Expecting the Unexpected: Predicting Panic Attacks From Mood, Twitter, and Apple Watch Data.

OBJECTIVE: Panic attacks are an impairing mental health problem that affects 11% of adults every year. Current criteria describe them as occurring without warning, despite evidence suggesting individuals can often identify attack triggers. We aimed to prospectively explore qualitative and quantitative factors associated with the onset of panic attacks. RESULTS: Of 87 participants, 95% retrospectively identified a trigger for their panic attacks. Worse individually reported mood and state-level mood, as indicated by Twitter ratings, were related to greater likelihood of next-day panic attack. In a subsample of participants who uploaded their wearable sensor data (n = 32), louder ambient noise and higher resting heart rate were related to greater likelihood of next-day panic attack. CONCLUSIONS: These promising results suggest that individuals who experience panic attacks may be able to anticipate their next attack which could be used to inform future prevention and intervention efforts.

Associations Between Configurations of Childhood Adversity and Adult Mental Health Disorder Outcomes.

The life course perspective and cumulative inequality theory suggest that childhood adversity, occurring during a sensitive period of the life course, can have long-term consequences for adult mental health and well-being. Yet, the long-term influence of adversity on adult outcomes may depend on both the features of adverse childhood experiences (e.g., the number, type, and co-occurrence of adversities) as well as the outcome assessed. Using latent class analysis applied to several waves of prospective data from the Great Smoky Mountain Study (GSMS; N=1,420) we identify subpopulations that are similar in their adversity experiences before age 18. We then predict adult internalizing and substance use disorder diagnoses by adversity experience. Results reveal five distinct classes of adversity, with unique risks for specific diagnoses in adulthood.

Intergenerational Effects of the Fast Track Intervention on Next-Generation Child Outcomes: A Preregistered Randomized Clinical Trial.

OBJECTIVE: The authors sought to determine whether the Fast Track mental health intervention delivered to individuals in childhood decreased mental health problems and the need for health services among the children of these individuals. METHODS: The authors examined whether Fast Track assignment in one generation of children (generation 2; G2) from grades 1 through 10 reduced parent-reported mental health problems and health services use in these children's children (generation 3; G3) 18 years later relative to a control group. The Fast Track intervention blended parent behavior-management training, child social-cognitive skills tutoring, home visits, and classroom social-ecology changes across grades 1-10 to ameliorate emerging conduct problems among the G2 children. For this study, 1,057 G3 children of Fast Track participants (N=581 intervention group, N=476 control group) were evaluated. RESULTS: G3 children of G2 parents who were randomized to the Fast Track intervention group used fewer general inpatient services and fewer inpatient or outpatient mental health services compared with G3 children of G2 parents randomized to the control group. Some of these effects were mediated: randomization to Fast Track predicted fewer internalizing problems and less use of corporal punishment among G2 adults at age 25, which subsequently predicted less general inpatient service use and outpatient mental health service use among the G3 children by the time the G2 parents were 34 years old. There were no significant differences between G3 children from these two groups on the use of other health services or on mental health measures. CONCLUSIONS: Fast Track was associated with lower use of general inpatient services and inpatient and outpatient mental health services intergenerationally, but effects on parent-reported mental health of the children were not apparent across generations. Investing in interventions for the mental health of children could reduce service use burdens across generations.

Family cash transfers in childhood and birthing persons and birth outcomes later in life.

Much literature in the US documents an intergenerational transmission of birthing person and perinatal morbidity in socioeconomically disadvantaged groups. A separate line of work indicates that family cash transfers may improve life chances of low-income families well into adulthood. By exploiting a quasi-random natural experiment of a large family cash transfer among a southeastern American Indian (AI) tribe in rural North Carolina, we examine whether a "perturbation" in socioeconomic status during childhood improves birthing person/perinatal outcomes when they become parents themselves. We acquired birth records on 6805 AI and non-AI infants born from 1995 to 2018. Regression methods to examine effect modification tested whether the birthing person's American Indian (AI) status and exposure to the family cash transfer during their childhood years corresponds with improvements in birthing person and perinatal outcomes. Findings show an increase in age at childbearing (coef: 0.15 years, 95% confidence interval [CI]: 0.05, 0.25) and a decrease in pre-pregnancy body mass index (BMI; coef: -0.42, 95% CI: -0.76, -0.09) with increased duration of cash transfer exposure during childhood. The odds of large-for-gestational age at delivery, as well as mean infant birthweight, is also reduced among AI births whose birthing person had relatively longer duration of exposure to the cash transfer. We, however, observe no relation with other birthing person/perinatal outcomes (e.g., tobacco use during pregnancy, preterm birth). In this rural AI population, cash transfers in one generation correspond with improved birthing person and infant health in the next generation.

