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Welcome back to the Easing Anxiety blog series, "What We Learned from the Benzo Survey."
In our 2nd post, we continue with the key demographics from the Benzodiazepine Survey of 2018/2019. Our first post from August 17 explored age groups. Today, we wrap up the key demographics with gender and country.
Scroll to the end of this post for details about the survey and research team.
GENDER
The benzodiazepine survey reported that 71.3% of all survey respondents were female, 25.7% were male, with 2.0% either "other gender identity" or "prefer not to say." Considering that 98% of all respondents identified themselves as male or female, we will focus there for now.
To simplify the above numbers, one could say that almost three times more women took the survey, than men. Which then begs the question, are women prescribed benzodiazepines more often than men?
According to a 2021 JAMA Open cohort study based on data from one of the largest commercial health insurance databases in the U.S., women are prescribed benzodiazepines at a rate almost double that of men. The records of 17,255,033 adults (51.3% female) were analyzed, and for March 2020 females were prescribed benzodiazepines at a rate of 4.91% and males at 2.66%. One side note from this research — a bit of good news — is that for both women and men the prescribing rate has decreased since 2018 (females 5.61%, males 3.03%).
But, this still leaves us with the biggest question of all. Why are more women prescribed benzodiazepines as compared to men?
I will admit, I spent some time researching this topic for this post. Unfortunately, the answers were not nearly as definitive as I had hooped. Doctor visit frequency, requests for medication, prescriber/patient biases, mental health support, and social media use were just a few of the proposed causes in a long list of possibilities.
It quickly became clear to me that this discussion is well beyond the scope of this blog post here. So, I determined it was wise to move on.
If this discussion is of interest to you, please let us know and we will tackle it in a future article.
Question (n=1,207):
Would you please give your gender? It may be important to know.
COUNTRY
Over 3/4 of the respondents to the survey were from the United States (76.6%). Canada followed with 8.8%, the United Kingdom at 3.8%, and Australia at 1.9%.
The remainder of the countries contributed less than 1% each of the respondents to the survey. Those who selected the "Other [country]" option below (5.6%) were asked by the survey to select there specific country. Those results are not reported here in this post.
Why are most of the respondents to the survey from the U.S.?
We don't have data to accurately identify the reason, but there are some logical speculations. Access to the survey was promoted mostly via U.S. based support groups and other websites. Also, advocacy for those dealing with benzodiazepine withdrawal and BIND is more active in the U.S. than other countries, thus those populations are more likely to attribute their symptoms to this class of drugs. The survey was also an English-based survey, so language barriers may have existed for non-English respondents.
The country question does not appear to provide unique insight into the BIND experience, but instead is more a bellwether highlighting limitations of the survey and the state of benzodiazepine awareness and advocacy in each country.
Question (n=1,207):
What country do you live in?
References
Milani SA, Raji MA, Chen L, Kuo Y. Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(10):e2131012. doi:10.1001/jamanetworkopen.2021.31012. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785392.
Faust DT, Lin LA, Blow, FC. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatric Services. 17 Dec 2018. Accessed September 1, 2023. https://doi.org/10.1176/appi.ps.201800321.
Survey papers are listed below.
About the Benzodiazepine Survey
About the Research
The largest survey of its kind, "The Benzodiazepine Survey of 2018/2019" was created and administered by Jane Macoubrie, PhD and Christy Huff, MD. Over 1,600 individuals took the survey, resulting in 1,207 qualified respondents. The survey constituted 20 questions, including demographic inquires. Some of these questions had multiple sub-questions and/or allowed multiple answers.
The survey generated three published research papers in scientific journals (as noted below) between April 25, 2022 and June 29, 2023. The research team is still together working on new benzodiazepine-related research projects.
Special thanks to the Alliance for Benzodiazepine Best Practices for sponsoring and organizing this research.
Published Papers
PAPER 1 — April 25, 2022
Reid Finlayson AJ, Macoubrie J, Huff C, Foster DE, Martin PR. Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology. 2022;12. doi:10.1177/20451253221082386. https://journals.sagepub.com/doi/full/10.1177/20451253221082386.
