J Korean Neuropsychiatr Assoc.  2021 Aug;60(3):213-222. 10.4306/jknpa.2021.60.3.213.

Emergency Department Visits for Panic Attacks and Ambient Air Pollution: A Time-Stratified Case-Crossover Analysis

• Moon YK
• Lee W
• Oh S
• Kim H
• Myung W
• Lee H
• Kim DK

• KMID: 2519856
• DOI: http://doi.org/10.4306/jknpa.2021.60.3.213

Abstract

Objectives
This study investigates the association between short-term exposure to air pollutants and panic attacks requiring emergency department (ED) visits.
Methods
We identified 1926 patients who visited EDs in Seoul with panic attacks as the primary cause during the period from 2008 to 2014. We estimated short-term exposure to particles <2.5 μm (PM_2.5), particles <10 μm (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO). We applied a time-stratified case-crossover study design and conducted a conditional logistic regression analysis to assess the association between air pollutants levels and ED visits due to panic attacks.
Results
Increasing O₃ concentration was significantly associated with an increased risk of panic attacks requiring ED visits (odds ratio: 1.15; 95% confidence interval: 1.04–1.27) on the same day of exposure. This association was robust to the sensitivity analysis using two pollutant models.
Conclusion
Our results show that short-term exposure to elevated O₃ concentration is associated with the exacerbation of panic attacks. This finding strongly suggests the detrimental effects of O₃ on major public health problems and provides insights for further research to investigate the causal associations between air pollution and poor mental health.

Keyword

Air pollutants; Ozone; Panic attack; Panic disorder; Case-crossover design