Abstract
Background The COVID-19 pandemic has exacerbated mental health challenges among adolescents, particularly among those with limited socioeconomic resources. It is unclear whether this trend is consistent across various features of adolescents’ residential area. We compare trends in socioeconomic inequalities in adolescent mental health between major cities and more rural areas in Norway from 2014 to 2024.
Methods
We used cross-sectional population-based data from the nationwide Ungdata survey collected in four time periods: T1 (2014-2016), T2 (2017-2019), T3 (2021), and T4 (2022-2024). Adolescents attending lower secondary education were included (n = 502420, 49.5% girls). Using general linear models, we calculated absolute and relative inequalities in self-rated depressive symptoms and loneliness, using slope (SII) and relative (RII) indices of inequality.
Results
From 2014 to 2024, the prevalence of depressive symptoms and loneliness increased among boys (5% to 8% and 10% to 15%) and girls (18% to 22% and 26% to 29%). This trend was consistent across urban and rural areas, peaking during the pandemic. Adolescents from less privileged socioeconomic backgrounds consistently showed higher prevalence's. Among rural girls, relative and absolute inequalities in depressive symptoms (RII 1.65 to 1.42, p < 0.001; SII 0.09 to 0.08, p = 0.16) and loneliness (RII 1.64 to 1.44, p < 0.001; SII 0.13 to 0.10, p = 0.001) decreased over time, while inequalities remained stable among urban girls. For rural boys, absolute inequalities in loneliness increased, while depressive symptoms inequalities remained stable regardless of residence.
Conclusions From 2014 to 2024, depressive symptoms and loneliness increased among Norwegian adolescents, peaking during the COVID-19 pandemic. Despite persistently high levels of inequality, rural girls showed a decline in both relative and absolute inequalities in mental health. However, rising loneliness inequalities among rural boys warrants attention.
Key messages
• The pandemic significantly exacerbated depressive symptoms and loneliness among adolescents, though these rates have declined post-pandemic.
• Socioeconomic disparities in adolescent mental health persist, with notable improvements among rural girls but increasing loneliness inequalities among rural boys.