Changes in mental health across gender and resilience among Norwegian adolescents into the COVID-19 pandemic: the Young-HUNT study

Abstract

Aims:

The objective of this follow-up study was to investigate whether changes in mental health from before and into the COVID-19 pandemic varied between girls and boys, as well as between adolescents with high and low levels of resilience.

Methods:

We included data from Norwegian adolescents (n = 1565, 64% girls) who participated in the Young-HUNT4 (2017–2019) and the Young-HUNT COVID (2021) surveys. We measured six dimensions of mental health using the Strength and Difficulties Questionnaire. The resilience factors—family cohesion, personal competence and social competence—were measured using the Resilience Scale for Adolescents. Linear mixed models were used to investigate whether change in the mental health dimensions depended on sex or level of resilience.

Results:

Change in mental health appeared to differ by sex and resilience level. Specifically, girls showed greater increases in hyperactivity, emotional symptoms and total difficulties, whereas boys displayed greater increases in peer problems along with greater decreases in prosocial behaviour. Compared with adolescents with low resilience, those with high resilience demonstrated a stronger increase in emotional symptoms, peer problems and total difficulties. Adolescents with low resilience displayed a greater decrease in prosocial behaviour. A decrease in conduct problems was observed among adolescents with low resilience, which was not evident among those with high resilience.

Conclusions:

The present findings suggest that girls and boys, as well as adolescents with high and low levels of resilience, may have experienced the pandemic situation somewhat differently.

Keywords

mental health adolescence longitudinal COVID-19 Young-HUNT Study

Background

The World Health Organisation has reported that mental health problems are one of the leading causes of disability and illness among adolescents [1]. The COVID-19 pandemic may have exacerbated this mental health crisis as many of the preventive measures implemented during this period impacted several areas of young people’s lives [2]. In Norway, for example, a nationwide school lockdown and broader social restrictions were implemented on 12 March 2020, followed by subsequent changes throughout 2020 and 2021 that sometimes varied between regions.

While it is important to consider overarching changes in mental health during the COVID-19 pandemic, differential changes likely occurred as well. Sex differences may exists as girls often report more internalising symptoms whereas boys tend to display more externalising behaviours [3]. Indeed, girls seem to be more likely than boys to report negative impact of the COVID-19 pandemic on their mental health and wellbeing [4]. Moreover, while increases in emotional problems have been shown to be more pronounced among girls, decreases in prosocial behaviours were more prominent among boys [5]. A possible explanation for the aforementioned findings could be that girls seemed to be more impacted by factors such as concern about others contracting the virus and the inability to see friends in person [4].

Another explanation is differences in levels of resilience, which often varies between boys and girls [6]. Resilience is shaped by individual and environmental resources and is often defined as the capacity to manage and adapt to stressful situations [7]. Differences in levels of resilience may therefore be important for understanding individual differences in coping during the extraordinary conditions of the COVID-19 pandemic [8]. Indeed, previous studies indicate that both individual and environmental resources were related to coping during the COVID-pandemic [9 –11]. For example, among adolescents, one study found that dysfunctional emotion regulation skills were associated with higher levels of depression and anxiety symptoms [9], whereas in another study a positive future orientation was related to lower levels of these symptoms [10]. Similar findings have been reported for environmental resources, with both parental involvement and warmth being associated with lower levels of psychological distress among emerging adults [11].

Despite a growing body of research exploring the impact of the COVID-19 pandemic on adolescent mental health, further studies are needed to better understand the various experiences of the pandemic. This knowledge may help identify strategies to prevent poor coping during future crises. With this backdrop, we examined the following research questions using a longitudinal dataset: Did the mental health of Norwegian adolescents change from before and into the COVID-19 pandemic? Did the potential changes vary between girls and boys or between adolescents with high versus low resilience?

Methods

Sample and procedure

This study used longitudinal data from 1565 adolescents who participated in the Young-HUNT4 (T1) and Young-HUNT COVID (T2) surveys. The Young-HUNT4 Survey was conducted between 2017 and 2019, with adolescents aged 13–19 years residing in the former Nord-Trøndelag County being invited to participate [12]. Informed consent was obtained from all participants, either by the adolescents themselves, or by parents and/or guardians for those under the age of 16 [12, 13]. Data collection took place during school hours; adolescents not attending school were contacted by post [12, 13].

