title: Pharmacologic treatment of posttraumatic stress disorder among privately insured Americans.
abstract: OBJECTIVE
  Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals.
  
  
  METHODS
  Data were from the MarketScan database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics.
  
  
  RESULTS
  Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics.
  
  
  CONCLUSIONS
  Psychotropic medications were frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common, substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to determine symptom-specific responses to medications across diagnoses.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. ilan.harpaz-rotem@yale.edu
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Somaia
authors.initials: S
authors.lastname: Mohamed
authors.forename: Rani A
authors.initials: RA
authors.lastname: Desai
mesh_terms: D000328:Adult; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017149:Private Sector; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014481:United States