Commentary: Integrative, multi-level explanatory models are needed to understand recent trends in sex, gender, and internalizing conditions, reflections on Keyes and Platt (2023).

Keyes' and Platt's (The Journal of Child Psychology and Psychiatry, 2023) review provides much-needed systematic evidence about why internalizing symptoms have increased and it clarifies the role of novel risk factors. The findings highlight that multiple factors at multiple levels are responsible for this phenomenon, many with small effects, within a complex interplay that is rarely well captured. As new insights emerge across disciplines, an important step is to renew efforts to integrate them to understand how internalizing symptoms develop for different people.

The substance use behaviors change of first-year college students before and during COVID-19 pandemic.

OBJECTIVE: This article tests the substance use behaviors of college students before and during COVID-19 pandemic. METHODS: In-depth assessment and nightly survey data was used from a longitudinal study (n = 675) which examined student substance use during the 2019-2020 academic year, both before and during the onset of the COVID-19 pandemic. Changes in beer/wine, tobacco, liquor, and marijuana use before versus during the pandemic, in addition to the interaction of COVID-19, were tested with gender and subjective social status. RESULTS: Marijuana use significantly decreased from a weekly prevalence of 9.9% before COVID-19 to 6.4% during COVID-19 (p = 0.002). A similar decrease was seen in liquor use (10.6% before COVID to 6.4% during COVID, p = 0.01). There was no significant change observed for beer/wine use or for tobacco use. CONCLUSION: In the wake of the COVID-19 pandemic, liquor, and marijuana use decreased for college students, while other substance use stayed the same.

Comparative assessment of the feasibility and validity of daily activity space in urban and non-urban settings.

Activity space research explores the behavioral impact of the spaces people move through in daily life. This research has focused on urban settings, devoting little attention to non-urban settings. We examined the validity of the activity space method, comparing feasibility and data quality in urban and non-urban contexts. Overall, we found that the method is easily implemented in both settings. We also found location data quality was comparable across residential and activity space settings. The major differences in GPS (Global Positioning System) density and accuracy came from the operating system (iOS versus Android) of the device used. The GPS-derived locations showed high agreement with participants' self-reported locations. We further validated GPS data by comparing at-home time allocation with the American Time Use Survey. This study suggests that it is possible to collect daily activity space data in non-urban settings that are of comparable quality to data from urban settings.

The Potential of Real-Time Behavior and Well-Being Assessments to Improve Medical Student Wellness.

PROBLEM: Medical students experience psychological distress more frequently than age-matched peers. Tracking medical student well-being has typically been limited to once- or twice-per-year questionnaires. Ongoing, real-time assessment of student behavior and well-being could facilitate individualized, timely interventions. APPROACH: Faculty at the University of Vermont, in conjunction with the Larner College of Medicine Office of Medical Education, developed a novel smartphone app in 2021 called WE MD to track and support medical student wellness. The app included the following features: 1) nightly surveys assessing wellness-related behaviors (e.g., social interaction, sleep, exercise) and outcomes (i.e., mood, focus, stress, overall well-being); 2) health reports that enabled users to graph various combinations of their own behaviors and outcomes, allowing them to visualize trends and understand possible correlations between behaviors and outcomes; 3) a resource library with articles and educational videos related to specific wellness behaviors or outcomes; and 4) research-based "insights" or brief tips intended to promote healthy habits. Participants also received virtual "coins" for interacting with the app that could be exchanged for various items in an online store. OUTCOMES: The WE MD program enrolled a substantial portion of the medical school population (43%); most of the students used the app on a regular basis. Students found the app to be acceptable and appreciated many features and also provided feedback on how to improve the app. Information from the nightly survey data converged with established measures but also identified variability over time in wellness behaviors and outcomes. NEXT STEPS: Data from the WE MD program suggest that app-based daily tracking of wellness behaviors and outcomes is a feasible, promising approach to promote student wellness and identify real-time patterns and risk periods for medical students. The app will be revised based on student feedback and adapted for use by students, residents, and faculty.

