Scandinavian Journal of Public Health

The COVID-19 pandemic affected life for a large proportion of the global population. In this study, we examined changes in well-being among employees in Denmark before, during and after the COVID-19 pandemic.

We used secondary survey data collected by a private company that had developed and provided a smartphone app to monitor employees’ well-being using the WHO-5 questionnaire. We included 6758 employees from 77 workplaces, yielding 111,705 observations of well-being scores. We investigated time trends in well-being by comparing well-being scores in the years before (2018 and 2019), during (2020 and 2021) and after (2022) the COVID-19 pandemic. We further compared well-being scores during the months of three distinct COVID-19 waves with the corresponding months before the COVID-19 pandemic.

We observed a clear seasonal variation, with higher well-being scores during the summer months (July and August) in each year, regardless of the COVID-19 situation. In both men and women, annual well-being scores were lowest during the COVID-19 years (68.6, and 67.3, respectively) compared with annual well-being scores before (68.9 and 69.3) and after (70.1 and 68.7) the COVID-19 pandemic. During three distinct COVID-19 waves in Denmark, women, but not men, showed statistically significant lower well-being scores compared with the corresponding months before the COVID-19 pandemic (all p<0.01).

The study results suggest that the COVID-19 pandemic was associated with a slight decrease in employees’ well-being that was more pronounced among women than among men. Independent of the COVID-19 situation, well-being scores showed clear seasonal variation.

The objective of the study was to assess differences in the accessibility of general practitioner (GP office visits, telephone contacts and electronic communication for patients with hypertension before, during and after the COVID-19 pandemic in primary healthcare.

From the primary healthcare register of the city of Turku in Southwestern Finland, subjects with the diagnosis of hypertension were identified. Data of GP office visits, telephone contacts, electronic communication, concomitant cardiometabolic diseases, low density lipoprotein and glomerular filtration rate were gathered from the hypertensive patients. The follow-up period was from 2019 to 2022.

The number of patients with hypertension decreased between the years 2019 and 2020 and again increased in 2021 to the 2019 level. Electronic communication increased steadily from 2019 to 2022, whereas telephone contacts decreased. A higher number of telephone contacts and higher number of electronic communication were associated with higher number of office visits. Elderly subjects used less electronic communication than younger subjects and the difference grew larger during and after the COVID-19 pandemic.

Elderly subjects with hypertension use digital services in primary healthcare less than their younger counterparts. Digital technologies may create structural inequality in access to, and availability of, primary healthcare services.

The outbreak of the COVID-19 pandemic and the following lockdown enforced substantial lifestyle changes in people’s everyday lives. This study aimed to assess the impacts of the COVID-19 restrictions on the ageing women’s mental, social and physical well-being.

Data were collected through two postal questionnaires. Baseline data were obtained in May–June 2019, prior to the pandemic. A follow-up survey was mailed to 760 eligible participants in August–September 2020; 571 women (75.1%) responded, forming the final cohort. The cohort comprised community-dwelling women born between 1932 and 1941 (mean age 82.5 years). Both surveys assessed health, lifestyle, mood, sleep, and technology use, with the follow-up including pandemic-related items.

Dietary habits improved with increased consumption of fruits, vegetables and fish, and decreased intake of sweets, pastries, alcohol and meat. Sleep quality and perceived sufficiency remained stable, although nighttime awakenings declined (p=0.023). Social interactions decreased for 43.6% of respondents, yet 20.2% reported receiving more support. Functional capacity deteriorated significantly, with reduced ability to climb several floors, run 100 m and cycle (all p<0.001).

Early lockdown was associated with both positive and negative outcomes. Favourable changes included healthier diets and stable sleep quality. Despite reduced face-to-face contact, perceived social support improved for some participants. However, physical functioning declined, underscoring the need to maintain mobility during prolonged restrictions.