In May–June 2021, the Young-HUNT COVID Survey was conducted in which all adolescents aged 16 years and above attending upper secondary schools in Trøndelag County were invited. This resulted in 3446 adolescents from the Young-HUNT4 Survey being invited, with 1565 adolescents participating in both surveys (45% response rate). Although data collection was intended to be carried out during school hours, the questionnaires were also made available online because of ongoing school lockdowns and teacher strikes in some schools.

Measures

Demographics

Information on sex and age was provided by HUNT Databank using participants’ personal number. Baseline age was rounded to the nearest integer. Questions included in the Young-HUNT Study can be found at https://hunt-db.medisin.ntnu.no/hunt-db/.

Strength and difficulties questionnaire

The strength and difficulties questionnaire (SDQ) [14] consists of 25 statements rated on a three-point Likert scale (0 – Not true, 1 – Somewhat true and 2 – Certainly true) divided into five subscales; emotional symptoms, hyperactivity, peer problems, conduct problems and prosocial behaviour (see Supplemental Table S1 for all questions). All subscales are measured using five items [14], with example questions from each subscales being as follows: ‘I worry a lot’, ‘I am restless, I cannot stay still for long’, ‘I have one good friend or more’, ‘I am often accused of lying or cheating’ and ‘I am helpful if someone is hurt, upset or feeling ill’. A sum score for each subscale was calculated, ranging from 0 to 10. We also calculated a sum score for total difficulties, ranging from 0 to 40.

Resilience scale for adolescents

Resilience was measured using the Resilience Scale for Adolescents (READ) [15], which has shown acceptable psychometric properties among Norwegian adolescents [16]. The Young-HUNT4 and Young-HUNT COVID surveys include a modified three-item version measuring personal competence, social competence and family cohesion (see Supplemental Table S1 for all questions). The statements are rated on a five-point Likert scale (1 – Totally agree, 2 – Agree, 3 – Average, 4 – Disagree and 5 – Totally disagree). Example questions are as follows: ‘In adversity, I tend to find something good to help me grow’, ‘I easily find new friends’ and ‘I feel comfortable with my family’. Each resilience factor was dichotomised using the median as a cut-off point, creating a relative categorisation of adolescents with high versus low levels of resilience. A sum score ranging from 3 to 15 was calculated as well, with a higher score indicating a higher level of resilience.

Statistical analysis

Descriptive statistics were conducted for all baseline variables. Paired sample t-tests were used to investigate mean changes in mental health and resilience between T1 and T2. We used independent t-tests to investigate whether baseline levels of mental health and resilience differed between non-respondents and respondents. Likewise, we tested whether baseline levels of resilience differed between boys and girls.

Linear mixed models were used to investigate whether changes in mental health differed by sex or level of resilience. First, we investigated whether change depended on sex by including one of the SDQ scales as the dependent variable, time (0 = T1, 1 = T2), sex (0 = Girls, 1 = Boys), and age as predictors, as well as an interaction term between time and sex. The participants’ ID numbers were included as a random effect to account for measurement dependency across time. A similar setup was used for the analyses of resilience by including one of the SDQ scales as the dependent variable and time, sex and age as predictors. An interaction term between sex and time was included as well. We conducted separate analyses for each resilience factor by including either family cohesion, personal competence or social competence as a predictor. As before, an interaction term between time and resilience was included, with the participants’ ID numbers included as a random effect. The margins function in Stata was then used to plot the interactions using estimated marginal means. All analyses were conducted in Stata version 18 (StataCorp LLC).

Results

Descriptive statistics

Descriptive statistics are presented in Table I. As shown in Table I, a comparison between T1 to T2 indicated a mean increase in hyperactivity, emotional symptoms, peer problems and total difficulties, along with a mean decrease in prosocial behaviour from T1 to T2. The mean level of conduct problems did not change significantly. For resilience, the mean levels of family cohesion, personal competence and social competence all decreased.

Table I.

Descriptive statistics of the included variables at T1 and T2 (n = 1565).