Intergenerational Effects of a Family Cash Transfer on the Home Environment.

OBJECTIVE: A natural experiment that provided income supplements to families has been associated with beneficial outcomes for children that persisted into adulthood. The children in this study are now adults, and many are parents. METHOD: The study builds on the longitudinal, representative Great Smoky Mountains study conducted from 1993 to 2020. At follow-up in their late 30s, 1,094 of the 1,348 living participants (81.2%) were assessed. Of these participants (67.6%), 739 were parents. A tribe in the area implemented a cash transfer program of approximately $5,000 annually per person to every tribal member based on the profits received from operating a casino. Ten aspects of the home environment of participants were assessed (eg, family chaos, substance use, and food insecurity) as well as a composite measure across all home environment indicators. The proposed analyses were preregistered (https://osf.io/ex638). RESULTS: Of the 739 parents assessed, 192 (26.0%) were American Indians. Parents whose families received cash transfers during childhood did not differ from parents whose families did not receive cash transfers on any of the home environment indicators or the composite measure. At the same time, there was little evidence of elevated risk for participants in either group in measures of parental mental health, substance use, and violence. CONCLUSION: A family cash transfer in childhood that had long-term effects on individual functioning did not impact the home environment of participants who became parents. Rather, parents in both groups were providing home environments generally conducive to their children's growth and development. STUDY PREREGISTRATION INFORMATION: Intergenerational Effects of a Family Cash Transfer on the Home Environment; https://osf.io/; ex638.

Discovering Digital Biomarkers of Panic Attack Risk in Consumer Wearables Data.

Panic attacks are an impairing mental health problem that impacts more than one out of every 10 adults in the United States (US). Clinical guidelines suggest panic attacks occur without warning and their unexpected nature worsens their impact on quality of life. Individuals who experience panic attacks would benefit from advance warning of when an attack is likely to occur so that appropriate steps could be taken to manage or prevent it. Our recent work suggests that an individual's likelihood of experiencing a panic attack can be predicted by self-reported mood and community-level Twitter-derived mood the previous day. Prior work also suggests that physiological markers may indicate a pending panic attack. However, the ability of objective physiological, behavioral, and environmental measures collected via consumer wearable sensors (referred to as digital biomarkers) to predict next-day panic attacks has not yet been explored. To address this question, we consider data from 38 individuals who regularly experienced panic attacks recruited from across the US. Participants responded to daily questions about their panic attacks for 28 days and provided access to data from their Apple Watches. Mixed Regressions, with an autoregressive covariance structure were used to estimate the prevalence of a next-day panic attack Results indicate that digital biomarkers of ambient noise (louder) and resting heart rate (higher) are indicative of experiencing a panic attack the next day. These preliminary results suggest, for the first time, that panic attacks may be predictable from digital biomarkers, opening the door to improvements in how panic attacks are managed and to the development of new preventative interventions.Clinical Relevance- Objective data from consumer wearables may predict when an individual is at high risk for experiencing a next-day panic attack. This information could guide treatment decisions, help individuals manage their panic, and inform the development of new preventative interventions.

The Impact of Childhood Mental Health and Substance Use on Methylation Aging Into Adulthood.