Several studies suggest that ethnic minorities are at higher risk of experiencing long COVID compared to majority populations. This study aimed to qualitatively explore the experiences of accessing care, diagnosis and rehabilitation among patients with long COVID in a multiethnic population in Denmark.

We carried out 18 semi-structured interviews with individuals of Danish, Turkish and Moroccan background who were diagnosed with long COVID. Informants were sampled purposively to secure variation in sex, age, country of origin and immigration status. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, member checked and subsequently analyzed using thematic framework analysis and NVivo software.

Our findings show that accessing care and rehabilitation for long COVID was difficult regardless of ethnic background. Following the novelty of COVID-19 and thus uncertainty of long COVID, informants had to self-advocate and navigate established and alternative healthcare services by themselves. Additionally, patients with Moroccan and Turkish minority background had to contend with experiences of differential treatment and of having their motives for seeking help questioned, while also finding it harder to benefit from the rehabilitation measures offered.

Our study demonstrates how the emergence of a new viral disease with unknown long-term sequelae resulted in a group of patients who largely carried the burden of getting better by themselves. Yet patients with an ethnic minority background experienced additional, worrying barriers. More research into relevant diagnosis, care and support for all long COVID patients is needed, especially among ethnic minorities.

The decision to vaccinate may be motivated by self-protection or community protection, and people may to varying degrees feel a personal responsibility or a collective obligation to vaccinate. In two preregistered survey experiments during the COVID-19 pandemic, we examined how a benefit framing (personal vs. collective) and a responsibility framing (personal vs. collective) influence vaccine intention.

We used a 2×2 survey experiment design to manipulate vaccine promotion framing systematically. The experiments were conducted on large, overlapping representative samples of Norwegian adults. Separate survey experiments were performed before (N=5474) and after (N=1789) the COVID-19 vaccine rollout in Norway.

Both experiments showed that framing vaccination choice as a collective (vs. personal) responsibility increased vaccine intention. In the first experiment there was no effect of benefit framing, while in the second experiment emphasising personal (vs. collective) benefit increased vaccine intentions. There was no interaction between the factors in either experiment. We also observed a considerable increase in vaccine intention between the first and second experiment.

These findings indicate that highlighting collective responsibility may boost vaccine uptake, whereas it is more difficult to conclude about emphasising personal versus collective benefits. Message framing may be worth considering when designing health communication strategies during infectious disease outbreaks.

The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.

Using full-population data on people in Sweden born in 1955 or earlier, we created a nested case-control study. Conditional logistic regressions with county fixed effects were estimated across three periods of vaccination rollout (Doses 1–2, 3–4, and 5–6). County fixed effects were compared across models with and without vaccination adjustment. Further, the benefits of vaccination coverage corresponding to the most successful regions were evaluated with potential impact fractions (PIFs).

Across counties, the final shares of vaccinated individuals ranged from 94% to 98% for Doses 1 and 2, 90% to 96% for Dose 3, 80% to 91% for Dose 4, 65% to 83% for Dose 5, and 13% to 47% for Dose 6. In models without vaccination adjustments, COVID-19 mortality ranged from −56% to +75% relative to an average county, and hospitalizations from −45% to +51%. Vaccination adjustment had little impact on the disparities. Overall PIFs were 8% to 11% for mortality and 7% to 8% for hospitalizations, with greater PIFs in urban counties.

While higher vaccination coverage, especially in urban areas, could have prevented COVID-19 deaths and hospitalizations among older adults in Sweden, the vaccinations were not a major driver of regional disparities in these outcomes.

This article examines how the Diderichsen model has been used and adapted in research on health inequalities during COVID-19, and explores how the pandemic has prompted further theoretical development. This review therefore addresses the question of how a well-established theoretical framework has helped researchers understand pandemic-related health inequalities and what opportunities exist for its continued refinement.

