Benzodiazepine prescribing at discharge from adult and older persons psychiatric inpatient units: A systematic review and meta-analysis.

Abstract

ObjectivePsychiatric inpatient discharge is a prescribing transition at which benzodiazepines initiated for short-term symptom control may unintentionally continue beyond discharge. Existing guidance is limited for prescribing decisions. We aimed to estimate benzodiazepine discharge prevalence from adult and older persons psychiatric inpatient units and examine between-study heterogeneity.MethodsWe searched five databases from inception to 31 December 2022, updated the search on 27 November 2025 (PROSPERO: CRD42022368986), and included studies reporting benzodiazepine prescribing at discharge from adult and older persons psychiatric inpatient units.ResultsTwenty-five studies contributed 28 cohorts and 15,517 discharge observations. Pooled discharge prevalence was 50% (95% CI: 37-62) in acute adult cohorts and 27% (95% CI: 18-38) in older persons cohorts, with substantial heterogeneity and very low certainty of evidence. Admission-to-discharge change was small and non-significant across 11 paired cohorts.ConclusionBenzodiazepine prescribing at psychiatric inpatient discharge was common and highly variable. Marked setting-level variation, lower prevalence in older persons settings, and divergent admission-to-discharge trajectories suggest modifiable systemic influences beyond patient-level factors. Although continuation may support community transition after inpatient stabilisation, its downstream impact remains unclear because post-discharge patient-centred outcomes were not reported. Future research should clarify the risk-benefit profile of continuation to inform transition-specific prescribing guidance.