Benzodiazepine users with PTSD more likely to attempt, complete suicide
Veterans with PTSD who received benzodiazepines were more than twice as likely to die due to suicide and were almost twice as likely to have medically documented suicide attempts than patients without benzodiazepine exposure, according to study findings.
Benzodiazepine users also had higher rates of health care utilization, findings published in Journal of Clinical Psychiatry revealed.
“Although benzodiazepines can provide short-term relief for anxiety, they are not recommended for the treatment of PTSD, in part because they are note effective in treating the four core symptom clusters of PTSD,” Rishi Deka, PhD, from VA San Diego Health Care Systems and VA Salt Lake City Health Care System, and colleagues wrote. “Despite these concerns, benzodiazepines are still prescribed to some veterans with PTSD.”
In this study, researchers examined the connections between benzodiazepine use and suicide risk and health care utilization and among veterans with PTSD who were active users of the Veterans Affairs health care system from 2001 through 2014. Using data from the VA’s Corporate Data Warehouse and the VA/DOD Suicide Data Repository, the investigators compared veterans with at least one 30-day prescription of a benzodiazepine within 1 year following PTSD diagnosis (exposure group) with veterans with no benzodiazepine use during this time (nonusers).
Overall, 242,493 patients were included in the propensity-matched cohort, 80,831 of whom received benzodiazepine prescription. Deka and colleagues found that veterans with PTSD who received benzodiazepines had significantly more hospitalizations (IRR = 1.27; 95% CI, 1.1-1.47), ED visits (IRR = 1.16; 95% CI, 1.13-1.2), general outpatient visits (IRR = 1.19; 95% CI, 1.16-1.21), outpatient mental health visits (IRR = 1.49; 95% CI, 1.41-1.57) and total mental health visits (IRR = 1.37; 95% CI, 1.34-1.4) compared with nonusers.
In total, 456 benzodiazepine users and 349 nonusers completed suicide over the study period. Veterans who used benzodiazepines were also significantly more likely to die by suicide (HR = 2.74; 95% CI, 2.4-3.13) and to have medically documented suicide attempts (HR = 1.85; 95% CI, 1.65-2.08) and suicidal thoughts (HR = 1.57; 95% CI, 1.48-1.67).
The number needed to harm for all-cause mortality was 15.6; for suicide death, the number needed to harm was 333.3. Therefore, the researchers report that the number of preventable veteran suicides in this cohort was about 243.
“The present study provides critical information about the potential risks associated with benzodiazepine use among veterans diagnosed with PTSD,” Deka and colleagues wrote. “From a clinical perspective, these results suggest that prescribers should carefully weigh the benefits and risks of prescribing a benzodiazepine, particularly the increased risk of suicide, among veterans diagnosed with PTSD.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.