Coping with conflict: short-term anxiolytic medication use amidst national stress in Israel

Anxiety is often studied at the individual level, with societal and environmental effects remaining under-researched. This study examines the impact of national security instability on short-term anti-anxiety medication purchases in Israel.

A retrospective cohort study using electronic medical records from an Israeli health fund covering over 2.6 million people, spanning January 1, 2006 to July 31, 2024. We assessed the association between 'military operations', the 'Second Lebanon War' and the 'October 7th War' and the incidence of short-term benzodiazepine purchases (a proxy for acute anxiety or stress responses prompting pharmacological treatment), differentiating first-ever from repeated purchases.

1,142,641 members aged 21 or older contributed 12,027,931 person-years at risk. The risk of first-time benzodiazepine purchases was 28% higher during military operations (95% CI: 1.21-1.34) and 44% higher during the Second Lebanon War (95% CI: 1.27-1.62). The October 7th war was the most significant armed conflict associated with an increased risk of short-term benzodiazepine treatment initiation over 19 years, at a 317% increase (95% CI 3.97-4.38). Unlike other conflicts, residential region did not influence anxiolytic patterns following October 7th.

Armed conflicts significantly influence anxiolytic use in Israel, with the recent war having the most pronounced effect. These findings underscore the need for emergent mental-health interventions during crises and long-term resilience approaches to prevent dependency.