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The European Journal of Public Health Advance Access published online on April 4, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm020
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© The Author 2007. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Prescription of benzodiazepines in general practice in the context of a man-made disaster: a longitudinal study

Thijs Fassaert1, Tina Dorn1, Peter M. M. Spreeuwenberg1, Martien C. J. M. van Dongen2, Christel J. A. W. van Gool2 and C. Joris Yzermans1,*

1 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
2 University of Maastricht, Maastricht, The Netherlands

Correspondence: Joris Yzermans, NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands, tel: 0031 (0)30 2729700, fax: 0031 (0)30 2729729, e-mail: j.yzermans{at}nivel.nl

Received August 28, 2006 , accepted February 5, 2007

Background: Mental health problems associated with benzodiazepine treatment are often highly prevalent in the aftermath of disasters. Nevertheless, not much is known about benzodiazepine use after disasters. Considering the negative effects associated with prolonged use and the adverse effects of benzodiazepines on recovery of patients with acute stress, the aim of the present study was to explore benzodiazepine use in the context of the Enschede fireworks disaster of 13 May 2000. Methods: A longitudinal study using electronic medical records of general practitioners. Subjects were patients aged 16 years and older, registered at one of the practices between 1999 and 2003 (1541 victims and 5370 references). Pre- and post-disaster data were available on benzodiazepine prescriptions, healthcare utilization and sociodemographic characteristics. Benzodiazepine use was defined using different criteria (e.g. any use, daily use, chronic use). Data were analysed using multivariate multilevel logistic regression analyses. Results: Compared with patients from a reference group, disaster victims were at increased risk of becoming an incident benzodiazepine user after the disaster. Benzodiazepine use also had a different time course among victims compared with references. However, daily or prolonged use of benzodiazepines was not often observed and did not show dramatic deviations among disaster victims compared with references. Conclusion: There is no convincing evidence that general practitioners systematically deviated from clinical guidelines for benzodiazepines, which generally advocate their short time application.

Keywords: benzodiazepines, disasters, longitudinal studies, multilevel analysis


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