Use of benzodiazepines, Z-drugs and SSRIs during wartime in Israel - a national cohort study.

backgroundArmed conflict can lead to increased stress, anxiety, and other psychological conditions. Benzodiazepines (BZDs), Z-drugs, and selective serotonin reuptake inhibitors (SSRIs) are used for stress-related conditions and sleep disturbances. This study aimed to identify the demographic and geographic predictors of BZD, Z-drug, and SSRI use during the first year of the 2023 Israel- Hamas war in Israel, while comparing these patterns to pre-war utilization trends.

methodsUsing data of 557,830 adults from the Meuhedet health maintenance organization, we compared the use of BZDs, Z-drugs, and SSRIs before and during the war, and between individuals residing near and away from combat areas. The analysis included two years of pre-war purchasing records and the first year of the war.

resultsDuring the year before the war, 78,307 individuals were identified as SSRI and/or BZD users, while 479,523 were non-users. Women predominated among medication users, who were generally older and had higher rates of psychiatric diagnoses compared to non-users. Previous use of SSRIs and BZDs was associated with a higher likelihood of wartime use (OR = 333.20, CI 320.74-346.21for SSRIs, OR = 140.44, CI 135.49–145.60 for BZDs). Women were also more likely to use these medications (OR = 1.30, CI 1.27–1.33 for SSRIs, and OR = 1.20, CI 1.18–1.25 for BZDs). Individuals living near combat areas were more likely to use BZDs (OR = 1.33, CI 1.25–1.42) and SSRIs (1.17, CI 1.09–1.27). The general population had a higher OR for the study medications compared to Arabs and Orthodox Jews.

conclusionsPrior use was the strongest factor predicting wartime BZD and SSRI use. Female sex, non-Orthodox Jewish identity, and residing near combat areas were also associated with increased use. These findings emphasize the need for proactive mental health interventions for at-risk groups during times of armed conflicts.