A narrative literature review was conducted using Google Scholar, Web of Science, PubMed and Scopus. Included studies cited a key publication presenting the Diderichsen model and addressed COVID-19 as a central topic. After screening 298 articles, 24 were included for full analysis. The studies were categorised by how they engaged with the model – conceptually, empirically or through further development.

The Diderichsen model was commonly used to frame discussions of health inequality or to interpret pandemic-related disparities in exposure, vulnerability and outcomes. Several studies emphasised occupational and housing-related exposure, class-based comorbidities and the unequal social consequences of COVID-19. A smaller number of studies proposed expanded frameworks, incorporating multilevel and temporal dimensions and introducing new mechanisms related to pandemic responses. These adaptations often focused on migrants, ethnic minorities and other particularly affected groups.

The review confirms the ongoing relevance of the Diderichsen model in pandemic health inequality research. It argues that the model can be further strengthened by explicitly incorporating concepts of political decision-making, symbolic recognition and social justice. This would improve its capacity to capture the full complexity of health inequalities in times of crisis.

Health effects of pandemics extend beyond morbidity and mortality from the disease itself and may include long-term mental health consequences. However, previous studies only consider narrowly defined populations at risk or examine pandemics caused by varied pathogens that may have inconsistent effects. We examine existing literature on these long-term mental health effects following one type of pandemic (influenza).

We conducted a systematic review of the long-term mental health effects of the 1889, 1918, 1957, 1968, and 2009 influenza pandemics. To our knowledge, this is the first review of studies of broad populations and multiple measures of mental health morbidity.

The literature search returned 8190 articles. After deduplication and title/abstract and full-text screening, 12 articles were reviewed. Seven articles focused on the 1918 pandemic and five on the 2009 pandemic. Study regions were USA or North America (n=5), Europe (n=3), and Asia (n=4). Long-term outcomes studied were suicide (n=4), admission to hospital or psychiatric facility (n=2), stress/anxiety/post-traumatic stress disorder (n=4) and schizophrenia and other/related conditions (n=2). The suggested mechanisms were infection (n=6), effects of non-pharmaceutical interventions (NPIs) (n=3), or other exposure pathways (n=3). Seven studies had a moderate risk of bias and five studies a high risk of bias.

Mental health effects have been an outcome of pandemics. Researchers should consider a variety of possible mechanisms, and that infection and restrictive NPIs may contribute to mental health morbidity. This study highlights the need for better understanding of the broader health, social, and demographic impacts of pandemics.

The Norwegian Institute of Public Health calculated excess mortality for Norway in 2024 using a reference period that included 2023—a year with significant excess mortality—and concluded there was no excess mortality in 2024. This study estimates excess mortality in 2024 using only pre-pandemic years as the reference, providing a basis for identifying excess COVID-19 related mortality.

We estimated excess mortality in 2024 using a negative binomial model trained on 2010–2019 data. Deaths were modelled by age (0, 1–19, 20–39, 40–64, 65–79, 80–89 and 90+ years) and sex, with population offsets. Expected mortality was projected using both a conservative approach where the prediction for 2023 was carried forward to 2024 and a non-conservative linear extrapolation to 2024.

The conservative approach estimated 2898 excess deaths (7.0%; 95% prediction interval (PI), 4.9–9.1%) in 2024. Significant excess mortality was observed in age groups 1–19 (45 deaths; 36.6% excess), 20–39 (107 deaths; 17.6% excess), 40–64 (439 deaths; 10.6% excess) and 65–79 (1631 deaths; 13.7% excess). Ages 1–39 and 40–64 accounted for approximately 5% and 15% of total excess mortality, respectively.

Persistent excess mortality from 2022 to 2024 suggests a new elevated mortality baseline and a reduction or reversal of Norway’s pre-pandemic mortality decline. Although multiple factors may contribute, given sustained excess mortality since 2022, our findings suggest that the unmitigated spread of SARS-CoV-2 in Norway since 2022 can be associated with increased mortality, particularly for those under 65.