| Description |
Posttraumatic stress disorder (PTSD) is a trauma and stressor-related disorder that occurs after exposure to a traumatic event. Veterans are at the greatest risk of developing PTSD. Although benzodiazepines are not recommended for the treatment of PTSD, they are still commonly prescribed to veterans. The overall distribution of therapies in the 1,134,201 cohort with PTSD is similar to that outlined in the 2010 Veterans Affairs Posttraumatic Stress Disorder Clinical Practice Guidelines. However, after the first-line psychotherapies and selective serotonin reuptake inhibitors (SSRIs), the not recommended benzodiazepines (7.07%) and atypical antipsychotics (7.53%) have the highest prevalence. The third most frequent overlapping therapy includes benzodiazepines in conjunction with SSRIs, although this percentage is only 0.49. In order to evaluate the association between benzodiazepines and health outcomes, 1:2 propensity score (PS) matching was employed to create a balanced cohort. Plots of standardized differences and distributions of propensity scores indicated that 1:2 PS matching eliminated observable differences (in confounders and risk factors) between benzodiazepines users and nonusers. The final cohort included a total of 81,831 benzodiazepine users and 161,662 nonusers for a total size of 242,493 veterans with PTSD. Generalized linear models and Cox proportional hazards models were used to assess health outcomes. Other than substance abuse outpatient visits (which was higher but statistically insignificant), benzodiazepine users had significantly higher incidence rate ratios for all health care visits. This includes hospitalizations (1.27), ED (1.16), general outpatient (1.18), total mental outpatient (1.37), and mental outpatient visits (1.48). With an outcome of suicide as cause of death, the statistically significant hazard ratio between benzodiazepine users and nonusers is 2.73, thus demonstrating significant elevation in the risk of suicide. The overall evidence from this study reveals that benzodiazepines are not uncommonly prescribed for patients with PTSD and that they are associated with greater health care utilization and suicide outcomes. Most importantly, this study strengthens the evidence against the use of benzodiazepines in veterans with PTSD and that clinicians should consider the benefits and risks - especially the almost three-fold increase in suicide death - when ultimately prescribing this pharmacotherapy. |
