UC San Diego

Objectives: There are currently no military studies on non-benzodiazepine sedative hypnotic (n-BSH) use among combat injured active-duty service members. There were three objectives of this dissertation: (1) describe rates and patterns of n-BSH medications in this population; (2) examine how n-BSH use affects perceived Health Related Quality of Life (HRQOL); and (3) examine the role of traumatic brain injury (TBI) in n-BSH prescription patterns among these injured service members. Methods: Three population-based retrospective studies were conducted on all U.S. service members who sustained injuries during deployed operations between September 2001 and Aug 2019 and who received pharmacological treatment for insomnia. These studies utilized six data sources from the Department of Defense (DoD); the Expeditionary Medical Encounter Database (EMED), Military Health System Data Repository (MDR), Pharmacy Data Transaction System (PDTS), Defense Manpower Data Center (DMDC), Career History Archival Medical and Personnel System (CHAMPS), and the Wounded Warrior Recovery Project (WWRP). DMDC and EMED contains deployment and combat information for Operations Iraqi Freedom and Enduring Freedom. Classification of injury, TBI status, n-BSH prescription patterns, and clinical diagnoses (assessed via ICD-9 and ICD-10 codes) were abstracted from the MDR and PDTS. Mental and physical wellbeing questionnaires from the WWRP were utilized to assess health related quality of life (HRQOL). Results: n-BSHs were the most frequently prescribed medication class among service members who sustained combat injuries. Long-term prescriptions were largely driving the high prevalence rates of n-BSH, given that 42.6% of service members were prescribed n-BSHs for 6 months or longer. Additionally, they experienced high rates of post-traumatic stress disorder (50.6%), TBI (42.5%), depression (39.1%), anxiety (52.0%), and chronic pain (15.1%). After adjustment, there was no statistically significant relationship between n-BSH prescription characteristics with service members’ HRQOL, or between TBI and n-BSH prescription characteristics. Conclusions: Combat injured service members’ n-BSH prescription patterns exceed Food and Drug Administration and American College of Physician guidelines. While n-BSH patterns did not differ by TBI or HRQOL, the high prevalence of long-term n-BSHs is alarming. Given their high prevalence of comorbid conditions in this population, clinical management of these service members should include a multidisciplinary approach.