Most studies have shown that health protection efforts during the COVID-19 pandemic such as repeated quarantine, confinement and lockdowns have negatively affected especially mental health in children and adolescents [32]. Even so, countries and geographical regions were subject to variations in the capacity to handle the situation and strictness in measurements, which would affect the populations differently. Norway represents a wealthy society with well-organized social benefit arrangements; hence restrictions were most probably less intrusive compared to some of the other populations which other studies were based on. In addition, our study population inhabit a rural area in Norway not as densely populated as the ones represented in many other COVID-19 focused studies.
In our study, data from the same region in Norway were collected pre-pandemic (2017–2019) and again well into the pandemic (May/June 2021) which gave us the unique possibility of studying factors related to the pandemic in the same adolescent population over time. The main findings of our study based on primarily two cross-sections of 16–20-year-olds living in the same area previously and under the COVID-19 pandemic were generally that the adolescents were not affected as negatively as could be expected; general health, quality of life and the adolescents’ perception of family economy seemed to have stayed unchanged. The rise in loneliness observed also before the pandemic, however, seemed to have continued into the pandemic. Interestingly, only boys and not girls reported poorer mental health from the time before the pandemic compared to into the pandemic, which is the opposite of what others have shown and deviate from the negative trends identified before the pandemic where girls compared to boys reported the most adverse development [9, 10, 33].
In contrast to the findings in the two cross-section, adverse general and mental health, quality of life and loneliness were identified longitudinally at the two time points pre-pandemic (2017–2019) and four years later into the pandemic at follow-up (June 2021) in a dataset consisting of 1565 individuals. Independent of the pandemic, the same negative development was observed in an earlier Young-HUNT based longitudinal dataset from 1995–1997 with follow-up in 2000–2001. Our suggestion is that the adverse health developments seen in the longitudinal sample spanning the period pre-pandemic into the pandemic is not a result of the pandemic restrictions, but rather a consequence of the increase in age from early until later adolescence as have been evident from other longitudinal studies [23, 34].
There has been a constant rise in loneliness observed globally over the last 20 years among young people with special emphasis on females [11]. The same trend has been identified in Norway [35, 36]. Young individuals are especially vulnerable to loneliness as they are in a state of social, psychosocial and cognitive transition from childhood to adulthood [37]. The increased loneliness prevalence causes public health concerns, as it is associated with risk factors such as suicidal behaviour [38, 39], social anxiety and depression [40] as well as future adult psychological illness and poor health outcomes [41]. It is therefore of immense importance to investigate whether the restrictions during the pandemic gave further rise in loneliness, with the associated adverse consequences for health and well-being. There is a suggestion that this negative trend is linked to the parallel rise in digital media usage such as social media and smart phones [11] which seems to have been further strengthened during the COVID-19 pandemic [42–44].
In our study, loneliness was more prevalent during the pandemic compared to prior to the pandemic in both sexes. This is in line with another Norwegian study, which show that loneliness had increased linearly from 2014 into the pandemic in 2021 [20]. Contrary to this, Hansen et al., identified no additional adverse change in loneliness during the pandemic in young Norwegian adults (18–24 years [45]. This was suggested to be because adolescents’ relationships with parents and peers during the pandemic did not seem to deteriorate [20].
In a recent review of studies concerning mental health in Europe during the COVID-19 pandemic, a general increase in mental health problems related to the pandemic was observed [46–48], although the findings are mixed [32]. By late 2020, i.e. after the most intrusive lock-down period, the increase appeared to have slowed down probably due to less fear and uncertainty amongst people. In our study, one of the most interesting findings was that only boys and not girls reported poorer mental health from the time before the pandemic compared to June 2021. This is in disagreement with the findings from a Finish study [49] and other Norwegian studies [19, 20] where mental distress seemed to worsen more in girls compared to boys. These discrepancies despite common Nordic conditions presumably being quite homogenous may be due to lack of total comparability concerning degree of urbanity. As mentioned, the population of the northern part of Trøndelag representing the sample in our study lack large cities, whilst the other Norwegian sample referred to [20] is nationally representative; hence with more participants inhabiting urban and more densely populated areas. A study that nicely describes the impact of different lockdown trajectories is the one by Meyer and colleagues where data are collected from two Australian states, Victoria, and Queensland [50].
