Depressive Symptoms, Mental Wellbeing, and Substance Use Among Adolescents Before and During the COVID-19 Pandemic in Iceland: A Longitudinal, Population-Based Study
Adolescence represents a crucial developmental period in shaping mental health trajectories. This study investigated the effect of the COVID-19 pandemic on mental health and substance use during this sensitive developmental stage.
In this longitudinal, population-based study, surveys were administered to a nationwide sample of 13–18-year-olds in Iceland in October or February in 2016 and 2018, and in October, 2020 (during the COVID-19 pandemic). The surveys assessed depressive symptoms with the Symptom Checklist-90, mental wellbeing with the Short Warwick Edinburgh Mental Wellbeing Scale, and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Demographic data were collected, which included language spoken at home although not ethnicity data. Mixed effects models were used to study the effect of gender, age, and survey year on trends in mental health outcomes.
59,701 survey responses were included; response rates ranged from 63% to 86%. An increase in depressive symptoms (β 0·57, 95% CI 0·53 to 0·60) and worsened mental wellbeing (β −0·46, 95% CI −0·49 to −0·42) were observed across all age groups during the pandemic compared with same-aged peers before COVID-19. These outcomes were significantly worse in adolescent girls compared with boys (β 4·16, 95% CI 4·05 to 4·28, and β −1·13, 95% CI −1·23 to −1·03, respectively). Cigarette smoking (OR 2·61, 95% CI 2·59 to 2·66), e-cigarette use (OR 2·61, 95% CI 2·59 to 2·64), and alcohol intoxication (OR 2·59, 95% CI 2·56 to 2·64) declined among 15–18-year-olds during COVID-19, with no similar gender differences.
The results suggest that COVID-19 has significantly impaired adolescent mental health. However, the decrease observed in substance use during the pandemic might be an unintended benefit of isolation, and might serve as a protective factor against future substance use disorders and dependence. Population-level prevention efforts, especially for girls, are warranted.
Research in context
We observed an increase in depressive symptoms and decrease in mental well-being, along with a decline in substance use, during the pandemic compared to same-age peers prior to the pandemic,” said Inga Eva Thorisdottir, chief data analyst at the Icelandic Centre for Social Research and Analysis (ICSRA), and the principal investigator and lead author of the reportInga Eva Thorisdottir, chief data analyst at the Icelandic Centre for Social Research and Analysis (ICSRA), the principal investigator and lead author of the report
The study found age and gender differences in adolescent mental health during the pandemic. Negative mental health outcomes were disproportionally reported by girls and older adolescents (13-18-year-olds).
The study revealed a decline in rates of cigarette smoking, e-cigarette usage and alcohol intoxication among 15-18-year-old adolescents during the pandemic. Authors suggest that the decrease observed in substance use during the pandemic may be an unintended benefit of isolation. This could serve as a protective factor against future substance use disorders and dependence.