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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.

Abstract

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.

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