	T1			T2			Paired t-test
	Mean or N	SD or %	Missing	M	SD	Missing	t	df	p
Age	14.68	1.08	0%
Sex
Girls	960	61%
Boys	605	39%	0%
Hyperactivity	3.88	2.19	6%	4.20	2.26	5%	–5.39	1405	<0.001
Emotional symptoms	3.10	2.50	6%	3.53	2.70	5%	–6.33	1411	<0.001
Conduct problems	1.68	1.50	6%	1.61	1.53	5%	1.44	1405	0.150
Peer problems	1.80	1.62	6%	2.30	1.76	5%	–9.87	1407	<0.001
Prosocial behaviour	7.92	1.68	5%	7.58	2.02	4%	5.97	1419	<0.001
Total difficulties	10.43	5.54	9%	11.60	5.82	7%	–7.19	1329	<0.001
Family cohesion	12.93	2.27	4%	12.12	2.90	3%	10.33	1456	<0.001
Personal competence	11.05	2.94	6%	10.33	3.09	3%	8.02	1427	<0.001
Social competence	10.48	3.14	3%	10.06	3.33	3%	4.75	1484	<0.001

SDQ: strength and difficulties questionnaire; T1: Young-HUNT4 Survey; T2: Young-HUNT COVID Survey.

Regarding differences between respondents and non-respondents, slightly lower levels of hyperactivity and social competence, along with higher levels of emotional symptoms were observed among respondents (Supplemental Table S3). We found no significant differences in the other measures.

Sex differences

Although no sex differences were found in the mean level of family cohesion (t[1496] = −1.22; p = 0.223), a higher mean level of personal competence (t[1466] = −7.63; p < 0.001) and social competence (t[1518] = −4.17; p < 0.001) was found among boys (Supplemental Table S2). With respect to changes in mental health (Table II), the interaction coefficient between sex and time was statistically significant for hyperactivity (p = 0.001), emotional symptoms (p < 0.001), peer problems (p = 0.032), prosocial behaviour (p = 0.004) and total difficulties (p = 0.031). However, the interaction coefficient was not statistically significant for conduct problems (p = 0.273). According to the estimated marginal means shown in Figure 1, increases in hyperactivity, emotional symptoms and total difficulties were more pronounced among girls. In contrast, peer problems increased, and prosocial behaviour decreased more among boys.

Table II.

Results from linear mixed model investigating the effect of sex on the changes in the six SDQ scales.

	H		ES		CP		PP		PB		TD
	β	p	β	p	β	p	β	p	β	p	β	p
Time x Sex	–0.39	0.001	–0.48	<0.001	–0.11	0.273	0.22	0.032	–0.34	0.004	–0.68	0.031
Time (T1 vs T2)	0.47	<0.001	0.62	<0.001	–0.03	0.580	0.41	< 0.001	–0.21	0.001	10.40	<0.001
Sex (Girls vs Boys)	0.00	0.999	–10.61	<0.001	0.32	<0.001	0.05	0.576	–0.72	<0.001	–10.29	<0.001
Age	0.09	0.052	0.16	0.001	–0.04	0.224	0.16	< 0.001	0.02	0.605	0.39	0.001

CP: conduct problems, ES: emotional symptoms; H: hyperactivity; PB: prosocial behaviour; PP: peer problems, SDQ: strength and difficulties questionnaire; T1: Young-HUNT4 Survey; T2: Young-HUNT COVID Survey; TD: total difficulties.

Differences between high versus low resilience

A similar pattern emerged across all three resilience factors (Table III). First, a statistically significant interaction coefficient was observed between time and family cohesion for emotional symptoms (p = 0.001), conduct problems (p < 0.001), peer problems (p = 0.011), prosocial behaviour (p = 0.005) and total difficulties (p < 0.001). Second, the interaction coefficient between time and personal competence was statistically significant for emotional symptoms (p = <0.001), conduct problems (p < 0.001), peer problems (p = 0.007) and total difficulties (p < 0.001). Finally, the interaction coefficient between time and social competence was statistically significant for emotional symptoms (p < 0.001), conduct problems (p < 0.001), peer problems (p < 0.001), prosocial behaviour (p = 0.001) and total difficulties (p < 0.001). The interaction coefficient was statistically non-significant for hyperactivity (family cohesion: p = 0.552, personal competence: p = 0.058, social competence: p = 0.284), as well as between time and personal competence for prosocial behaviour (p = 0.087).

Table III.

Results from linear mixed models investigating the effect of resilience on changes in the six SDQ scales.

