Women Veterans with PTSD More Likely Than Men to Receive Guideline Discordant Medication
BACKGROUND:
Veterans are at increased risk for PTSD, with greater lifetime prevalence among women than men. Women Veterans are also more likely than men to receive medications that VA clinical practice guidelines recommend against to treat PTSD. To understand this difference, this study examined potential confounders in incident prescribing of guideline discordant medications (GDM) in Veterans with PTSD. Participants were 704,699 Veterans (106,924 women) who received VA care for PTSD during 2020 and incident GDM prescriptions during 2021, including benzodiazepines, antipsychotics, select anticonvulsants, and select antidepressants. The primary outcome was incident prescribing of at least one VA guideline discordant PTSD medication during 2021. Researchers estimated the difference in risk for GDM initiation between men and women, adjusting for Veteran, prescriber, and facility-level covariates.
FINDINGS:
- Women Veterans with PTSD were 67% more likely than men to initiate a GDM, where more than half of this effect was explained by bipolar disorder diagnosis, age, and the number of distinct psychiatric medications prescribed in the prior year. After adjustment, women Veterans remained at 22% greater risk for an incident GDM, suggesting that other factors remain unidentified.
- GDMs for PTSD were initiated in 78,552 (11%) Veterans in the study population during 2021.
- While some provider and facility characteristics were significantly associated with GDM prescribing, they did not explain the observed gender difference.
IMPLICATIONS:
- If, as findings suggest, clinical complexity is driving the gender difference in PTSD GDM prescribing, it is important to investigate why women with PTSD are more complex to treat than men.
- To inform clinical practice guidelines, future research is needed to identify the distinct needs of women Veterans and the impact of psychiatric comorbidities on their PTSD treatment.
LIMITATIONS:
- This study was limited by the lack of robust data for gender expansive Veterans with PTSD.
- Researchers could identify only medications dispensed through VA, which may underestimate GDM exposure from non-VA sources, or misclassify some prevalent recipients as incident recipients.
- Veterans with PTSD may have been under-identified, as some Veterans may not have received VHA services in 2020 because of the COVID-19 pandemic.
AUTHOR/FUNDING INFORMATION:
Steffensmeier KS, Hadlandsmyth K, Bernardy N, et al. What’s Gender Got to Do with It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans. The Journal of Clinical Psychiatry. June 5, 2024;85(2):23m15174.
This study was funded by
HSR. Drs. Steffensmeier and Hadlandsmyth are with HSR’s Center for Access & Delivery Research and Evaluation (
CADRE). Dr. Bernardy is with the National Center for PTSD.
