Social Determinants of Treatment Delay in Panic Disorder

Background and Purpose: In panic disorder (PD), early detection and treatment can improve outcomes. Delays in initial treatment contact after first onset of a mental disorder can worsen symptoms and lower treatment success rates. Treatment delays in mental disorders can occur due to various factors, including low awareness of the disorders, economic problems, and cultural barriers. Despite the importance of addressing social determinants of treatment delay in PD, there are few studies investigating this issue. Therefore, this study aimed to identify social determinants affecting the implementation of PD treatment by examining demographic and clinical factors that influence the delay in starting treatment after symptom onset.

Methods: Data from 970 adult PD patients aged 18 years or older were collected at CHA Bundang Hospital to analyze social determinants affecting PD treatment implementation. The study examined the period (in months) from symptom onset to the start of treatment as the treatment delay period, along with gender [453 males(46.7%), 516 females(53.2%)], age [mean=39.32 years old(SD 11.58)], education level [high school or lower: n=485(58.6%), college or higher: n=342(41.4%)], employment status [unemployment: n=94(11.3%), employment: n=741(88.7%)], average monthly income [less than $1800: n=439(55.2%), more than $1800: n=356(44.8%)], and living with a partner [without partner: n=321(37.4%), with partner: n=538(62.5%)] as socio-demographic factors. Clinical factors included the Panic Disorder Severity Scale (PDSS) measuring symptom severity [mean=10.61(SD 6.287), range 0-28) and agoraphobia [with agoraphobia: n=594(69.1%), without agoraphobia: n=266(30.9%)]. The analysis used descriptive statistics, t-tests, correlation analysis, and linear regression analysis.

Results: The results showed that the average treatment delay period from symptom onset to treatment initiation was 37.8 months (range 0-456 months, SD 63.5). T-tests indicated that gender, average monthly income level, employment status, and living with a partner were not significantly related to treatment delay period, while agoraphobia was significant (t=-2.656, p=.008). Correlation analysis showed that age increase treatment delay period (r=.130, p=.000), but education level and PDSS were not statistically significant. Regression analysis model was significant (adjusted R²=.041, F=4.326, p=.000). Treatment delay was significantly associated with older age (period increased with age (ß=.239, t=5.103, p=.000), living without partner (ß=.100, t=2.153, p=.032), and the presence of agoraphobia (ß=.103, t=2.533, p=.012).

Conclusions and Implications: The results of this study indicate that older age, living without partner, and agoraphobia symptoms are social determinants that contribute to treatment delay in individuals with panic disorder in PD. Older individuals may have lower awareness of panic disorder and may spend more time seeking medical diagnosis for other physical illnesses. Moreover, those living without partner, or with agoraphobia may experience a delay in seeking treatment due to lack of social support or limitations in social activities. These findings highlight the need for mental health policies and services addressing these social determinants, it may be possible to improve treatment outcomes and ultimately enhance the quality of life for those living with panic disorder.