	H		ES		CP		PP		PB		TD
	β	p	β	p	β	p	β	p	β	p	β	p
Family cohesion
Time x Family cohesion	0.07	0.552	–0.45	0.001	–0.42	<0.001	–0.25	0.011	0.31	0.005	–10.13	<0.001
Time x Sex	–0.40	0.001	–0.52	<0.001	–0.12	0.209	0.22	0.029	–0.34	0.004	–0.72	0.022
Time (T1 vs T2)	0.43	<0.001	0.84	<0.001	0.18	0.007	0.54	<0.001	–0.36	<0.001	10.97	<0.001
Family cohesion (high vs low)	0.87	<0.001	10.18	<0.001	0.70	<0.001	0.76	<0.001	–0.89	<0.001	30.55	<0.001
Sex (girls vs boys)	0.04	0.710	–10.58	<0.001	0.36	<0.001	0.06	0.476	–0.72	<0.001	–10.18	<0.001
Age	0.07	0.111	0.13	0.007	–0.06	0.031	0.14	<0.001	0.05	0.167	0.29	0.011
Personal competence
Time x Personal competence	–0.24	0.058	–0.58	<0.001	–0.40	<0.001	–0.26	0.007	0.19	0.087	–10.46	<0.001
Time x Sex	–0.46	<0.001	–0.57	<0.001	–0.17	0.083	0.19	0.062	–0.27	0.023	–0.92	0.004
Time (T1 vs T2)	0.58	<0.001	0.94	<0.001	0.18	0.011	0.57	<0.001	–0.32	<0.001	20.21	<0.001
Personal competence (high vs low)	0.93	<0.001	10.58	<0.001	0.54	<0.001	0.73	<0.001	–0.66	<0.001	30.75	<0.001
Sex (girls vs boys)	0.16	0.167	–10.37	<0.001	0.41	<0.001	0.17	0.053	–0.84	<0.001	–00.68	0.018
Age	0.06	0.221	0.12	0.017	–0.06	0.066	0.14	<0.001	0.06	0.120	0.27	0.022
Social competence
Time x Social competence	–0.13	0.284	–0.50	<0.001	–0.34	<0.001	–0.38	<0.001	0.36	0.001	–10.48	<0.001
Time x Sex	–0.42	0.001	–0.54	<0.001	–0.14	0.137	0.19	0.060	–0.30	0.012	–0.84	0.008
Time (T1 vs T2)	0.54	<0.001	0.88	<0.001	0.15	0.034	0.61	<0.001	–0.39	<0.001	20.18	<0.001
Social competence (high vs low)	0.19	0.088	10.21	<0.001	0.10	0.205	0.90	<0.001	–0.74	<0.001	20.51	<0.001
Sex (girls vs boys)	0.01	0.953	–10.50	<0.001	0.34	<0.001	0.12	0.129	–0.78	<0.001	–10.08	<0.001
Age	0.09	0.040	0.11	0.023	–0.04	0.235	0.13	<0.001	0.05	0.168	0.30	0.011

CP: conduct problems; ES: emotional symptoms; H: hyperactivity; PB: prosocial behaviour; PP: peer problems; SDQ: strength and difficulties questionnaire; T1: Young-HUNT4 Survey; T2: Young-HUNT COVID Survey; TD: total difficulties.

As shown in Figure 2, increases in emotional symptoms, peer problems, and total difficulties were more pronounced among adolescents with high resilience. Adolescents with high family cohesion and social competence also displayed a greater decrease in prosocial behaviour compared with those with low levels. In contrast, a decrease in conduct problems was only observed among adolescents with low levels of resilience.

Discussion

In this study, we observed an overall increase in hyperactivity, emotional symptoms, peer problems and total difficulties, along with a reduction in prosocial behaviour, family cohesion, social competence and personal competence among Norwegian adolescents from before to 1 year into the COVID-19 pandemic. Investigations of sex differences revealed that girls displayed the greatest increases in hyperactivity, emotional symptoms and total difficulties. Boys, on the other hand, showed a greater increase in peer problems and a more pronounced decrease in prosocial behaviour. Regarding resilience, adolescents with high levels of family cohesion, personal competence and social competence displayed stronger increases in emotional symptoms, peer problems and total difficulties. Adolescents with high family cohesion and social competence also displayed a greater decrease in prosocial behaviour. However, decreases in conduct problems were observed only among those with low family cohesion, personal competence and social competence.

