Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study

Ingibjorg Eva Thorisdottir; Bryndis Bjork Asgeirsdottir; Alfgeir Logi Kristjansson; Heiddis Bjork Valdimarsdottir; Erla Maria Jonsdottir Tolgyes; Jon Sigfusson; John Philip Allegrante; Inga Dora Sigfusdottir; Thorhildur Halldorsdottir

doi:10.1016/S2215-0366(21)00156-5

Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study

Lancet Psychiatry. 2021 Aug;8(8):663-672. doi: 10.1016/S2215-0366(21)00156-5. Epub 2021 Jun 3.

Authors

Ingibjorg Eva Thorisdottir¹, Bryndis Bjork Asgeirsdottir², Alfgeir Logi Kristjansson³, Heiddis Bjork Valdimarsdottir⁴, Erla Maria Jonsdottir Tolgyes¹, Jon Sigfusson¹, John Philip Allegrante⁵, Inga Dora Sigfusdottir⁶, Thorhildur Halldorsdottir⁷

Affiliations

¹ Icelandic Center for Social Research and Analysis, Reykjavik, Iceland.
² Department of Psychology, Reykjavik University, Reykjavik, Iceland.
³ Icelandic Center for Social Research and Analysis, Reykjavik, Iceland; Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV, USA.
⁴ Department of Psychology, Reykjavik University, Reykjavik, Iceland; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁶ Icelandic Center for Social Research and Analysis, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Reykjavik, Iceland; Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA.
⁷ Department of Psychology, Reykjavik University, Reykjavik, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: thorhildurh@ru.is.

PMID: 34090582
DOI: 10.1016/S2215-0366(21)00156-5

Abstract

Background: Adolescence represents a crucial developmental period in shaping mental health trajectories. In this study, we investigated the effect of the COVID-19 pandemic on mental health and substance use during this sensitive developmental stage.

Methods: 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. We used mixed effects models to study the effect of gender, age, and survey year on trends in mental health outcomes.

Findings: 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.

Interpretation: Our 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.

Funding: Icelandic Research Fund.

Translation: For the Icelandic translation of the abstract see Supplementary Materials section.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age Factors
Brief Psychiatric Rating Scale
COVID-19 / psychology*
Depression / epidemiology*
Electronic Nicotine Delivery Systems / statistics & numerical data
Female
Humans
Iceland / epidemiology
Longitudinal Studies
Male
Mental Health*
Sex Factors
Substance-Related Disorders / epidemiology*
Surveys and Questionnaires