{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:04:21Z","timestamp":1767917061898,"version":"3.49.0"},"reference-count":68,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,8,31]],"date-time":"2013-08-31T00:00:00Z","timestamp":1377907200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Second generation antipsychotics (SGAs) are widely used for post\u2010traumatic stress disorder (PTSD), although without strong evidence base. With substantial numbers of veterans returning from Iraq\/Afghanistan conflicts with PTSD, it is important to characterize the extent of SGA use and identify associated factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We determined time trends and patient characteristics associated with the use of SGAs in veterans with PTSD, without comorbid schizophrenia or bipolar disorders, using the Department of Veterans Affairs national administrative data 2003\u20132010.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 732\u2009085 veterans with PTSD, 27.6% received an intentional trial of an SGA in 2003\u20132010. The annual number treated with SGAs almost doubled (45\u2009268 to 84\u2009197, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), while prescribing rates decreased (28.6% to 21.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In multivariate analyses, African Americans (odds ratio (OR)\u2009=\u20091.07, 95%confidence interval (CI)\u2009=\u20091.06\u20131.09) and Hispanics (OR\u2009= 1.13, 95%CI\u2009=\u20091.10\u20131.17) were more likely to receive SGAs than Whites. Strongest clinical associations were with prior diagnosis of depression (OR\u2009=\u20091.96; 95%CI\u2009=\u20091.94\u20131.99), substance use disorders (OR\u2009=\u20091.86; 95%CI\u2009=\u20091.84\u20131.88), and other anxiety disorders (OR\u2009=\u20091.27; 95%CI\u2009=\u20091.26\u20131.29) (all <jats:italic>p<\/jats:italic>\u2009\u2013\u2009&lt;\u20090.0001) as well as cardiovascular risk factors. Veterans previously deployed to Iraq\/Afghanistan had lower likelihood of SGA receipt. Substantial regional differences were demonstrated (South\u2009&gt;\u2009Northeast; Midwest and West\u2009&lt;\u2009Northeast; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001); regional administrative units (veterans integrated service networks) contributed minimally to regional differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Post\u2010traumatic stress disorder population growth is driving substantial increases in SGA use. Decreasing rates of the Department of Veterans Affairs prescribing may be due to integrated system\u2010wide mechanisms (e.g., national practice guidelines), although regional variations remain prominent. These analyses provide foundational steps for identifying modifiable provider\u2010level and organization\u2010level determinants of SGA prescription in this growing population. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.3507","type":"journal-article","created":{"date-parts":[[2013,8,31]],"date-time":"2013-08-31T06:02:53Z","timestamp":1377928973000},"page":"77-86","source":"Crossref","is-referenced-by-count":24,"title":["Off\u2010label use of second generation antipsychotics for post\u2010traumatic stress disorder in the Department of Veterans Affairs: time trends and sociodemographic, comorbidity, and regional correlates"],"prefix":"10.1002","volume":"23","author":[{"given":"Mark S.","family":"Bauer","sequence":"first","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital  Bedford MA USA"},{"name":"Department of Psychiatry Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital  Bedford MA USA"},{"name":"Massachusetts General Hospital  Boston MA USA"},{"name":"Research Center for Medical Statistics and Actuarial Science Xi'an University for Finance and Economics  Xi'an Shaanxi Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingfei","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital  Bedford MA USA"},{"name":"Department of Mathematical Sciences Bentley University  Waltham MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Bajor","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital  Bedford MA USA"},{"name":"Department of Psychiatry Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Rasmusson","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Women's Health Sciences Division VA Boston Healthcare System  Boston MA USA"},{"name":"Department of Psychiatry Boston University School of Medicine  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lewis E.","family":"Kazis","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital  Bedford MA USA"},{"name":"Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management Boston University School of Public Health  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,8,31]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.453"},{"issue":"5","key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1176\/ps.2008.59.5.540","article-title":"Effect of prior authorization of second\u2010generation antipsychotic agents on pharmacy utilization and reimbursements","volume":"59","author":"Law MR","year":"2008","journal-title":"Psychiatr Serv"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/00048670903489890"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2009.07.003"},{"key":"e_1_2_7_6_1","first-page":"e346","article-title":"The unintended (and costly) effects due to the introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in a Canadian public prescription drug program: 1996\/97 to 2005\/06","volume":"16","author":"O'Reilly DJ","year":"2009","journal-title":"Can J Clin Pharmacol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2009.03.037"},{"key":"e_1_2_7_8_1","unstructured":"CareyB.Drugs found ineffective for veterans\u2019 stress.The New York Times August 2 2011.http:\/\/www.nytimes.com\/2011\/08\/03\/health\/research\/03psych.html?scp=10&sq=august+3%2C+2011&st=nyt[24 August 2011]."},{"key":"e_1_2_7_9_1","unstructured":"BrewinB.VA spent $717 million on a drug deemed as effective as a placebo. August 22 2011.http:\/\/www.nextgov.com\/nextgov\/ng_20110822_6423.php?oref=topstory[24 August 2011]."},{"key":"e_1_2_7_10_1","unstructured":"FriedmanRA.A call for caution on antipsychotic drugs.The New York Times August 24 2012.http:\/\/www.nytimes.com\/2012\/09\/25\/health\/a\u2010call\u2010for\u2010caution\u2010in\u2010the\u2010use\u2010of\u2010antipsychotic\u2010drugs.html?