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Pharmacoepidemiology

Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic

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To identify the key insights or developments described in this article

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JAMA Network Open

Published Online: October 25, 2021

Original Investigation

Article Information and Disclosures

Sadaf Arefi Milani, PhD, MPH^1,2,3;

Mukaila A. Raji, MD, MS^1,2,4;

Lu Chen, MS⁵;

Yong-Fang Kuo, PhD^1,2,3,4,5

Author Affiliations

¹Department of Internal Medicine–Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston
²Sealy Center on Aging, University of Texas Medical Branch, Galveston
³Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, Galveston
⁴Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
⁵Office of Biostatistics, University of Texas Medical Branch, Galveston

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Key Points

Question What are the changes in prescribing rates in men and women of benzodiazepines, Z-hypnotics, and serotonergic drugs during the COVID-19 pandemic (2020 and 2021) compared with prior years (2018 and 2019)?

Findings This cohort study of US adults (15.1 million to 17.3 million depending on the year studied) found an increase in Z-hypnotic and serotonergic drug prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women at the start of the COVID-19 pandemic.

Meaning These findings suggest a substantial association of COVID-19–associated social isolation, stay-at-home orders, and other COVID-related mitigation measures with mental health issues, especially among women.

Abstract

Importance The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women.

Objective To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]), which are commonly prescribed for anxiety, insomnia, and depression.

Design, Setting, and Participants This cohort study used data from Clinformatics Data Mart, one of the largest commercial health insurance databases in the US. Enrollees 18 years or older were required to have complete enrollment in a given month during our study period, January 1, 2018, to March 31, 2021, to be included for that month.

Main Outcomes and Measures Prescription of a benzodiazepine, Z-hypnotic, or SSRI or SNRI. For each month, the percentage of patients with benzodiazepine, Z-hypnotic, or SSRI or SNRI prescriptions by sex was calculated.

Results The records of 17 255 033 adults (mean [SD] age, 51.7 [19.5] years; 51.3% female) were examined in 2018, 17 340 731 adults (mean [SD] age, 52.5 [19.7] years; 51.6% female) in 2019, 16 916 910 adults (mean [SD] age, 53.7 [19.8] years; 51.9% female) in 2020, and 15 135 998 adults (mean [SD] age, 56.2 [19.8] years; 52.5% female) in 2021. Compared with men, women had a higher rate of prescriptions for all 3 drugs classes and had larger changes in prescription rates over time. Benzodiazepine prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%), except for a slight increase in April 2020 among women. Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%). Prescribing of SSRIs and SNRIs increased from January 2018 (women: 12.77%; 95% CI; 12.75%-12.80%; men: 5.56%; 95% CI, 5.44%-5.58%) to April 2020 for men (6.73%; 95% CI, 6.71%-6.75%) and October 2020 for women (15.18%; 95% CI, 15.16%-15.21%).

Conclusions and Relevance In this cohort study, coinciding with the COVID-19 pandemic onset was an increase in Z-hypnotic as well as SSRI and SNRI prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women, findings that suggest a substantial mental health impact of COVID-19–associated mitigation measures.

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Article Information

Accepted for Publication: August 21, 2021.

Published: October 25, 2021. doi:10.1001/jamanetworkopen.2021.31012

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Milani SA et al. JAMA Network Open.

Corresponding Author: Sadaf Arefi Milani, PhD, MPH, Department of Internal Medicine–Geriatrics and Palliative Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77550-0177 (samilani@utmb.edu).

Author Contributions: Ms Chen and Dr Kuo had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Raji, Kuo.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Milani, Raji.

Critical revision of the manuscript for important intellectual content: Raji, Chen, Kuo.

Statistical analysis: Chen.

Obtained funding: Raji, Kuo.

Supervision: Raji, Kuo.

Conflict of Interest Disclosures: Dr Milani reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, nonfinancial support from the University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center, and grants from the Texas Resource Center for Minority Aging Research during the conduct of the study. Drs Raji and Kuo reported receiving grants from the National Institute on Drug Abuse, National Institutes of Health, and serving as multiple principal investigators on research with the National Institute on Drug Abuse, National Institutes of Health, during the conduct of the study. No other disclosures were reported.

Funding/Support: This work is supported by grant P30AG024832 from the University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center and grant P30AG059301 from the Texas Resource Center for Minority Aging Research from the National Institute on Aging; research career development award K12HD052023 from the Building Interdisciplinary Research Careers in Women’s Health Program, Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and grant R01‐DA039192 from the National Institute on Drug Abuse (Drs Raji and Kuo).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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