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Self-reported Mental and Physical Health Among Norwegian Adolescents Before and During the COVID-19 Pandemic

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To identify the key insights or developments described in this article
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Key Points

Question  Are there differences in self-reported depression symptoms, friendships, physical health, and organized sports participation among adolescents in Norway before vs during the COVID-19 pandemic and across levels of experienced pandemic-related anxiety?

Findings  This cohort study including 2536 adolescents found that Norwegian adolescents starting high school during the COVID-19-year had lower odds of sports participation than their peers starting high school in preceding years, but no significant differences in depression symptoms, friendships, and physical health. However, elevated depression symptoms and poor physical health were significantly more common in the subgroup of adolescents experiencing high pandemic-related anxiety in the COVID-19 cohort compared with their peers in the pre–COVID cohort.

Meaning  These findings suggest that most adolescents from this sample coped adequately with the pandemic conditions but that strategies aiming to mitigate the impact of COVID-19 may benefit from identifying youth disproportionally affected by the pandemic-related anxieties.


Importance  The COVID-19 pandemic and resulting conditions may negatively affect adolescents.

Objective  To examine aspects of self-reported mental and physical health among adolescents in Norway before and during the pandemic, including the role of pandemic-associated anxiety.

Design, Setting, and Participants  This cohort study examined a diverse nationwide sample of grade 11 students from the longitudinal MyLife study in Norway. The original study recruitment of all 8th, 9th, and 10th graders from the same middle schools facilitated identification of 2 sociodemographically comparable cohorts assessed in October to December 2018 and 2019, before the COVID-19 pandemic, and October to December 2020, during the pandemic. School entry and enrollment in Norway is determined by the birth year, and students usually start high school (11th grade) during the fall of the year of their 16th birthday. Data were analyzed from March to June 2021.

Exposures  The COVID-19 pandemic and associated conditions in Norway.

Main Outcomes and Measures  In grades 10 and 11, adolescents reported their depression symptoms using the Patient Health Questionnaire-9 (cutoff scores for moderate/severe depression, ≥15), number of close friends, physical health, and organized sports participation. Cohort differences were examined with a set of nested regression models, incrementally controlling for sociodemographic covariates and grade 10 outcomes.

Results  A sample of 2536 adolescents (1505 [59.4%] girls) was analyzed, including 1621 adolescents before the pandemic and 915 adolescents during the pandemic, of whom 158 adolescents (17.3%) reported high pandemic anxiety. The only significant difference in outcomes between the COVID-19 cohort and the pre–COVID-19 cohort were lower odds of organized sports participation (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.87). However, in subanalyses comparing adolescents with high anxiety during the COVID-19 pandemic with adolescents in the pre–COVID-19 cohort, adolescents with high pandemic anxiety were more likely to experience clinical-level depression symptoms (aOR, 2.17; 95% CI, 1.39-3.37) and poor physical health (aOR, 1.53; 95% CI, 1.01-2.31).

Conclusions and Relevance  In this cohort study of Norwegian adolescents, adolescents who started high school during the pandemic year had lower odds of organized sports participation in late 2020, but were otherwise comparable in terms of self-reported mental and physical health with their pre–COVID-19 counterparts. However, adolescents in the COVID-19 cohort experiencing high pandemic-related anxiety had significantly greater odds of poorer mental and physical health than adolescents in the pre–COVID-19 cohort. Strategies aiming to mitigate the impact of COVID-19 may benefit from identifying youth disproportionally affected by the pandemic conditions.

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Article Information

Accepted for Publication: June 15, 2021.

Published: August 24, 2021. doi:10.1001/jamanetworkopen.2021.21934

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Burdzovic Andreas J et al. JAMA Network Open.

Corresponding Author: Jasmina Burdzovic Andreas, PhD, ScM, Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213 Oslo, Norway (jabu@fhi.no).

Author Contributions: Drs Burdzovic Andreas and Brunborg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Both authors.

Administrative, technical, or material support: Both authors.

Conflict of Interest Disclosures: None reported.