While our findings align well with most previous studies indicating a deterioration in adolescent mental health from before to during the COVID-19 pandemic [17], we also observed that changes in mental health varied between girls and boys. For most of the measures included, girls appeared to experience a more pronounced increase in mental health problems than boys. This finding aligns well with those of a Canadian study showing that girls were the primary drivers of increases in depressive symptoms from before to during the COVID-19 pandemic [18]. However, in one study of Norwegian adolescents, changes in internalising and externalising symptoms were not found to differ significantly between girls and boys [19]. Moreover, in another Norwegian study, the prevalence of mental distress was only found to increase among boys [20]. These contrasting results suggest that subtle nuances among dimensions of mental health may be important to consider.

Sex-based differences in ways of coping may also account for our findings as girls are more likely to seek social support and engage in problem-solving than boys [21]. Since the COVID-19 restrictions limited access to key sources of social support (e.g., friends and teachers) for extended periods, it is possible that girls’ coping strategies were affected disproportionately, leading to greater deterioration in their mental health. In support of this, a report by the World Health Organisation found that girls were more likely than boys to report high levels of psychological health complaints when the pandemic negatively affected their relationships with family and friends [2].

Resilience may also be a contributing factor as previous studies show that girls tend to report lower levels of resilience [6], and women are often more affected by disasters [22]. Indeed, while we found no differences in the mean levels of family cohesion, girls tended to report lower baseline levels of social and personal competence. Taken together, girls may be more vulnerable when it comes to adapting to the circumstances of the COVID-19 pandemic, contributing to a greater mental health decline.

It should be noted, however, that increases in peer problems, along with decreases in prosocial behaviour, were more pronounced among boys. This is perhaps surprising as boys were found to report somewhat higher baseline levels of social competence than girls. However, as boys tend to seek less social support than girls [21], and because the COVID-19 pandemic involved prolonged restrictions on in-person contact, boys’ social relationships with peers may have been affected more adversely compared with girls.

Our findings also suggest that the mental health of adolescents mainly worsened among those with high baseline resilience. These results contrast with studies indicating that high levels of resilience are associated with less depression and anxiety symptoms [23, 24]. However, other studies support our findings, showing that people deemed least vulnerable may have experienced the greatest declines in mental health and life satisfaction [19, 25]. For example, while Norwegian adolescents whose family situation worsened during the COVID-19 pandemic exhibited the greatest decline in externalising symptoms, those who reported an improvement in their family situation displayed the largest increase in internalising symptoms [19].

Although it may seem counterintuitive, it is important to note that resilience is a dynamic phenomenon that can shift depending on the circumstances [26]. Exposure to stress may in some cases even produce a steeling effect by making people more resilient to future adversities [26]. As such, people with high resilience may have experienced the COVID-19 pandemic as more disruptive, leading to a greater decline in their mental health. In support of this, a Norwegian study found that life satisfaction appeared to drop most among adolescents from higher socioeconomic backgrounds during the initial weeks of the national lockdown [25]. Another Norwegian study even reported a reduction in self-reported mental health problems among girls from lower socioeconomic backgrounds [20]. It is therefore possible that well-resourced families perceived the lockdown as more restrictive.

Strengths and limitations

A strength of this study is its follow-up design, allowing examination of changes in mental health before and during the COVID-19 pandemic. Another strength is that the study is based on the Young-HUNT Study, which is a well-established population-based health survey with consistently high response rates. However, participation in the Young-HUNT COVID Survey was quite low, likely due to factors such as teacher strikes and regional lockdowns. Despite the availability of online participation, these circumstances may have contributed to lower response, potentially reducing the representativeness of the study sample. Comparison of respondents and non-respondents revealed that their baseline levels were largely similar, despite minor differences in levels of hyperactivity, emotional symptoms and social competence. Still, respondents and non-respondents may have varied in their degree of changes in mental health before and into the COVID-19. For example, if adolescents who were particularly affected by the COVID-19 pandemic refrained from participating, this could lead to an underestimation of changes and potentially influence the pattern of change observed across sex and resilience.

