Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA)

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Benzodiazepines (BZDs) are not only used as a treatment for anxiety and depression (besides epilepsy), but also inappropriately for chronic insomnia, pain, somatic illnesses [1] and uncontrollable stress.• In spite of lack of effectiveness and adverse health consequences in chronic BZD use, over 50% are long-term users.• The relative importance of sociodemographic, psychological and physical determinants of BZD use in general and inappropriate use has never been investigated in a comprehensive, multivariable model. WHAT THIS STUDY ADDS• BZDs were used by a considerable proportion of the NESDA participants and BZD use was rarely in accordance with all guidelines, mainly because of an extended duration of use.• Mentally or physically vulnerable subjects were most likely to use BZDs as well as to use it inappropriately.• Clinicians should be vigilant when initiating BZD prescriptions for vulnerable subjects, particularly when patients are chronically ill and old, as those subjects are at high risk of inappropriate use. AIMResults on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODSWe included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. RESULTSBZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%

Patterns of chronic benzodiazepine use in the elderly

“…In this group, the majority were women who had depression and used antidepressants, which are factors that are strongly related to BZD use 24 . Previous studies that examined the role of living alone or marital status obtained similar results 13,25 . This finding was not an independent factor that was associated with outcome in a multivariate analysis.…”

“…Depressive 11,12 and anxiety disorders are frequent in the elderly, constituting an important source of emotional suffering and consequently the increased use of this pharmacological class 8,13 . Newer treatment consensus recommendations for depressive and anxiety disorders do not suggest BZDs as a first-line therapeutic 14,15 .…”

Socio-demographic factors and long-term use of benzodiazepines in patients with depression, anxiety or insomnia

“…A majority of previous studies investigating long-term use of benzodiazepines have been based on relatively small sample sizes and/or self-reported data (Anthierens et al, 2007;Demyttenaere et al, 2008;Fassaert et al, 2007;Manthey et al, 2012;Manthey et al, 2011;Quigley et al, 2006;Zandstra et al, 2002). The present study contributes to the body of knowledge as it is based on data from a large primary health care population of 919 941 individuals.…”

“…It is possible that these findings are partly explained by other health problems or co-morbidities in older age. Former studies show that long-term use of benzodiazepines is more common among persons with somatic illnesses and chronic pain (Manthey et al, 2011). In addition, individuals with somatic illnesses and/or chronic pain may have sleeping difficulties to a higher extent than healthy individuals, which may explain the higher odds of long-term use of benzodiazepines in older age.…”

“…Somatic illnesses are more common among individuals wth low SES and comorbidity is a factor shown to increase longterm use of benzodiazepines (Manthey et al, 2011). The poorer health among individuals with low SES might partly be explained by difficulties in leading a healthy lifestyle including being physically active and having a moderate intake of alcohol.…”