Posttrauma Benzodiazepine Use and Subsequent PTSD: A Population-Wide Analysis Following Extreme Traumatic Exposure.

Area of Science:

• Psychiatry
• Pharmacology
• Epidemiology

Background:

• Posttraumatic stress disorder (PTSD) is a significant concern following mass trauma.
• Benzodiazepine use in the acute aftermath of trauma is debated due to potential risks.
• Understanding the association between early benzodiazepine use and PTSD is crucial for clinical guidelines.

Purpose of the Study:

• To investigate if benzodiazepine use within 30 days of mass trauma influences PTSD risk.
• To determine if the timing and persistence of benzodiazepine use modify the association with PTSD.
• To evaluate the impact of benzodiazepine use on PTSD incidence in a large, real-world cohort.

Main Methods:

• Retrospective cohort study utilizing a large clinical dataset (approx. 4 million individuals).
• Identified 15,570 benzodiazepine-naïve adults prescribed benzodiazepines within 30 days of mass trauma (October 7, 2023).
• Analyzed medication exposure by prescription timing (early ≤7 days, late 8-30 days) and persistence, assessing 12-month PTSD diagnoses using Cox proportional hazards models.

Main Results:

• Overall PTSD incidence was 5.0%.
• No increased PTSD risk was observed for early or late benzodiazepine prescription compared to non-prescription.
• Persistent benzodiazepine use was associated with significantly elevated PTSD risk (HR=1.60-2.07).
• Gaza border residents exposed to high trauma showed reduced PTSD risk with early/late benzodiazepine use.

Conclusions:

• Short-term benzodiazepine use within 30 days post-mass trauma is not linked to increased 12-month PTSD risk in a naturalistic setting.
• Persistent benzodiazepine use, however, is associated with a higher risk of developing PTSD.
• Findings suggest that current clinical caution against early benzodiazepine use after trauma may need re-evaluation, especially for short-term, non-persistent use.