Additional limitations to consider include the potential impact of measurement error and regression to the mean. First, assessing changes between two time points poses challenges, as distinguishing between actual change and measurement error can be difficult [27]. Therefore, the overall findings of this study should be interpreted with caution. Second, regression to the mean may have influenced the observed changes [28]. For example, although people with high resilience showed a greater decline in mental health, those with low resilience exhibited a consistently higher symptom burden at both time points. This suggests that those with lower resilience may have shown less change simply because they had already reported high symptom levels initially—a phenomenon known as the ceiling effect [29].

Conclusions

Our study shows that the mental health and resilience of Norwegian adolescents declined from before to 1 year into the COVID-19 pandemic. The decline in mental health was generally more pronounced among girls than boys. While adolescents with low resilience generally reported poorer mental health both before and during the pandemic, those with high resilience tended to experience the greatest decline. These findings highlight the importance of examining individual differences in coping during stressful periods, as those who typically appear resilient may also be vulnerable under certain situations.

Supplemental Material

sj-docx-1-sjp-10.1177_14034948261463421 – Supplemental material for Changes in mental health across gender and resilience among Norwegian adolescents into the COVID-19 pandemic: the Young-HUNT study

Supplemental material, sj-docx-1-sjp-10.1177_14034948261463421 for Changes in mental health across gender and resilience among Norwegian adolescents into the COVID-19 pandemic: the Young-HUNT study by Bodil EV Aasan, Erik R Sund and Kirsti Kvaløy in Scandinavian Journal of Public Health

Footnotes

Acknowledgements

The Trøndelag Health Study (HUNT) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU), Trøndelag County Council, Central Norway Regional Health Authority and the Norwegian Institute of Public Health.

Data availability

HUNT data cannot be made publicly accessible but may be accessed upon request to the HUNT Data Access Committee (hunt@medicine.ntnu.no).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study was funded by the Research Council of Norway (No. 320851).

Ethical approval

This study was approved by the Regional Committee for Medical Research Ethics (No. 2021/381487) and the HUNT Data Access Committee.

ORCID iDs

Bodil EV Aasan

Erik R Sund

Kirsti Kvaløy

Supplemental material

Supplemental material for this article is available online.

References

World Health Organisation. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. 2nd ed. World Health Organisation, 2023

Cosma

Bersia

Abdrakhmanova

, et al. Coping through crisis: COVID-19 pandemic experiences and adolescent mental health and well-being in the WHO European Region. Impact of the COVID-19 pandemic on young people’s health and well-being from the findings of the HBSC survey round 2021/2022. WHO Regional Office for Europe, 2023.

Rosenfield

Mouzon

. Gender and mental health. In: Aneshensel

Phelan

Bierman

(eds) Handbook of the Sociology of Mental Health. Springer Netherlands, 2013, pp. 277–296

Halldorsdottir

Thorisdottir

Meyers

CCA

, et al. Adolescent well-being amid the COVID-19 pandemic: are girls struggling more than boys? JCPP Adv 2021; 1: e12027. https://doi.org/10.1002/jcv2.12027

Qian

. COVID-19 and adolescent mental health in the United Kingdom. J Adolesc Health 2021; 69: 26–32. https://doi.org/10.1016/j.jadohealth.2021.04.005

Skrove

Romundstad

Indredavik

. Resilience, lifestyle and symptoms of anxiety and depression in adolescence: the Young-HUNT study. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 407–416. https://doi.org/10.1007/s00127-012-0561-2

Windle

. What is resilience? A review and concept analysis. Rev Clin Gerontol 2011; 21: 152–169. https://doi.org/10.1017/S0959259810000420

Masten

Motti-Stefanidi

. Multisystem resilience for children and youth in disaster: reflections in the context of COVID-19. Advers Resil Sci 2020: 1: 95–106. https://doi.org/10.1007/s42844-020-00010-w

Pedrini

Meloni

Lanfredi

, et al. Adolescents’ mental health and maladaptive behaviors before the Covid-19 pandemic and 1-year after: analysis of trajectories over time and associated factors. Child Adolesc Psychiatry Ment Health 2022; 16: 42. https://doi.org/10.1186/s13034-022-00474-x

10.

