Impact of COVID-19 Pandemic Lockdown on Mental Well-Being of Norwegian Adolescents During the First Wave-Socioeconomic Position and Gender Differences.

Background: The lockdowns associated with the COVID-19 pandemic has been called a crisis in mental health, and adolescents may have been among the most affected. Comparing the first period of societal lockdown in spring 2020 to periods going back to 2014 using a rich cross-sectional dataset based on repeated surveys, we explore the potential changes in self-reported mental well-being across sociodemographic groups among Norway's adolescents. Methods: Norway closed schools and implemented strict restrictions in March 2020; an electronic questionnaire survey was distributed to lower secondary school students in Trøndelag county (N = 2,443) in May 2020. Results were compared with similar surveys conducted annually in the same county dating back to 2014. Logistic regression models were applied to investigate potential changes in depressive symptoms, loneliness, and quality of life and life satisfaction, and to detect possible differences in the impact of lockdown between the genders and socioeconomic groups. Results: The prevalence of boys and girls reporting high quality of life (43-34%; 23-16%) and life satisfaction (91-80%; 82-69%) decreased significantly compared to the pre-pandemic. For girls only, lockdown was associated with higher odds for reporting high depressive symptoms. As expected, the least privileged socioeconomic groups showed the greatest psychological distress. However, our trend analyses provided no evidence that the socioeconomic inequalities in psychological distress (according to prevalence of high depressive symptoms or loneliness) changed substantial in any direction during the first wave of the pandemic [between the pre-pandemic and inter-pandemic periods]. Conclusion: Adolescents are vulnerable, and interventions should provide them with mental health support during crises such as societal lockdown. In particular, the social and health policy, public health, and further research should target these least privileged groups.

Psychological distress in late adolescence: The role of inequalities in family affluence and municipal socioeconomic characteristics in Norway.

The present study aims to explore, in the national context of Norway, how municipal socioeconomic indicators affect anxiety and depressive symptom scores among senior high school students and whether this potential municipal effect is dependent on the adolescents' family affluence levels. This cross-sectional study is based on questionnaire data collected in five waves (2014-2018) of the Ungdata survey. The study sample consisted of 97,460 adolescents aged 16-18 years attending high school in 156 municipalities in Norway. Measures of psychological distress, depression, and anxiety symptoms were based on the screening instrument, Hopkins Symptom Checklist-10. Two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents' mental health. In general, the results indicate substantial psychological symptom load among the study sample. Inequalities in adolescents' psychological distress between family affluence groups were evident, with the lowest symptom loads in the most affluent families. The predicted depressive and anxiety symptoms among the students increased slightly along with the percentage of municipal residents with tertiary educations and with increasing income inequalities in their residential municipality. However, the interaction models suggest that the adverse effects of higher municipal education level and greater income inequality are, to a certain extent, steepest for adolescents with medium family affluence. This study highlights two key findings. Both municipality effects and family affluence account for a relatively small proportion of the total variance in the students' psychological symptoms loads; however, the mental health inequalities we explored between socioeconomic strata on both the individual and municipal levels are not insignificant in a public health perspective. Results are discussed in the context of psychosocial mechanisms related to social comparison and perceptions of social status that may be applicable in egalitarian welfare states such as Norway.

Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From 2014 to 2018: A Repeated Cross-Sectional Study.

BACKGROUND: Adolescents' mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents' mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014-2018. METHODS: The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014-2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014-2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period. CONCLUSION: Rising rates of adolescents' psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents' mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.

Residential Mobility, Family Structure, and Completion of Upper Secondary Education - A Registry-Based Cohort Study of the Norwegian Adolescent Population.

BACKGROUND: Longitudinal studies exploring the complex interplay between family structures and residential mobility on educational achievement and failure are lacking. We investigate the interplay between the number of residential moves during late childhood, parental education level, family living situation, and the probability of completing upper secondary education. METHODOLOGY: Detailed longitudinal data for a random sample of 30% of the entire Norwegian population born 1982 to 1989 (N = 121,247) and information on all their relocations between Norwegian enumeration districts from ages 10 to 18 years were extracted from the Norwegian population registries. Family structures were grouped into four intersectional family strata defined by combining categories of parental education level (distinguishing poorly educated and well-educated families) and the family's living situation (comparing non-intact families with intact families). We applied two-level logistic regression models, which incorporated individual and family contextual factors, to estimate possible differences in completion rates of upper secondary education. RESULTS: Non-completion of secondary education (which constitutes 29% of the study sample) increases incrementally with the number of residential changes across all four family structures, but this effect was not distributed evenly between the different family strata. Individuals in "well-educated, intact families" seem to be least affected by residential moves. On the other hand, the highest disadvantage of frequent moves was among adolescents in the stratum "poorly educated, intact families." In poorly educated families the probabilities of completing secondary school among non-intact and intact families converge toward each other as the number of moves increase. About 43% of the variation in school completion may be attributed to differences between families. The highest risk of school non-completion was found among adolescents in poorly educated families, which accounted for 74% of the non-completers. CONCLUSION: We demonstrated underlying links between residential mobility and family structures on non-completion of upper secondary education. The adverse effect of frequent moves calls for attention in schools, public health agencies, and housing policies. The findings should be considered in a life course perspective, as the accumulation of unfavorable conditions during childhood and adolescence tends to constrict future prospects in terms of health and quality of life.

Non-completion of secondary education and early disability in Norway: geographic patterns, individual and community risks.

