Despite Guidelines, Women Veterans are More Likely to Receive Unrecommended Psychiatric Medications for PTSD than Men
BACKGROUND:
Women have a 2-3 times higher risk of developing PTSD relative to men, and Veterans have higher rates of PTSD compared to civilians. Recently, multiple VA initiatives have sought to increase the safety of medication prescribing practices; however, VA efforts to improve these practices have often overlooked the intersection of PTSD and gender differences. Thus, the primary objectives of this work were to examine PTSD prescribing practices over the last decade (i.e., 2010–2019) for women and men receiving VA care – and to determine the impact of comorbid diagnoses and demographic characteristics on these practices. Using VA data, investigators identified all Veterans who received VA care for PTSD in 2019 (n = 877,785; 14% were women), as well as additional cohorts for calendar years 2010, 2013, and 2016. Analyses contrasted the likelihood of receiving a given medication class across genders, adjusting for demographic characteristics, the number of PTSD encounters, psychiatric comorbidity (i.e., depressive disorders, bipolar disorders, anxiety disorders, psychotic disorders, and substance use disorder), and sleep disorders.
FINDINGS:
- Across medication classes and years, women were more likely to receive all psychiatric medications of interest.
- Gender differences were notably larger for medications recommended against using for PTSD, including benzodiazepines and anticonvulsants, after adjustment for psychiatric comorbidity.
- Benzodiazepine prescriptions decreased in both women and men across the study decade, but the difference between prescribing for women and men persisted.
- Antidepressants recommended against use for PTSD treatment decreased across time for both men and women, however the adjusted gender gap increased from being slightly lower for women in 2010 to being 27% higher in 2019.
- Generally, for both women and men, the likelihood of receiving a recommended psychiatric medication was higher when comorbid depressive and anxious disorders were present.
IMPLICATIONS:
- To inform tailored intervention strategies, future work is needed to fully understand why women receive more medications that experts recommended against using for the treatment of PTSD.
LIMITATIONS:
- Using administrative data did not allow for a complete understanding of the reasons for gender differences in prescribing patterns – and did not include medications that may have been prescribed outside VA.
AUTHOR/FUNDING INFORMATION:
This study was funded by VA’s Office of Rural Health. Drs. Hadlandsmyth and Lund are part of HSR&D’s Center for Comprehensive Access and Delivery Research and Evaluation (CADRE)
Hadlandsmyth K, Bernardy N, and Lund B. Gender Differences in Medication Prescribing Patterns for Veterans with Post-traumatic Stress Disorder: A 10-Year Follow-Up Study. Journal of Traumatic Stress. July 7, 2022; online ahead of print.
