Benzodiazepine prescribing in chronic military-related PTSD: real-world patterns and correlates in specialized care.

Abstract

Objective: To estimate the prevalence of benzodiazepine prescribing among patients with posttraumatic stress disorder (PTSD), identify patient- and practice-level correlates of benzodiazepine use, and examine the clinical rationale underlying prescribing decisions. We aimed to characterize real-world patterns and determinants of benzodiazepine use in a specialized tertiary care military and Veteran PTSD setting, where PTSD is often chronic and treatment-refractory, and to clarify the clinical factors associated with benzodiazepine prescribing.

Methods: We conducted a cross-sectional study using clinician-reported data from 13 psychiatrists practicing in Canadian tertiary care Operational Stress Injury clinics. Psychiatrists provided current prescribing information for 438 military personnel and Veterans receiving treatment for a primary diagnosis of PTSD. Multivariable logistic regression examined associations between patient and provider characteristics, treatment history, and benzodiazepine prescribing. Analyses adjusted for age, sex, and clinical site, and accounted for clustering at the provider level.

Results: Benzodiazepines were prescribed to 22% of patients. Use was more frequent among patients with longer PTSD duration and greater cumulative pharmacotherapy exposure. Each additional year of PTSD was associated with a 12% increase in adjusted odds of benzodiazepine use (OR 1.12, 95% CI 1.06-1.18). Patients with ≥ 5 years of pharmacotherapy exposure had two- to three-fold greater odds compared with those treated < 5 years. Benzodiazepine monotherapy was rare (< 1%), with most use occurring in combination with other psychotropic medications.

Conclusions: In these specialized clinics, benzodiazepine use was more common among patients with persistent illness and extensive treatment histories. These patterns suggest use occurs primarily in the context of chronic and complex care, underscoring the importance of clear clinical guidance for real-world practice.