United Nations Development Programme. The 2020 Human Development Report 2020. Accessed May 26, 2021. http://hdr.undp.org/sites/default/files/hdr2020.pdf
Ursin  G , Skjesol  I , Tritter  J .  The COVID-19 pandemic in Norway: the dominance of social implications in framing the policy response.   Health Policy Technol. 2020;9(4):663-672. doi:10.1016/j.hlpt.2020.08.004PubMedGoogle ScholarCrossref
Christensen  T , Lægreid  P .  Balancing governance capacity and legitimacy—how the Norwegian government handled the COVID-19 crisis as a high performer.   Public Adm Rev. 2020;80(5):774-779. doi:10.1111/puar.13241 PubMedGoogle ScholarCrossref
Hafstad  GS , Sætren  SS , Wentzel-Larsen  T , Augusti  E-M .  Adolescents’ symptoms of anxiety and depression before and during the COVID-19 outbreak—a prospective population-based study of teenagers in Norway.   Lancet Regional Health: Europe. 2021;5:100093. doi:10.1016/j.lanepe.2021.100093Google Scholar
Lehmann  S , Skogen  JC , Haug  E ,  et al.  Perceived consequences and worries among youth in Norway during the COVID-19 pandemic lockdown.   Scand J Public Health. Published online March 1, 2021. doi:10.1177/1403494821993714PubMedGoogle Scholar
The Government of Norway. Tidslinje: myndighetenes håndtering av koronasituasjonen. Accessed May 26, 2021. https://www.regjeringen.no/no/tema/Koronasituasjonen/tidslinje-koronaviruset/id2692402/
Ebrahimi  OV , Hoffart  A , Johnson  SU .  Physical distancing and mental health during the COVID-19 pandemic: factors associated with psychological symptoms and adherence to pandemic mitigation strategies.   Clin Psychol Sci. Published online March 12, 2021. doi:10.1177/2167702621994545Google Scholar
Statistics Norway. Dette er Norge 2017. Accessed May 26, 2021. https://www.ssb.no/en/befolkning/artikler-og-publikasjoner/_attachment/323659
Strandbu  Å , Bakken  A , Stefansen  K .  The continued importance of family sport culture for sport participation during the teenage years.   Sport Educ Soc. 2020;25(8):931-945. doi:10.1080/13573322.2019.1676221Google ScholarCrossref
Skille  EÅ .  Sport for all in Scandinavia: sport policy and participation in Norway, Sweden and Denmark.   Int J Sport Policy Polit. 2011;3(3):327-339. doi:10.1080/19406940.2011.596153Google ScholarCrossref
Garvey  P.   The Norwegian country cabin and functionalism: a tale of two modernities.   Soc Anthropol. 2008;16(2):203-220. doi:10.1111/j.1469-8676.2008.00029.x Google ScholarCrossref
Raknes  G , Strøm  MS , Sulo  G , Øverland  S , Roelants  M , Juliusson  PB .  Lockdown and non–COVID-19 deaths: cause-specific mortality during the first wave of the 2020 pandemic in Norway: a population-based register study.   medRxiv. 2021:2021.02.09.21251326. doi:10.1101/2021.02.09.21251326Google Scholar
The Lancet Public Health.  COVID-19: from a PHEIC to a public mental health crisis?   Lancet Public Health. 2020;5(8):e414. doi:10.1016/S2468-2667(20)30165-1 PubMedGoogle Scholar
Vigo  D , Patten  S , Pajer  K ,  et al.  Mental health of communities during the COVID-19 pandemic.   Can J Psychiatry. 2020;65(10):681-687. doi:10.1177/0706743720926676 PubMedGoogle ScholarCrossref
The Lancet Child Adolescent Health.  Growing up in the shadow of COVID-19.   Lancet Child Adolesc Health. 2020;4(12):853. doi:10.1016/S2352-4642(20)30349-7 PubMedGoogle ScholarCrossref
Jones  EAK , Mitra  AK , Bhuiyan  AR .  Impact of COVID-19 on mental health in adolescents: a systematic review   Int J Environ Res Public Health. 2021;18(5):1-9. doi:10.3390/ijerph18052470PubMedGoogle ScholarCrossref
Novins  DK , Stoddard  J , Althoff  RR ,  et al.  Editors’ note and special communication: research priorities in child and adolescent mental health emerging from the COVID-19 pandemic.   J Am Acad Child Adolesc Psychiatry. 2021;60(5):544-554.e8. doi:10.1016/j.jaac.2021.03.005PubMedGoogle ScholarCrossref
Public Health Ontario.  Negative Impacts of Community-Based Public Health Measures During a Pandemic (e.g., COVID-19) on Children and Families. Queen's Printer for Ontario; 2020.