_r=0[25 September 2012]."},{"issue":"2","key":"e_1_2_7_11_1","first-page":"6","article-title":"Prospective study to evaluate the efficacy of aripiprazole as a monotherapy in patients with severe chronic posttraumatic stress disorder: an open trial","volume":"40","author":"Villarreal G","year":"2007","journal-title":"Psycholpharmacol Bull"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145706006596"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.11.039"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2008.12.004"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/YIC.0b013e32825ea324"},{"key":"e_1_2_7_16_1","volume-title":"Clinical Practice Guideline for Management of Post\u2010Traumatic Stress Disorder","author":"Department of Veterans Affairs (VA)","year":"2003"},{"key":"e_1_2_7_17_1","volume-title":"Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder","author":"American Psychiatric Association","year":"2004"},{"key":"e_1_2_7_18_1","volume-title":"Posttraumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care","author":"National Collaborating Centre for Mental Health","year":"2005"},{"key":"e_1_2_7_19_1","volume-title":"Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence","author":"Institute of Medicine Committee on Treatment of Posttraumatic Stress Disorder","year":"2008"},{"key":"e_1_2_7_20_1","volume-title":"Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies","author":"Foa EB","year":"2008"},{"key":"e_1_2_7_21_1","volume-title":"Practice Guideline for the Treatment of Patients With Acute Stress Disorder and Posttraumatic Stress Disorder","author":"Benedek DM","year":"2009"},{"key":"e_1_2_7_22_1","volume-title":"Clinical Practice Guideline for Management of Post\u2010Traumatic Stress","author":"Department of Veterans Affairs\/Department of Defense (VA\/DoD)","year":"2010"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1080"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0806994"},{"issue":"1","key":"e_1_2_7_25_1","first-page":"20","article-title":"Metabolic considerations in the use of antipsychotic medications: a review of recent evidence","volume":"68","author":"Newcomer JW","year":"2007","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2008.09.012"},{"key":"e_1_2_7_27_1","unstructured":"US Food and Drug Administration.Deaths with antipsychotics in elderly patients with behavioral disturbances. Public Health Advisory 2005. US Department of Health and Human Services; April 11 2005.http:\/\/www.fda.gov\/Drugs\/DrugSafety\/PostmarketDrugSafetyInformationforPatientsandProviders\/DrugSafetyInformationforHeathcareProfessionals\/PublicHealthAdvisories\/ucm053171.htm[31 August 2011]."},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.066035"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318070c07b"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/1524839906298494"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.027"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1176\/ps.2009.60.9.1175"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201100432"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.002022012"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004479-200604000-00011"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ddr.20080"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2009.08.0115"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.682658"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/0471722146"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11m07311"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3272"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.456"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201100544"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10597-009-9200-0"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-1288"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.10.1817"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.55.6.677"},{"key":"e_1_2_7_48_1","doi-asserted-by":"crossref","unstructured":"KreyenbuhlJ ZitoJM BuchananRW et al.Racial disparity in the pharmacological management of schizophrenia.Schizophr Bull2003;29(2):183\u2013193.","DOI":"10.1093\/oxfordjournals.schbul.a006996"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.4.567"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02287829"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.55.2.151"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.52.11.1523"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.57.1.70"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.schbul.a033465"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L155"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0b013e3283413505"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v66n0420f"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.HTR.0000314525.93381.69"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617712000458"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2012.10.009"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2012.11.007"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d1513"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-011-0408-2"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2011.03.016"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2214.2011.01246.x"},{"key":"e_1_2_7_66_1","volume-title":"Diffusion of Innovations","author":"Rogers E","year":"2003"},{"key":"e_1_2_7_67_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHH.0000311886.98627.b7"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049731509335569"},{"key":"e_1_2_7_69_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.28.5.w782"}],"container-title":["Pharmacoepidemiology and Drug Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpds.3507","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pds.3507","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:31:15Z","timestamp":1696465875000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pds.3507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,31]]},"references-count":68,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,1]]}},"alternative-id":["10.1002\/pds.3507"],"URL":"https:\/\/doi.org\/10.1002\/pds.3507","archive":["Portico"],"relation":{},"ISSN":["1053-8569","1099-1557"],"issn-type":[{"value":"1053-8569","type":"print"},{"value":"1099-1557","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,31]]}}}