Quality of life in panic disorder: the influence of clinical features and personality traits.

OBJECTIVE
To identify which clinical features and personality traits are associated with quality of life (QoL) in panic disorder (PD) patients.


METHODS
This was a cross-sectional study with PD patients. The brief version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Big Five Inventory (BFI) were used to assess QoL and personality traits respectively. The strength of correlations was measured with Pearson's, Spearman's, and point-biserial correlation coefficients. We also performed multiple linear regressions, considering sociodemographic data and scores from clinical scales as independent variables and QoL scores as dependent variables.


RESULTS
A total of 98 patients were evaluated. Depressive symptoms had a strong negative correlation with QoL and, to a lesser extent, panic and anxiety symptoms were also negatively correlated with QoL. While consciousness, extraversion, and agreeableness had mild positive correlations with QoL, neuroticism had a strong negative correlation.


CONCLUSION
Symptoms of depression, anxiety, and panic seem to have a negative impact on the QoL of PD patients. Personality traits, especially neuroticism, may also influence QoL in these patients.


Introduction
Panic disorder (PD) is an anxiety disorder 1 known for its negative impact on patients' quality of life (QoL), 2 independently of other factors. 3 Major depressive disorder (MDD) is a common comorbidity (55.6% in lifetime), 4 which also has an impact on QoL. 5 Comorbidity with PD increases depression severity, further affecting QoL. 6 Assessment of QoL has increasingly been used as an outcome measure in clinical trials, in effectiveness studies, in health technology assessments, and in epidemiological surveys to assess the subjective health and well-being of the population. 7 Previous studies have shown the effect of PD on these domains, mainly on psychological and physical domains. 8,9 It has also been demonstrated that successful treatment of PD is associated with improvements in QoL. 10 Other factors may impact QoL.
such as PD subtype. For example, non-respiratory subtype (NR) patients had worse psychological QoL than respiratory subtype (RS) patients. 11 The RS is one of the PD subtypes described by Briggs et al. 12 Respiratory subtype patients are more likely to have a family history of PD and have higher comorbidity rates for depressive disorders, longer illness duration, and low neuroticism scores. 13 These patients also score higher on PD severity scales and improvement with pharmacological treatment is observed more quickly than in patients without this subtype. 12,14 Personality traits are also associated with anxiety and mood disorders and are probably risk factors for PD. 15 The Five Factor Model, also known as the Big Five Inventory (BFI), is one of the personality models most used in clinical research. This model includes five personality dimensions: extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience. 16 Many studies have demonstrated that PD, agoraphobia, social anxiety disorder, simple phobia, and MDD are associated with high neuroticism. [17][18][19] Agoraphobia is also correlated with low extraversion. 18 The BAI is a self-administered questionnaire with 21 items designed to assess the severity of anxiety symptoms in adult psychiatric populations. Its score ranges from 0 to 63, with a higher score denoting a more severe degree of anxiety. The BDI is also a self-administered questionnaire, with a score ranging from 0 to 63 and higher scores indicate more severe were defined as having the RS. 12 The respiratory ratio (RR) was calculated by dividing the respiratory symptom score by the total DSQ score. 32 The BFI is

Results
We recruited 98 patients with PD diagnoses. This was an adequate number, since the total sample size calculated for the correlation was 85. Demographic and clinical features are described in Tables 1 and 2. The statistical analysis is summarized in Tables 3 and 4.

Discussion
Our results show that our group of PD patients has "moderate" to "markedly ill" disorder severity, with lower QoL values than the average population. 33 The focusing on PD or panic attacks, and treat them incisively, since they can impair these patients' QoL.
One of the main limitations of the current study was the lack of a control group with healthy individuals, which would have allowed us to compare the impact of PD on QoL. Additionally, there are many severe cases in our sample, with more than half of patients with a history of recurrence, and severity and chronicity could also have an impact on QoL. Finally, the neuroticism personality trait can sometimes be mistaken for depression symptoms, thus it is a current possible cause that both are strongly associated with worse QoL.

Conclusion
Symptoms of depression, anxiety, and panic have a significant negative impact on the QoL of PD patients.
Personality traits, especially neuroticism, may also influence QoL in these patients. Depressive symptoms seem to have stronger associations with QoL impairment.
Longitudinal studies are needed to better understand the causality and prognosis of QoL in PD patients.

Disclosure
No conflicts of interest declared concerning the publication of this article.