OBJECTIVE: To test whether childhood mental health symptoms, substance use, and early adversity accelerate the rate of DNA methylation (DNAm) aging from adolescence to adulthood. METHOD: DNAm was assayed from blood samples in 381 participants in both adolescence (mean [SD] age = 13.9 [1.6] years) and adulthood (mean [SD] age = 25.9 [2.7] years). Structured diagnostic interviews were completed with participants and their parents at multiple childhood observations (1,950 total) to assess symptoms of common mental health disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, anxiety, and depression) and common types of substance use (alcohol, cannabis, nicotine) and early adversities. RESULTS: Neither childhood mental health symptoms nor substance use variables were associated with DNAm aging cross-sectionally. In contrast, the following mental health symptoms and substance variables were associated with accelerated DNAm aging from adolescence to adulthood: depressive symptoms (b = 0.314, SE = 0.127, p = .014), internalizing symptoms (b = 0.108, SE = 0.049, p = .029), weekly cannabis use (b =1.665, SE = 0.591, p = .005), and years of weekly cannabis use (b = 0.718, SE = 0.283, p = .012). In models testing all individual variables simultaneously, the combined effect of the variables was equivalent to a potential difference of 3.17 to 3.76 years in DNAm aging. A final model tested a variable assessing cumulative exposure to mental health symptoms, substance use, and early adversities. This cumulative variable was strongly associated with accelerated aging (b = 0.126, SE = 0.044, p = .005). CONCLUSION: Mental health symptoms and substance use accelerated DNAm aging into adulthood in a manner consistent with a shared risk mechanism.

Adult Mental Health, Substance Use Disorders, and Functional Outcomes of Children Resilient to Early Adversity.

OBJECTIVE: Some children are unaffected by mental illness despite exposure to childhood adversity. These children are typically considered resilient. The objective of this study was to follow up such resilient children in adulthood to characterize mental health status, substance use, and functional outcomes. METHODS: The analysis was based on the prospective, representative Great Smoky Mountains Study (N=1,420). Participants were assessed for psychiatric disorders and exposure to adversity with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9-16; 6,674 observations). In total, 1,266 participants (86.3%) were followed up in adulthood at ages 25 and 30 to assess psychiatric disorders, substance use disorders, and functional outcomes. RESULTS: Seventy-five percent of the sample had met criteria for a psychiatric disorder or displayed subthreshold psychiatric problems by age 16. The number of adverse childhood experiences was strongly associated with childhood psychiatric status. Of children exposed to multiple adversities (N=650), 12.2% (N=63) did not display psychiatric problems. This group meets common definitions of childhood resilience. In adulthood, these individuals showing childhood resilience had greater risk of anxiety (risk ratio=2.9, 95% CI=1.0-9.1) and depressive (risk ratio=4.5, 95% CI=1.1-16.7) disorders, as well as worse physical health (means ratio=0.7, 95% CI=0.5-0.9) and financial or educational functioning (means ratio=0.6, 95% CI=0.5-0.7), compared with individuals exposed to fewer childhood adversities. These individuals showing childhood resilience did not have elevated risk for substance use disorders. CONCLUSIONS: Resilience to childhood adversity was uncommon. Individuals who appeared resilient in childhood were at risk for delayed poorer outcomes in adulthood. Public health efforts should prioritize minimizing early adversity exposure over promoting resilience.

Early life adversity and psychopathology in preschoolers: mechanisms and moderators.

Developmental theories suggest that exposure to early life adversity (ELA) alters developing emotional response systems, predicting risk for psychopathology across the life span. The present study examines whether negative emotionality (NE), a trait-like measure of emotionality that develops during early childhood, mediates the association between ELA and psychopathology in a representative sample of 917 preschoolers (Mage = 3.84). Additionally, we explored whether cognitive control, which supports attentional focusing and inhibition and has been identified as a transdiagnostic protective factor, moderates the impact of heightened emotionality following adversity on psychopathology risk. We utilized parent report of adversity, psychopathology, and NE and parent report and task-based measures of cognitive control. Structural equation modeling of cross-sectional data revealed that NE partially mediated the link between ELA and psychopathology symptoms. Moreover, parent-reported cognitive control buffered this link such that the effect of ELA on psychopathology through NE was stronger in children with low versus high cognitive control. These results identify elevated NE as one mechanism linking ELA and psychopathology, specifically among children with poorer top-down control, informing our understanding of key risk and protective factors among adversity-exposed children.

Methylome-wide association study of anxiety disorders.