We found based on the cross-sectional comparison of the 16–20-year-olds pre- and under the COVID-19 pandemic that general health, quality of life and the adolescents’ perception of family economy seemed to have stayed unchanged. This could be because the restrictions in general did not have such negative effects on health as would expected, or that the most stringent restrictions had been lifted at the point of data collection (May/June 2021) and conditions had normalised. As shown in a Dutch study, levels of loneliness, general mental health and life satisfaction declined initially in the pandemic but then improved to previous levels when restrictions were more relaxed [51]. This has also been shown by others who have suggested that the decline is a result of increased resilience in the population who adapted to the situation [52] and also were influenced by the positive effects of collective solidarity [53].
The fact that general health and life satisfaction stayed unchanged probably also depended on the adolescents perceiving their household financial situation to be the same as before. Financial decline related to the pandemic has in previous studies been shown to have negative impacts on physical and mental health in adolescents [54, 55], whereof several demonstrate that girls’ mental health was more adversely affected than boys’ in more vulnerable socioeconomic situations during the pandemic [56, 57].
In general, girls seem to be more prone to develop mental health problems than boys and factors influencing this are suggested to involve imposed expectations, social roles [58] and stronger stress reactivity [59]. Even if the proportion of girls compared to boys were shown to report adverse health and well-being generally, girls in our study did not develop negatively in the COVID-19 pandemic period. In fact, girls in the low SEP group seemed to be better off than before the pandemic. Family support and school contentment is important for mental health and well-being [60] and school pressure and coping in daily life are causes of poor life satisfaction and mental health [61, 62], also pinpointed by many adolescent girls themselves in Norway. As the effect of school pressure most probably changed in the pandemic period, it is tempting to speculate on the potential positive influence on girls this may have had. In a British survey, one-third of the students (aged 8–18) reported improvement in their mental wellbeing during the first COVID-19 lockdown and these were more likely than their peers to report improvement concerning factors such as school, relational, and lifestyle [6]. The authors suggest the reduction in school stress or learning systems during the pandemic to be better suited for some. Another issue interesting to emphasise related to our findings is the worrying trend of school refusals and “flight” from public schools among children and adolescents in Norway which has increased after the pandemic [63] and the mechanisms related to this [64]. Even if the pandemic resulted in disadvantages such as enhanced outsideness and reduced social skills [63], it is tempting to speculated whether life outside the school atmosphere also were beneficial for some adolescents.
In conclusion, our study indicate that the pandemic did not lead to a decline in the overall health and quality of life in adolescents, except for the increase in loneliness and mental distress among boys. In general, girls appeared to cope better than boys, with health and life quality even showing improvement among girls from families with lower socioeconomic position. Understanding the contextual factors that contributed to this positive development and finding ways to sustain this situation beyond the pandemic is crucial for preventing further deterioration of mental health and well-being among adolescents in the future.
Strengths and limitations
The major strength of this study is the ability to compare the situation concerning adolescents’ health and well-being prior to and into the pandemic in the same population. The HUNT Study is a large population-based study largely representative of Norwegians [65, 66], although it does not include large city inhabitants. The population is relatively homogenous, with a low migration rate. Nearly everyone attends the same public schools and benefits from the same welfare and public health services although it may vary marginally between municipalities. The observed negative mental health and loneliness trends [9, 36] agree with both national and global circumstances [11, 20, 67].
There are several limitations to the study, one being that data is based on self-report. Another drawback is the low participation rate in the Young-HUNT COVID Survey. As the variations in the school’s participation rates were due to the randomness of teachers that were on strike, regional lockdowns, and flexible times at school because of cancelled exams, reduced representativeness is not likely an important issue. In addition, confirming coincident characteristics in the main study sample, Young-HUNT4 Survey, compared with non-participants in the follow-up (Young-HUNT COVID) from the same survey, precluded the presence of selection bias and strengthened our findings. Anyhow, the influence due to variation in lockdown measures would be difficult to precisely account for as different regions and municipalities implemented different types of lockdown measures. At some points nationwide lockdown were declared, whereas some regions advocated for social distancing and limitations on gatherings rather than legally enforcing a lockdown.
The question concerning family economy is an objective perception, although how the adolescents feel will most likely affect mental health and well-being the most. An alternative measure of SEP could be parental education, which would require family linkage through Statistics Norway.