PAPER 2 — February 6, 2023
Huff C, Finlayson AJR, Foster DE, Martin PR. Enduring neurological sequelae of benzodiazepine use: an Internet survey. Therapeutic Advances in Psychopharmacology. 2023;13. doi:10.1177/20451253221145561. https://journals.sagepub.com/doi/10.1177/20451253221145561.
PAPER 3 — June 29, 2023
Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584.
Research Team
Research Team / Authors (alphabetical)
A. J. Reid Finlayson, MD, MMHC — Vanderbilt University Medical Center
D E Foster — Benzodiazepine Action Work Group
Christy Huff, MD — Benzodiazepine Information Coalition
Peter R. Martin, MD, MSc — Vanderbilt University Medical Center
Alexis Ritvo, MD, MPH — University of Colorado Anschutz Medical Campus
Bernard Silvernail — The Alliance for Benzodiazepine Best Practices
Acknowledgements
The Alliance for Benzodiazepine Best Practices — Sponsoring Organization
Jane Macoubrie, Ph.D. — Survey originator
Jo Ann LeQuang — Medical Writer
Limitations
This study has several limitations.
The study reported on ‘suicidal thoughts’, which can range from fleeting notions of self-harm to passive desperation, preparatory planning, and disinhibition. Suicidal thoughts may be underreported, even in an anonymous online survey, as respondents might hesitate or be embarrassed to report self-destructive thoughts.
There was no control group. Much of the survey dealt with symptoms presented in multiple-choice lists, and it is possible that patients may have been suggestible to the list presented, may not have correctly remembered past symptoms, or may incorrectly attribute certain symptoms or feelings to benzodiazepines.
We did not account for a nocebo effect.
The large number of write-in comments suggests that many respondents felt the survey did not allow them to fully describe the extent of their experiences and emotions.
Another limitation of our survey is that it recruited respondents from social media and online sources that deal with benzodiazepine use and withdrawal. Respondents were self-selected, forming a convenience sample that may not represent the population of benzodiazepine users as a whole because visitors may have sought sites such as these specifically because they have experienced problems. Moreover, those who use the Internet for health information tend to be younger, and those who join online support groups for medical conditions tend to be in generally worse health. Our results thus may not be generalizable to the population of all people taking benzodiazepines.
Data Analysis
A medical statistician produced the initial results of this survey utilizing SAS Software. Subsequent data analysis was performed in greater detail by an experienced data scientist who imported the survey data into a custom SQL Server data model.
Customized queries were employed to obtain correlations among the data. In particular, this analysis examined conditions for which benzodiazepines were prescribed and compared them to symptoms and adverse life effects reported by patients who were tapering or had discontinued benzodiazepine use.
All analyses were delivered via a structured reporting process and validated against the original SAS reports. The survey was made available online through websites and internet benzodiazepine support groups and general health and wellness groups.
The data scientist mentioned above is D E Foster, who is also the author of this blog series and the founder of Easing Anxiety. D has been a member of the Benzodiazepine Survey Research Team since 2019, providing general benzodiazepine knowledge and lived-experience in addition to formal data analysis and reporting. Prior to his withdrawal from benzodiazepines, D worked as a database developer and data scientist for over 25 years.
For Informational Purposes Only
All information presented on Easing Anxiety is for informational purposes only, and should never be considered medical or health advice. Withdrawal, tapering, or any change in dosage of benzodiazepines or any other prescription drugs should only be done under the direct supervision of a licensed physician.
This article was written by a living, breathing, human person.
Please read our site disclaimer for more information.
Well, it’s good to see some research being done, but I think it’s even better to see that no one is jumping to conclusions (like “a frog with no legs cannot hear” …you know that one, right?🙄 If not, I’ll fill you in later.) Or that drinking really expensive wine is good for your health. Period. (As if people who can afford really expensive wine don’t in general have better living conditions and health care than other people. Argh.) Thumbs up for the realization of the lack of solid conclusions based on the limitations of the survey, but also thumbs up because at least it’s a start. 😉👍. You go, D.