Anxiety Disorders (ANX) such as panic disorder, generalized anxiety disorder, and phobias, are highly prevalent conditions that are moderately heritable. Evidence suggests that DNA methylation may play a role, as it is involved in critical adaptations to changing environments. Applying an enrichment-based sequencing approach covering nearly 28 million autosomal CpG sites, we conducted a methylome-wide association study (MWAS) of lifetime ANX in 1132 participants (618 cases/514 controls) from the Netherlands Study of Depression and Anxiety. Using epigenomic deconvolution, we performed MWAS for the main cell types in blood: granulocytes, T-cells, B-cells and monocytes. Cell-type specific analyses identified 280 and 82 methylome-wide significant associations (q-value < 0.1) in monocytes and granulocytes, respectively. Our top finding in monocytes was located in ZNF823 on chromosome 19 (p = 1.38 × 10-10) previously associated with schizophrenia. We observed significant overlap (p < 1 × 10-06) with the same direction of effect in monocytes (210 sites), T-cells (135 sites), and B-cells (727 sites) between this Discovery MWAS signal and a comparable replication dataset from the Great Smoky Mountains Study (N = 433). Overlapping Discovery-Replication MWAS signal was enriched for findings from published GWAS of ANX, major depression, and post-traumatic stress disorder. In monocytes, two specific sites in the FZR1 gene showed significant replication after Bonferroni correction with an additional 15 nominally replicated sites in monocytes and 4 in T-cells. FZR1 regulates neurogenesis in the hippocampus, and its knockout leads to impairments in associative fear memory and long-term potentiation in mice. In the largest and most extensive methylome-wide study of ANX, we identified replicable methylation sites located in genes of potential relevance for brain mechanisms of psychiatric conditions.

Day-to-day variation in adolescent food insecurity.

This study examined differences in both average and variability in daily adolescent food insecurity, by adolescents' levels of economic disadvantage and race/ethnicity. We used data from a 14-day ecological momentary assessment of 395 adolescents enrolled in public schools in North Carolina. Each evening, adolescents were asked questions about that day's food insecurity. Economically disadvantaged adolescents reported both higher average food insecurity and more day-to-day variability in food insecurity than non-economically disadvantaged adolescents. Controlling for economic disadvantage, Black adolescents also experienced both higher average food insecurity and more variability from day to day than White or Hispanic adolescents. For those receiving Supplemental Nutrition Assistance Program (SNAP) benefits, daily food insecurity was higher in the second half of the month after SNAP transfer than in the beginning of the month. Food insecurity among adolescents is not static but varies from day to day. This daily variation is greater for economically disadvantaged youth.

Prospective Associations of Childhood Housing Insecurity With Anxiety and Depression Symptoms During Childhood and Adulthood.

Importance: Childhood housing insecurity has dramatically increased in the US in recent decades, but whether an association with adverse mental health outcomes exists after adjusting for repeated measures of childhood poverty is unclear. Objective: To test whether childhood housing insecurity is associated with later anxiety and depression symptoms after adjusting for time-varying measures of childhood poverty. Design, Setting, and Participants: This prospective cohort study included individuals aged 9, 11, and 13 years at baseline from the Great Smoky Mountains Study in western North Carolina. Participants were assessed up to 11 times from January 1993 to December 2015. Data were analyzed from October 2021 to October 2022. Exposure: Participants and their parents reported social factors annually when participants were 9 to 16 years of age. A comprehensive measure of childhood housing insecurity was constructed based on frequent residential moves, reduced standard of living, forced separation from home, and foster care status. Main Outcomes and Measures: Between ages 9 and 16 years, the Child and Adolescent Psychiatric Assessment was used up to 7 times to evaluate childhood anxiety and depression symptoms. Adult anxiety and depression symptoms were assessed at ages 19, 21, 26, and 30 years using the Young Adult Psychiatric Assessment. Results: Of the 1339 participants (mean [SD] age, 11.3 [1.63] years), 739 (55.2%; 51.1% weighted) were male; 1203 individuals assessed up to 30 years of age were included in the adulthood outcome analyses. Standardized mean (SD) baseline anxiety and depression symptom scores were higher among children who experienced housing insecurity than among those who never experienced housing insecurity (anxiety: 0.49 [1.15] vs 0.22 [1.02]; depression: 0.20 [1.08] vs -0.06 [0.82]). Individuals who experienced childhood housing insecurity had higher anxiety symptom scores (fixed effects: standardized mean difference [SMD], 0.21; 95% CI, 0.12-0.30; random effects: SMD, 0.25; 95% CI, 0.15-0.35) and higher depression symptom scores (fixed effects: SMD, 0.18; 95% CI, 0.09-0.28; random effects: SMD, 0.26; 95% CI, 0.14-0.37) during childhood. In adulthood, childhood housing insecurity was associated with higher depression symptom scores (SMD, 0.11; 95% CI, 0.00-0.21). Conclusions and Relevance: In this cohort study, housing insecurity was associated with anxiety and depression during childhood and with depression during adulthood. Because housing insecurity is a modifiable, policy-relevant factor associated with psychopathology, these results suggest that social policies that support secure housing may be an important prevention strategy.

