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Benzodiazepine use associated with co-morbid post-traumatic stress syndrome and depression in older adults seeking services in general medical settings

Published online by Cambridge University Press:  25 January 2016

Helen-Maria Vasiliadis ,
Catherine Lamoureux-Lamarche  and
Michel Préville
Helen-Maria Vasiliadis*
Affiliation:
Department of Community Health Sciences, University of Sherbrooke; Longueuil, QC, Canada Hôpital Charles-Le Moyne Research Center, affiliated to the Universtiy of Sherbrooke, Longueuil, QC, Canada
Catherine Lamoureux-Lamarche
Affiliation:
Université de Sherbrooke, Longueuil, QC, Canada
Michel Préville
Affiliation:
Department of Community Health Sciences, University of Sherbrooke; Longueuil, QC, Canada Hôpital Charles-Le Moyne Research Center, affiliated to the Universtiy of Sherbrooke, Longueuil, QC, Canada
*
Correspondence should be addressed to: Helen-Maria Vasiliadis, Centre de recherche – Hôpital Charles-Le Moyne, Campus de Longueuil – Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil (QC) J4K 0A8, Canada. Phone: 450-466-5000, 3701. Email: Helen-maria.vasiliadis@usherbooke.ca.
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Abstract

Background:

Benzodiazepines (BZD) should be limited in older adults. This study aimed to determine the association between BZD use and the presence of a probable post-traumatic stress syndrome (PTSS) and whether this association is dependent on gender and co-morbid physical and mental conditions.

Methods:

Data were retained from the Étude sur la Santé des Aînés (ESA) – Services study (2011–2013) and included 1,453 older adults (≥65 years) who completed a face to face at-home interview, who were covered under Quebec's public drug insurance plan, and had given permission to access their Régie de l'Assurance Maladie du Québec (RAMQ) medical and pharmaceutical services data. The presence of a PTSS was measured using the Impact of Event Scale-Revised (IES-R). The use of BZD and antidepressants in the year prior to interview was ascertained from data reported in the RAMQ drug registry. The presence of depression and an anxiety disorder was assessed with the ESA-Questionnaire which was based on DSM-5 criteria. The interaction between PTSS and gender, depression, anxiety, and multi-morbidity was also assessed.

Results:

The prevalence of PTSS and BZD use reached 4.5% and 31.2%. Participants with PTSS were 1.9 (95% CI = 1.1–3.2) times more likely to use BZD. The presence of depression had a negative impact on the association between BZD use and PTSS (p = 0.04).

Conclusion:

The use of BZD in older adults with PTSS is still prevalent today. Differences in benzodiazepine prescribing practices for more complex co-morbid psychiatric cases needs to be further studied.

