly less than heart disease, (6.6 days per month of impaired work performance) and is 40% greater than work impairment for individuals with diabetes (3.6 days per month).
The Cost of Panic to Employers
In addition to the costs of panic attacks and panic disorder from work impairment, these conditions also result in higher than average healthcare costs for affected employees. Patients with panic attacks or panic disorder often misinterpret their panic symptoms of a racing heart, dizziness, sweating and nausea as a serious life threatening event such as a heart attack or stroke, prompting emergency room visits and multiple primary and specialist doctor visits. Once these individuals are diagnosed with panic, they are typically treated with cognitive behavioral therapy (CBT) and/or prescription medications (typically anti-depressants and benzodiazepines). If locally available, CBT is burdensome for the patient (12-weeks of weekly sessions) with limited effectiveness. Patients frequently discontinue the medications due to adverse side-effects.
A recent analysis conducted by a health economics firm reported that compared with age, gender and health risk-factor matched controls, PD patients:
- Incur an average of $5,300 more expense than matched healthy individuals
- Are 5.4 times more likely to have an any-cause Emergency Room visit
- Are 5.3 times more likely to have an Emergency Room visit related to panic symptoms or other psychiatric diagnosis
- Incur 3.4 times more Professional claims and 6 times more Pharmacy claims
- Over three years, are 5.6 times more likely to develop an additional Mental Health/Substance Abuse Disorder
*Data on file
For employers, with self-funded health insurance plans, the high health costs of panic patients directly result in higher health care expenses for the company and its employees. For employers paying a portion of employees’ health insurance premiums, increased healthcare services utilization drives future premium increases.
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