Associations of preschool reactive bed-sharing with sociodemographic factors, sleep disturbance, and psychopathology.

OBJECTIVE: To advance understanding of early childhood bed-sharing and its clinical significance, we examined reactive bed-sharing rates, sociodemographic correlates, persistence, and concurrent and longitudinal associations with sleep disturbances and psychopathology. METHODS: Data from a representative cohort of 917 children (mean age 3.8 years) recruited from primary pediatric clinics in a Southeastern city for a preschool anxiety study were used. Sociodemographics and diagnostic classifications for sleep disturbances and psychopathology were obtained using the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic interview administered to caregivers. A subsample of 187 children was re-assessed approximately 24.7 months after the initial PAPA interview. RESULTS: Reactive bed-sharing was reported by 38.4% of parents, 22.9% nightly and 15.5% weekly, and declined with age. At follow-up, 48.9% of nightly bed-sharers and 88.7% of weekly bed-sharers were no longer bed-sharing. Sociodemographics associated with nightly bed-sharing were Black and (combined) American Indian, Alaska Native and Asian race and ethnicity, low income and parent education less than high school. Concurrently, bed-sharing nightly was associated with separation anxiety and sleep terrors; bed-sharing weekly was associated with sleep terrors and difficulty staying asleep. No longitudinal associations were found between reactive bed-sharing and sleep disturbances or psychopathology after controlling for sociodemographics, baseline status of the outcome and time between interviews. CONCLUSIONS: Reactive bed-sharing is relatively common among preschoolers, varies significantly by sociodemographic factors, declines during the preschool years and is more persistent among nightly than weekly bed-sharers. Reactive bed-sharing may be an indicator of sleep disturbances and/or anxiety but there is no evidence that bed-sharing is an antecedent or consequence of sleep disturbances or psychopathology.

Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults.

BACKGROUND: It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals. METHODS: To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects. RESULTS: Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects. CONCLUSIONS: Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

Discovering Digital Biomarkers of Panic Attack Risk in Consumer Wearables Data.

Panic attacks are an impairing mental health problem that impacts more than one out of every 10 adults in the United States (US). Clinical guidelines suggest panic attacks occur without warning and their unexpected nature worsens their impact on quality of life. Individuals who experience panic attacks would benefit from advance warning of when an attack is likely to occur so that appropriate steps could be taken to manage or prevent it. Our recent work suggests that an individual's likelihood of experiencing a panic attack can be predicted by self-reported mood and community-level Twitter-derived mood the previous day. Prior work also suggests that physiological markers may indicate a pending panic attack. However, the ability of objective physiological, behavioral, and environmental measures to predict next-day panic attacks has not yet been explored. To address this question, we consider data from 38 individuals who regularly experienced panic attacks recruited from across the US. Participants responded to daily questions about their panic attacks for 28 days and provided access to data from their Apple Watches. Results indicate that objective measures of ambient noise (louder) and resting heart rate (higher) are related to the likelihood of experiencing a panic attack the next day. These preliminary results suggest, for the first time, that panic attacks may be predictable from data passively collected by consumer wearable devices, opening the door to improvements in how panic attacks are managed and to the development of new preventative interventions. Clinical Relevance: Objective data from consumer wearables may predict when an individual is at high risk for experiencing a next-day panic attack. This information could guide treatment decisions, help individuals manage their panic, and inform the development of new preventative interventions.