Department of Economics and Business Economics

Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity

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DOI

  • Jawad H Butt, 1 Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet , Denmark .
  • ,
  • Søren Dalsgaard
  • Christian Torp-Pedersen, 4 Department of Health Science and Technology, Aalborg University , Aalborg, Denmark .
  • ,
  • Lars Køber, 1 Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet , Denmark .
  • ,
  • Gunnar H Gislason, 5 Department of Cardiology, Herlev and Gentofte University Hospital , Hellerup, Denmark .
  • ,
  • Christina Kruuse, 8 Department of Neurology, Herlev and Gentofte University Hospital , Herlev Denmark .
  • ,
  • Emil L Fosbøl, 1 Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet , Denmark .

OBJECTIVES: Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students at risk of later psychiatric events.

METHODS: Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves for unadjusted associations and multivariable cause-specific Cox proportional hazard analyses for adjusted hazard ratios (HRs).

RESULTS: We identified 12,147 healthy students with exam-related beta-blocker use and 12,147 matched healthy students with no current or prior use of beta-blockers (median age, 19 years; 80.3% women). Among all healthy students, 0.14% had a first-time prescription for a beta-blocker during the exam period with the highest proportion among students aged 19 years (0.39%). Eighty-one percent of the students filled only that single prescription for a beta-blocker during follow-up. During follow-up, 2225 (18.3%) beta-blocker users and 1400 (11.5%) nonbeta-blocker users were prescribed an antidepressant (p < 0.0001); 1225 (10.1%) beta-blocker users and 658 (5.4%) nonbeta-blocker users were prescribed a psychotropic drug (p < 0.0001); and 16 (0.13%) beta-blocker users and 6 (0.05%) nonbeta-blocker users attempted suicide (p = 0.03). Exam-related beta-blocker use was associated with an increased risk of antidepressant use (adjusted HRs, 1.68 [95% confidence intervals (CIs), 1.57-1.79], p < 0.0001), other psychotropic medication use (HR, 1.93 [95% CI, 1.76-2.12] p < 0.0001), and suicide attempts (HR, 2.67 [95% CI, 1.04-6.82] p = 0.04).

CONCLUSION: In healthy students, use of beta-blockers during the exam period was associated with an increased risk of psychiatric outcomes and might identify psychologically vulnerable students who need special attention.

Original languageEnglish
JournalJournal of Child and Adolescent Psychopharmacology
Volume27
Issue3
Pages (from-to)266-273
ISSN1044-5463
DOIs
Publication statusPublished - 26 Oct 2017

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