Factors Influencing Health Perceptions in Patients With Panic Disorder Norman B. Schmidt, Michael J. Telch, and Thomas E. Joiner, Jr. Subjective perceptions of health have been found to be related to a variety of consequential variables including health care utilization and mortality. A num- ber of studies have found that patients with panic disorder generally perceive themselves as having poor health.:, However, factors underlying self-perceptions of health are largely unexplored in this population. The present study examined three factors believed to contribute to health perceptions: (1) presence of comor- bid medical conditions, {2) tendency to somaticize or worry about health, and (3) level of co-occurring depression. The sample consisted of 81 patients who met DSM-III-R criteria for panic disorder. An assess- ment battery that determined self-perceptions of health, level of depression, and the major clinical dimensions of panic disorder (i.e., panic attacks, anxi- ety, and phobic avoidance) was administered to all participants. As predicted, analyses indicated that each of the hypothesized factors was significantly related to poorer perceived health. Setwise hierarchi- cal multiple regression analyses controlling for demo- graphic variables indicated that health perceptions are strongly and independently associated with depres- sion and the presence of a medical condition. Subjec- tive health perceptions in panic disorder are multifacto- rial and are related to both realistic appraisals of health and distorted perceptions caused by depressed mood. Copyright © 1996 by W.B, Saunders Company E P~DEMIOLOGICAL DATA suggest that panic disorder has a markedly negative impact on quality of life. I The effects of panic disorder on quality of life are comparable to the impact of major depression 1,2 and major medi- cal conditions. 3 One index of quality of life is the subjective perception of health. Health percep- tions affect health-seeking behaviors and utiliza- tion of health care, both of which are high among patients with panic disorder. 4 In addi- tion, self-rated health has been found to predict mortality after controlling for actual health status. ~ In fact, health perceptions have been found to predict mortality better than health status assessed by physicians. 6 Although patients with panic disorder gener- ally perceive that they have poor health, the factors underlying self-perceptions of health are largely unexplored in these patients. It may be that patients with panic disorder are accurately appraising their health status. On the other hand, their perceptions may be distorted due to factors inherent to panic disorder or other related factors. We present several hypotheses regarding factors that potentially affect self- perceptions of health. MEDICAL COMORBIDITY HYPOTHESIS The relationship between panic disorder and perceptions of health is likely influenced by actual health status. The relationship between panic disorder and medical illness is complex. Medical conditions may contribute to the devel- opment of panic disorder, 7 and/or comorbid medical conditions may exacerbate panic disor- der symptoms. 8 Epidemiological studies have found significantly higher rates of chronic medi- cal conditions among anxiety disorder patients. 9 Thus, patients with panic disorder may be accurately appraising their health status. The medical comorbidity hypothesis predicts that negative health perceptions are due to the high rate of comorbid medical conditions among patients with panic disorder. SOMATIZATION HYPOTHESIS Another possibility is that negative health perceptions are due to a general tendency to worry about health. Panic-related worry and anxiety is central to the panic disorder syn- drome, 1° and much of this worry is directed at health-related concerns (e.g., fear of dying and fear of heart attack). Many panic disorder From the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Psychology, University of Texas, Austin; and Department of Psychiatry, University of Texas Medical Branch, Galveston, TX. Supported by USUHS Grant No. C072BN-O1 (N.B.S.) and National Institute of Mental Health Grant No. MH74-600-203 (M.J.T.). Address reprint requests to Norman B. Schmidt, Ph.D., Department of Medical and Clinical Psychology, Uniformed Services Universityof the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20901-4799. Copyright © 1996by W.B. Saunders Company 0010-440X/96/3704-0001503.00/0 Comprehensive Psychiatry, Vol. 37, No. 4 (July/August), 1996: pp 253-260 253