BACKGROUND: School non-completion and early work disability is a great public health challenge in Norway, as in most western countries. This study aims to investigate how medically based disability pension (DP) among young adults varies geographically and how municipal socioeconomic conditions interact with non-completion of secondary education in determining DP risk. METHODS: The study includes a nationally representative sample of 30% of all Norwegians (N = 350,699) aged 21-40 in 2010 from Statistic Norway's population registries. Multilevel models incorporating factors at the individual, neighbourhood and municipal levels were applied to estimate the neighbourhood and municipality general contextual effects in DP receipt, and detect possible differences in the impact of municipal socioeconomic conditions on DP risk between completers and non-completers of secondary education. RESULTS: A pattern of spatial clustering at the neighbourhood (ICC = 0.124) and municipality (ICC = 0.021) levels are clearly evident, indicating that the underlying causes of DP receipt have a systematic neighbourhood and municipality variation in Norway. Non-completion of secondary education is strongly correlated with DP receipt among those younger than 40. Socioeconomic characteristics of the municipality are also significantly correlated with DP risk, but these associations are conditioned by the completion of secondary education. Living in a socioeconomically advantageous municipality (i.e. high income, high education levels and low unemployment and social security payment rates) is associated with a higher risk of DP, but only among those who do not complete their secondary education. Although the proportion of DPs was equal in rural and urban areas, it is evident that young people living in urban settings are more at risk of early DP than their counterparts living in rural parts of the country when controlling for other risk factors. CONCLUSION: The association between school non-completion and DP risk varies between municipalities and local socioeconomic environments. The interplay between personal characteristics and the local community is important in DP risk among young adults, implying that preventive measures should be directed not only at the individual level, but also include the educational system and the local community.

Correction: Do family and neighbourhood matter in secondary school completion? A multilevel study of determinants and their interactions in a life-course perspective.

[This corrects the article DOI: 10.1371/journal.pone.0172281.].

Do family and neighbourhood matter in secondary school completion? A multilevel study of determinants and their interactions in a life-course perspective.

BACKGROUND: Completion of secondary education is important for individuals' future health and health behaviour. The fundamental purpose of this study is to investigate the variation and clustering of school completion in families and neighbourhoods. Secondly, we aim to examine the impact of individuals' family structure and neighbourhood of residence and examine to what extent parental education level moderates these associations. METHODS: Longitudinal register data for 30% of the entire Norwegian population aged 21-27 years in 2010 (N = 107,003) was extracted from Statistic Norway´s event database. Three-level logistic regression models, which incorporated individual, family, and neighbourhood contextual factors, were applied to estimate the family and neighbourhood general contextual effects and detect possible educational differences in the impact of family structure and urban place of residence in school completion. RESULTS: Completion rates were significantly higher within families with higher education level (79% in tertiary educated families vs. 61% and 48% in secondary and primary educated families respectively) and were strongly correlated within families (ICC = 39.6) and neighbourhoods (ICC = 5.7). Several structural factors at the family level negatively associated with school completion (e.g., family disruption, large family size, and young maternal age) were more prevalent and displayed more negative impact among primary educated individuals. Urban residence was associated with school completion, but only among the tertiary educated. CONCLUSIONS: Investment in the resources in the individuals' immediate surroundings, including family and neighbourhood, may address a substantial portion of the social inequalities in the completion of upper secondary education. The high intra-familial correlation in school completion suggests that public health policies and future research should acknowledge family environments in order to improve secondary education completion rates among young people within lower educated families.

Disability Pensions Among Young Adults in Vocational Rehabilitation.

OBJECTIVES: Lack of work-participation and early disability pensions (DP's) among young adults are increasing public health problems in most western European countries. The present study investigated determinants of early DP in young adults in vocational rehabilitation. METHODS: Data from 928 young adults (aged 18-40 years) attending a vocational rehabilitation program was linked to DP's recorded in the Norwegian Labor and Welfare Organization registries (1992-2010) and later compared to a group of 65 employees (workers). We used logistic regression to estimate the odds ratio for entitlement to DP following rehabilitation, adjusting for socio-demographical, psychosocial and health-behavior factors. RESULTS: Significant differences in socio-demographical, psychosocial and health-behavior factors were found between the rehabilitation group and workers. A total of 60 individuals (6.5%) were granted a DP during follow-up. Increase in age, teenage parenthood, single status, as well as low education level and not being employed were found to be the strongest independent determinants of DP. CONCLUSION: Poor social relations (being lone), early childbearing and weak connection to working life contributed to increase in risk of DP's among young adults in vocational rehabilitation, also after adjusting for education level. These findings are important in the prevention of early disability retirements among young adults and should be considered in the development of targeted interventions aimed at individuals particularly at risk of not being integrated into future work lives.

Chronic pain patients--effects on mental health and pain after a 57-week multidisciplinary rehabilitation program.

Chronic musculoskeletal pain is a common health complaint in Norway and constitutes the largest proportion in terms of those who suffer long-term sickness and are in receipt of disability pensions. The aim of this study was to examine the relation between changes in pain and mental health among men and women with chronic musculoskeletal pain after a rehabilitation program. A total of 201 subjects (132 women and 63 men) with chronic pain (>6 months) and without any manifest organic diseases were referred to the 57-week multidisciplinary rehabilitation program. Measurements of pain (visual analog scale) and mental health (Hospital Anxiety and Depression Scale [HADS]), as well as sociodemographic data, were obtained before and after the rehabilitation period. At baseline, men showed higher HADS scores than women. Both women and men reported significant improvements in pain and mental health. The subjects scored higher on HADS both before and after the rehabilitation compared with a population-based study in the region. Older men and men with low education levels showed less improvement in HADS scores. In women, a significant association was found between change in pain and both change in anxiety and change in depression. The results support the hypothesis that there may be a strong association between change in chronic pain and psychologic factors, but there were gender differences.