Key Takeaways
Extended Takeaways
- In the main 3-group analysis, 12-month PTSD risk was similar whether prescriptions were not filled, filled within ≤7 days, or filled in 8–30 days: 5.2%, 4.7%, and 5.0%, respectively, with overlapping Kaplan-Meier curves (log-rank χ2 =0.8; P =.7).
- Adjustment for demographics and baseline psychiatric history did not materially change the primary finding; in the fully adjusted model, early purchase had HR 0.98, 95% CI=0.80–1.20; P=.868 and late purchase had HR 1.11, 95% CI=0.94–1.31; P=.218 versus nonpurchasers.
- Refill behavior separated risk more clearly than initial redemption timing: persistent users had 12-month PTSD rates of 9.1% and 9.9%, compared with 4.1%, 4.4%, and 5.2% in early-discontinuation, late-discontinuation, and no-purchase groups.
- Compared with nonpurchasers, persistent use was associated with significantly higher PTSD risk after full adjustment, with HR 1.60, 95% CI=1.14–2.25; P=.006 for early-persistent users and HR 2.07, 95% CI =1.60–2.68; P<.001 for late-persistent users, whereas discontinuation groups were not significantly different.
- Among Gaza border residents, overall PTSD incidence was 39.1%, but purchasers had lower observed rates than nonpurchasers—31.1% for early purchasers and 35.1% for late purchasers versus 53.0% for nonpurchasers—suggesting no detectable harm signal even in the highest-exposure subgroup.
- The study design strengthens clinical interpretability because it compared patients who all received a new benzodiazepine prescription, then contrasted those who redeemed it with those who did not; prior mental health variables were closely balanced across groups (SMDs 0.01–0.05), helping reduce confounding by indication.