Keywords

post-traumatic stress disorderco-morbid depressionbenzodiazepine useolder adults
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 913 - 920
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Alvareng, J. M., Loyola Filho, A. L., Firmo, J. O., Lima-Costa, M. F. and Uchoa, E. (2008). Prevalence and socio-demographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambui Health and Aging Study (BHAS). Review Brasilia Psiquiatrica, 30, 7–11.Google Scholar
American Geriatrics Society (2012). Beers criteria update expert panel: american geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatric Society, 60, 616–631.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Washington, DC: American Psychiatric Association.Google Scholar
Bernardy, N. C., Lund, B. C., Alexander, B., Jenkyn, A. B., Schnurr, P. P. and Friedman, M. J. (2013). Gender differences in prescribing among veterans diagnosed with posttraumatic stress disorder. Journal of General Internal Medicine, 28, S542–S548.Google Scholar
Bossé, C., Préville, M. and Vasiliadis, H.-M. (2011). Suicidal ideations, death thoughts, and use of benzodiazepines in the elderly population. Canadian Journal of Community Mental Health, 30, 1–13.Google Scholar
Brunet, A., St-Hilaire, A., Jehel, L. and King, S. (2003). Validation of a French version of the impact of event scale-revised. Canadian Journal of Psychiatry, 48, 56–61.Google Scholar
Chopra, M. P. et al. (2014). PTSD is a chronic, fluctuating disorder affecting the mental quality of life in older adults. American Journal of Geriatric Psychiatry, 22, 86–97.Google Scholar
Christianson, S. and Marren, J. (2012). The Impact of Event Scale-Revised (IES-R). MEDSURG Nursing, 21, 321–322.Google Scholar
Creamer, M., Bell, R. and Failla, S. (2003). Psychometric properties of the impact of eventscale - revised. Behavioural Research Therapeutics, 41, 1489–1496.CrossRefGoogle Scholar
Durai, U. N. et al. (2011). Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: comorbid conditions and self-rated health status. Journal of the American Geriatric Society, 59, 1087–1092.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state’’ a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Fortin, M., Mercer, S. W. and Salisbury, C. (2014). Introducing multimorbidity. In Mercer, S. W., Salisbury, C. J. and Fortin, M (eds.), ABC of Multimorbidity (pp. 1–4). Oxford: Wiley-Blackwell.Google Scholar
Fourrier, A., Letenneur, L., Dartigues, J. F., Moore, N. and Bégaud, B. (2011). Benzodiazepine use in an elderly community dwelling population. Characteristics of users and factors associated with subsequent use. European Journal of Clinical Pharmacology, 57, 419–425.CrossRefGoogle Scholar
Glaesmer, H., Brähler, E., Gündel, H. and Riedel-Heller, S. G. (2011). The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study. Psychosomatics Medicine, 73, 401–406.Google Scholar
Guina, J., Rossetter, S. R., Derhodes, B. J., Nahhas, R. W. and Welton, R. S. (2015). Benzodiazepines for PTSD: a systematic review and meta-analysis. Journal Of Psychiatric Practice, 21, 281–303.Google Scholar
Jeffreys, M., Capehart, B. and Friedman, M. J. (2012) Pharmacotherapy for posttraumatic stress disorder: review with clinical applications. Journal of Rehabilitative Research Development, 49, 703–715.Google Scholar
Katzman, M. A. et al. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14, S1.Google Scholar
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M. and Nelson, C. B. (1995) Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.Google Scholar
Lam, R. W. et al. (2009). Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. Journal of Affective Disorders, 117, S26–43.Google Scholar
Lund, B. C., Bernardy, N. C., Alexander, B. and Friedman, M. J. (2012). Declining benzodiazepine use in veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry, 73, 292–296.CrossRefGoogle ScholarPubMed
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M. and Grant, B. F. (2012). Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. American Journal of Geriatric Psychiatry, 20, 380–390.Google Scholar
Préville, M. et al. (2008). The epidemiology of psychiatric disorders in Quebec's older adult population. Canadian Journal of Psychiatry, 53, 822–832.Google Scholar
Préville, M. et al. (2012). Correlates of potentially inappropriate prescriptions of BZD among older adults: results from the ESA study. Canadian Journal of Aging, 31, 313–322.Google Scholar
Préville, M. et al. (2014). The 6-month prevalence of posttraumatic stress syndrome (PTSS) among older adults: validity and reliability of the PTSS scale. Canadian Journal of Psychiatry, 59, 548–555.Google Scholar
Schaffer, A. et al. (2012). The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders. Annals of Clinical Psychiatry, 24, 6–22.Google Scholar
van Zelst, W. H., de Beurs, E., Beekman, A. T., van Dyck, R. and Deeg, D. D. (2006). Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD. International Journal of Geriatric Psychiatry, 21, 180–188.Google Scholar
Volkert, J., Schulz, H., Härter, M., Wlodarczyk, O. and Andreas, S. (2013). The prevalence of mental disorders in older people in western countries - a meta-analysis. Ageing Research Reviews, 12, 339–353.CrossRefGoogle ScholarPubMed
Warner, C. H., Warner, C. M., Appenzeller, G. N. and Hoge, C. W. (2013). Identifying and managing posttraumatic stress disorder. American Family Physician, 88, 827–834.Google Scholar
World Health Organization. (2004). International Statistical Classification of Diseases and Related Health Problems 10th Revision [WHO Web site]. 2004. Available at: http://apps.who.int/classifications/apps/icd/icd10online2004/fr-icd.htm; last accessed 4 January 2015.Google Scholar
Zhang, Z., Shi, Z., Wang, L. and Liu, M. (2012). Post-traumatic stress disorder, anxiety and depression among the elderly: a survey of the hard-hit areas a year after the Wenchuan earthquake. Stress Health, 28, 61–68.Google Scholar