Fegert  JM , Vitiello  B , Plener  PL , Clemens  V .  Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality.   Child Adolesc Psychiatry Ment Health. 2020;14:20. doi:10.1186/s13034-020-00329-3 PubMedGoogle ScholarCrossref
Giannopoulou  I , Efstathiou  V , Triantafyllou  G , Korkoliakou  P , Douzenis  A .  Adding stress to the stressed: senior high school students’ mental health amidst the COVID-19 nationwide lockdown in Greece.   Psychiatry Res. 2021;295:113560. doi:10.1016/j.psychres.2020.113560 PubMedGoogle Scholar
Newlove-Delgado  T , McManus  S , Sadler  K ,  et al; Mental Health of Children and Young People group.  Child mental health in England before and during the COVID-19 lockdown.   Lancet Psychiatry. 2021;8(5):353-354. doi:10.1016/S2215-0366(20)30570-8 PubMedGoogle ScholarCrossref
Ravens-Sieberer  U , Kaman  A , Erhart  M , Devine  J , Schlack  R , Otto  C .  Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany.   Eur Child Adolesc Psychiatry. 2021:1-11. doi:10.1007/s00787-021-01726-5PubMedGoogle Scholar
Loades  ME , Chatburn  E , Higson-Sweeney  N ,  et al.  Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19.   J Am Acad Child Adolesc Psychiatry. 2020;59(11):1218-1239.e3. doi:10.1016/j.jaac.2020.05.009PubMedGoogle ScholarCrossref
Thorisdottir  IE , Asgeirsdottir  BB , Kristjansson  AL ,  et al.  Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study.   Lancet Psychiatry. 2021;S2215-0366(21)00156-5. doi:10.1016/S2215-0366(21)00156-5PubMedGoogle Scholar
Evans  S , Alkan  E , Bhangoo  JK , Tenenbaum  H , Ng-Knight  T .  Effects of the COVID-19 lockdown on mental health, wellbeing, sleep, and alcohol use in a UK student sample.   Psychiatry Res. 2021;298:113819. doi:10.1016/j.psychres.2021.113819PubMedGoogle Scholar
Hawes  MT , Szenczy  AK , Olino  TM , Nelson  BD , Klein  DN .  Trajectories of depression, anxiety and pandemic experiences: a longitudinal study of youth in New York during the Spring-Summer of 2020.   Psychiatry Res. 2021;298:113778. doi:10.1016/j.psychres.2021.113778 PubMedGoogle Scholar
Soest  TV , Bakken  A , Pedersen  W , Sletten  MA .  Life satisfaction among adolescents before and during the COVID-19 pandemic [in Norwegian].   Tidsskr Nor Laegeforen. 2020;140(10). doi:10.4045/tidsskr.20.0437PubMedGoogle Scholar
Munasinghe  S , Sperandei  S , Freebairn  L ,  et al.  The impact of physical distancing policies during the COVID-19 pandemic on health and well-being among Australian adolescents.   J Adolesc Health. 2020;67(5):653-661. doi:10.1016/j.jadohealth.2020.08.008 PubMedGoogle ScholarCrossref
Pavlovic  A , DeFina  LF , Natale  BL ,  et al.  Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs.   BMC Public Health. 2021;21(1):485. doi:10.1186/s12889-021-10545-xPubMedGoogle ScholarCrossref
Zheng  C , Huang  WY , Sheridan  S , Sit  CH-P , Chen  X-K , Wong  SH-S .  COVID-19 pandemic brings a sedentary lifestyle in young adults: a cross-sectional and longitudinal study.   Int J Environ Res Public Health. 2020;17(17):6035. doi:10.3390/ijerph17176035 PubMedGoogle ScholarCrossref
Stockwell  S , Trott  M , Tully  M ,  et al.  Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review.   BMJ Open Sport Exerc Med. 2021;7(1):e000960. doi:10.1136/bmjsem-2020-000960PubMedGoogle Scholar
Holmes  EA , O’Connor  RC , Perry  VH ,  et al.  Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.   Lancet Psychiatry. 2020;7(6):547-560. doi:10.1016/S2215-0366(20)30168-1 PubMedGoogle ScholarCrossref
McElroy  E , Patalay  P , Moltrecht  B ,  et al.  Demographic and health factors associated with pandemic anxiety in the context of COVID-19.   Br J Health Psychol. 2020;25(4):934-944. doi:10.1111/bjhp.12470 PubMedGoogle ScholarCrossref
Iob  E , Frank  P , Steptoe  A , Fancourt  D .  Levels of severity of depressive symptoms among at-risk groups in the UK during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(10):e2026064. doi:10.1001/jamanetworkopen.2020.26064 PubMedGoogle Scholar
