Abstract
ABSTRACTOBJECTIVEThe Department of Veterans Affairs (VA) and Department of Defense (DoD) issued a revised posttraumatic stress disorder (PTSD) Clinical Practice Guideline (CPG) in 2010 with specific pharmacotherapy recommendations for evidence-based quality care. The authors examined prescribing frequencies over an 11-year period prior to the release of the new guideline to determine gender differences in pharmacotherapy treatment in veterans with PTSD.METHODNational administrative VA data from 1999 to 2009 were used to identify veterans with PTSD using ICD-9 codes extracted from inpatient discharges and outpatient clinic visits. Prescribing of antidepressants, antipsychotics and hypnotics was determined for each year using prescription drug files.RESULTSWomen were more likely than men to receive medication across all classes except prazosin where men had higher prescribing frequency. The proportion of women receiving either of the first-line pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI), increased from 56.4 % in 1999 to 65.7 % in 2009, higher rates than seen in men (49.2 % to 58.3 %). Atypical antipsychotic prescriptions increased from 14.6 % to 26.3 % and nonbenzodiazepine hypnotics increased from 3.8 % to 16.9 % for women, higher frequencies than seen in men for both medications (OR = 1.31, 1.43 respectively). The most notable gender discrepancy was observed for benzodiazepines where prescriptions decreased for men (36.7 % in 1999 to 29.8 % in 2009) but steadily increased for women from 33.4 % to 38.3 %.CONCLUSIONA consistent pattern of increased prescribing of psychotropic medications among women with PTSD was seen compared to men. Prescribing frequency for benzodiazepines showed a marked gender difference with a steady increase for women despite guideline recommendations against use and a decrease for men. Common co-occurring disorders and sleep symptom management are important factors of PTSD pharmacotherapy and may contribute to gender differences seen in prescribing benzodiazepines in women but do not fully explain the apparent disparity.
Highlights
American women represent a disproportionate number of adults who receive prescriptions for psychotropic medications, with one in four women receiving such medications compared to 15 % of men.[1]
The number of female veterans being treated for posttraumatic stress disorder (PTSD) in the Veterans Affairs (VA) health care system tripled during our time frame, from 10,484 in 1999 or 6.2 % of the population to 36,978 in 2009, which represents 7.5 % of the treated population
As prescribing increased in men, the gender ratio for selective serotonin reuptake inhibitors (SSRI)/serotoninnorepinephrine reuptake inhibitors (SNRI) remained relatively consistent across the 11-year study period, ranging from 1.34 to 1.57
Summary
American women represent a disproportionate number of adults who receive prescriptions for psychotropic medications, with one in four women receiving such medications compared to 15 % of men.[1]. Women are the fastest growing cohort within the veteran community and represent approximately 16 % of military personnel who have served in Afghanistan and Iraq.[4] The rapid growth of women veterans makes it important to examine gender differences in one of the most common diagnoses among veterans seeking care, PTSD. 60 % of privately insured patients with PTSD receive pharmacotherapy for the disorder,[5] while close to 80 % of veterans receiving care for PTSD in VA are treated with psychiatric medications.[6] In the privately insured patients, women were 11⁄2 times more likely to JGIM
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