Rogers

Melde

Williams

, et al. Adolescent mental health and resilience before and during the COVID-19 pandemic. J Adolesc Health 2024; 75: 43–50. https://doi.org/10.1016/j.jadohealth.2024.02.023

11.

del Carmen García-Mendoza

De La Fuente

Sánchez-Queija

, et al. Family functioning and mental health before and during the COVID-19 pandemic: a two-cohort comparison of emerging adults. Curr Psychol 2024; 43: 23213–23223. https://doi.org/10.1007/s12144-024-06015-3

12.

Rangul

Holmen

Langhammer

, et al. Cohort profile update: the Young-HUNT study, Norway. Int J Epidemiol 2024; 53: dyae013. https://doi.org/10.1093/ije/dyae013

13.

Holmen

Bratberg

Krokstad

, et al. Cohort profile of the Young-HUNT Study, Norway: a population-based study of adolescents. Int J Epidemiol 2014; 43: 536–544. https://doi.org/10.1093/ije/dys232

14.

Goodman

. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997; 38: 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x

15.

Hjemdal

Friborg

Stiles

, et al. A new scale for adolescent resilience: grasping the central protective resources behind healthy development. Meas Eval Couns Dev 2006; 39: 84–96. https://doi.org/10.1080/07481756.2006.11909791

16.

von Soest

Mossige

Stefansen

, et al. A validation study of the resilience scale for adolescents (READ). J Psychopathol Behav Assess 2010; 32: 215–225. https://doi.org/10.1007/s10862-009-9149-x

17.

Kauhanen

Wan Mohd Yunus

WMA

Lempinen

, et al. A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2023; 32: 995–1013. https://doi.org/10.1007/s00787-022-02060-0

18.

Hollenstein

Colasante

Lougheed

. Adolescent and maternal anxiety symptoms decreased but depressive symptoms increased before to during COVID-19 lockdown. J Res Adolesc 2021; 31: 517–530. https://doi.org/10.1111/jora.12663

19.

Lehmann

Skogen

Sandal

, et al. Emerging mental health problems during the COVID-19 pandemic among presumably resilient youth—a 9-month follow-up. BMC Psychiatry 2022; 22: 67. https://doi.org/10.1186/s12888-021-03650-z

20.

Kvaløy

Sund

Rimehaug

, et al. Adolescents’ health and well-being into the COVID-19 pandemic: a two-wave prospective investigation—the HUNT study. Soc Psychiatry Psychiatr Epidemiol. 2025; 61: 723–734 https://doi.org/10.1007/s00127-025-02978-1

21.

Eschenbeck

Kohlmann

C-W

Lohaus

. Gender differences in coping strategies in children and adolescents. J Individ Differ 2007; 28: 18–26. https://doi.org/10.1027/1614-0001.28.1.18

22.

Rodriguez-Llanes

Vos

Guha-Sapir

. Measuring psychological resilience to disasters: are evidence-based indicators an achievable goal? Environ Health 2013; 12: 115. https://doi.org/10.1186/1476-069X-12-115

23.

Fogarty

Brown

Gartland

, et al. Psychosocial factors associated with adolescent depressive and anxiety symptoms during the COVID-19 pandemic. Int J Behav Dev 2022; 46: 308–319. https://doi.org/10.1177/01650254221084100

24.

Shi

Zhao

Liu

, et al. Resilience and mental health: A longitudinal cohort study of Chinese adolescents before and during COVID-19. Front Psychiatry 2022; 13: 948036. https://doi.org/10.3389/fpsyt.2022.948036

25.

von Soest

Bakken

Pedersen

, et al. Life satisfaction among adolescents before and during the COVID-19 pandemic. Tidsskr Den Nor Legeforening 2020; 140: 0437. https://doi.org/https://tidsskriftet.no/en/2020/06/originalartikkel/life-satisfaction-among-adolescents-and-during-covid-19-pandemic

26.

Rutter

. Resilience as a dynamic concept. Dev Psychopathol 2012; 24: 335–344. https://doi.org/10.1017/S0954579412000028

27.

Singer

Willett

. Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, 2003.

28.

Barnett

. Regression to the mean: what it is and how to deal with it. Int J Epidemiol 2005; 34: 215–220. https://doi.org/10.1093/ije/dyh299

29.

Garin

. Ceiling effect. In: Michalos

(ed) Encyclopedia of quality of life and well-being research. Springer Netherlands, 2014, pp. 631–633

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