Brunborg  GS , Scheffels  J , Tokle  R , Buvik  K , Kvaavik  E , Burdzovic Andreas  J .  Monitoring young lifestyles (MyLife)—a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway.   BMJ Open. 2019;9(10):e031084. doi:10.1136/bmjopen-2019-031084 PubMedGoogle Scholar
Duncan  SC , Duncan  TE , Hops  H .  Analysis of longitudinal data within accelerated longitudinal designs.   Psycholog Methods. 1996;1(3):236-248. doi:10.1037/1082-989X.1.3.236 Google ScholarCrossref
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: a new depression diagnostic and severity measure.   Psychiatr Ann. 2002;32:509-521.Google ScholarCrossref
Ettman  CK , Abdalla  SM , Cohen  GH , Sampson  L , Vivier  PM , Galea  S .  Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686 PubMedGoogle Scholar
Burdzovic Andreas  J , Brunborg  GS .  Depressive symptomatology among Norwegian adolescent boys and girls: the Patient Health Questionnaire-9 (PHQ-9) psychometric properties and correlates.   Front Psychol. 2017;8:887. doi:10.3389/fpsyg.2017.00887 PubMedGoogle ScholarCrossref
Wisting  L , Johnson  SU , Bulik  CM , Andreassen  OA , Rø  Ø , Bang  L .  Psychometric properties of the Norwegian version of the Patient Health Questionnaire-9 (PHQ-9) in a large female sample of adults with and without eating disorders.   BMC Psychiatry. 2021;21(1):6. doi:10.1186/s12888-020-03013-0 PubMedGoogle ScholarCrossref
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association; 1994.
Goodman  E , Adler  NE , Kawachi  I , Frazier  AL , Huang  B , Colditz  GA .  Adolescents’ perceptions of social status: development and evaluation of a new indicator.   Pediatrics. 2001;108(2):E31. doi:10.1542/peds.108.2.e31 PubMedGoogle Scholar
Newcomb  MD , Huba  GJ , Bentler  PM .  A multidimensional assessment of stressful life events among adolescents: derivation and correlates.   J Health Soc Behav. 1981;22(4):400-415. doi:10.2307/2136681 Google ScholarCrossref
Williams  RL .  A note on robust variance estimation for cluster-correlated data.   Biometrics. 2000;56(2):645-646. doi:10.1111/j.0006-341X.2000.00645.x PubMedGoogle ScholarCrossref
Craig  P , Cooper  C , Gunnell  D ,  et al.  Using natural experiments to evaluate population health interventions: new Medical Research Council guidance.   J Epidemiol Community Health. 2012;66(12):1182-1186. doi:10.1136/jech-2011-200375 PubMedGoogle ScholarCrossref
Bronfenbrenner  U .  The Ecology of Human Development—Experiments by Nature and Design. Harvard University Press; 1979.
Jo  Inchley , Dorothy  Currie , Sanja  Budisavljevic ,  et al, eds.  Spotlight on Adolescent Health and Well-being: Findings From the 2017/2018 Health Behaviour in School-Aged Children (HBSC) Survey in Europe and Canada International Report. WHO Regional Office for Europe; 2020.
Masten  AS , Motti-Stefanidi  F .  Multisystem resilience for children and youth in disaster: reflections in the context of COVID-19.   Advers Resil Sci. 2020;1(2):1-12. doi:10.1007/s42844-020-00010-wPubMedGoogle Scholar
Marchini  S , Zaurino  E , Bouziotis  J , Brondino  N , Delvenne  V , Delhaye  M .  Study of resilience and loneliness in youth (18-25 years old) during the COVID-19 pandemic lockdown measures.   J Community Psychol. 2021;49(2):468-480. doi:10.1002/jcop.22473 PubMedGoogle ScholarCrossref
Kang  S , Sun  Y , Zhang  X , Sun  F , Wang  B , Zhu  W .  Is physical activity associated with mental health among Chinese adolescents during isolation in COVID-19 Pandemic?   J Epidemiol Glob Health. 2021;11(1):26-33. doi:10.2991/jegh.k.200908.001 PubMedGoogle ScholarCrossref
Tso  WWY , Wong  RS , Tung  KTS ,  et al.  Vulnerability and resilience in children during the COVID-19 pandemic.   Eur Child Adolesc Psychiatry. 2020:1-16. doi:10.1007/s00787-020-01680-8PubMedGoogle Scholar
Rothman  KJ , Gallacher  JE , Hatch  EE .  Why representativeness should be avoided.   Int J Epidemiol. 2013;42(4):1012-1014. doi:10.1093/ije/dys223 PubMedGoogle ScholarCrossref
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