Discussion
agoraphobic, panic disorders, anxiety, panic disorder, panic, anxiety-related impairments, depression
VIRUS
More than five years after the original trial ended, we investigated potential long-term effects of a practice team-based intervention (CBT and case management) for patients with panic disorder during the Covid-19 pandemic. Group differences of the anxiety severity (OASIS) in cross sectional analysis at the 60months follow-up were found with medium effect sizes. Especially one item differed between groups with large effect size (“How much does anxiety or fear affect your ability to complete necessary tasks at work, school, or home?”), indicating that the intervention group suffered less from impairment through fear. However, these are very tentative interpretations, since after Bonferroni correction significance level was no longer reached.In general, while CBT is widely recognised as effective treatment for panic disorders [Interestingly, in our study, the IG and CG differed moderately to strongly with regard to anxiety severity and impairment (measured by OASIS) but not with regard to the other anxiety scales (measured by BAI, PAS, Fear-of-Covid-19-Scale, and MIA). This might be related to what the different anxiety scales address in detail: The BAI asks about various physiological anxiety symptoms, the two PAS items address frequency & intensity of panic attacks, Fear-of-Covid-19-Scale refers to fears and physical sensations in association with the virus and the MIA deals with agoraphobic avoidance behaviour. The OASIS uniquely asks specifically how fear impairs people in their everyday life: The last two OASIS items examine the extent of anxiety-related impairments in professional/domestic (Item 4) and social (Item 5) domains and the total sum score negatively correlates with the construct of perceived quality of life [We assume that CBT-based interventions including psychoeducation may have a positively affected patients’ understanding of their symptoms; thus, they might feel less impaired by their panic attacks and anxiety symptoms in everyday life, even in a crisis situation like the Covid-19 pandemic. Furthermore, the pandemic might have resulted in positive and potentially buffering changes for some, including a better work–life balance through home-office [In the longitudinal analysis, IG and CG both showed an increase in anxiety and depression symptoms, which might be attributed to the external circumstances brought about by the pandemic. The slightly better values of the IG regarding anxiety and depression could be due to the fact that these patients might have maintained behaviour and self-management strategies, which helped them cope with the crisis situation. However, we must also keep in mind that there might have been many other factors within the six years after the end of the original trial which influenced people’s behaviour and which we did not assess.Germany-wide data from surveys conducted by a large insurance company over the last 30 years showed that in the German population, anxiety levels were at an all-time low in 2020 and 2021 [Patient assessment of chronic care was significantly lower during the 60 months follow-up, probably because GP care reached its limit during the pandemic: GPs were overburdened with vaccinations and Covid-19 patients; additionally, they had to cope with staff shortages due to the Covid-19 pandemic. Thus, they might not have the appropriate time for their chronic patients. Our findings coincide with a survey that was commissioned by the AOK-Bundesverband (Federal Association of the health insurance “AOK”) and has been conducted in several waves since 2019 (N = 2000 participants). It found that since the beginning of the Covid-19 pandemic, fewer and fewer Germans believe that health care in their region works well or very well [During the Covid-19 pandemic, access to health services was difficult; thus, technological advancements, e.g. eHealth supported tools or iCBT, should be considered as promising solutions [