Coping with Conflict: Short-Term Anxiolytic Medication Use Amidst National Stress in Israel
Authors: Patalon Tal , Saciuk Yaki , Yonatan Yogev , Hoshen Moshe , Trotzky Daniel , Pachys Gal , Fischel Tsvi , Nitzan Dorit , Gazit Sivan 
Published: October 2024

Background

Exposures to stress and traumatic events plays a significant role in triggering or precipitating anxiety. Nonetheless, these are often examined at the individual level, while societal-environmental exposures and their association with anxiety disorders are under-researched, especially in the Israeli context. This study leverages 19 years of longitudinal data from a large healthcare organization to examine the impact of national security instability on short-term anxiolytic purchases in Israel.

Methods

We conducted a retrospective cohort study using electronic medical records of over 1.1 million individuals from 2006 to 2024, examining rates of first-time and renewed use of anxiolytic medications of the benzodiazepines group during periods of armed conflict, including military operations and wars. Cox proportional hazards models were used to assess associations, adjusting for confounders such as age, sex, socioeconomic status, socioreligious sector, residence and previous psychiatric treatment.

Results

The risk for first purchase of an anxiety-relief short terms medication during military operations was 28% higher (HR 1.28, 95% CI: 1.21-1.34) compared to periods of relative national stability, after adjustments, and 44% higher during the Second Lebanon War (HR 1.44, 95% CI 1.27-1.62). The events of October 7thwere the most significant armed conflict increasing the risk for anxiety-related reaction necessitating treatment throughout the 19-years follow-up, with individuals at 317% increased risk for treatment initiation compared to periods of relative national stability (HR 4.17, 95% CI 3.97-4.38). Alongside a baseline increased risk for initiating anti-anxiety treatment, women experienced an additional elevated risk for anxiolytic therapy during times of national security threats, with 26% additional increased risk during military operations and an 81% increased risk following the events of October 7th. Residents of northern Israel had an increased risk of purchasing anxiolytics during the Second Lebanon War (HR 1.39, 95% CI: 1.12-1.72), while during military operations it was the residents of southern Israel who faced an increased risk for anxiolytic usage, with an HR of 1.18 (95% CI: 1.05-1.33). Conversely, the residential region did not significantly influence anti-anxiety treatment patterns following October 7th among residents of southern or northern Israel, compared to individuals living in central Israel, indicating a broader national impact beyond regional differences.

Conclusions

National armed conflicts significantly influence anxiolytic medication use in Israel, with the October 7th war showing the most pronounced effect. These findings highlight the need for comprehensive mental health interventions during times of national crisis, focusing on both short-term relief and long-term mental health support to prevent dependency and improve mental health outcomes in the wake of national crises.