Abstract
The present study aims to explore, in the national context of Norway, how municipal socioeconomic indicators affect anxiety and depressive symptom scores among senior high school students and whether this potential municipal effect is dependent on the adolescents' family affluence levels. This cross-sectional study is based on questionnaire data collected in five waves (2014-2018) of the Ungdata survey. The study sample consisted of 97,460 adolescents aged 16-18 years attending high school in 156 municipalities in Norway. Measures of psychological distress, depression, and anxiety symptoms were based on the screening instrument, Hopkins Symptom Checklist-10. Two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents' mental health. In general, the results indicate substantial psychological symptom load among the study sample. Inequalities in adolescents' psychological distress between family affluence groups were evident, with the lowest symptom loads in the most affluent families. The predicted depressive and anxiety symptoms among the students increased slightly along with the percentage of municipal residents with tertiary educations and with increasing income inequalities in their residential municipality. However, the interaction models suggest that the adverse effects of higher municipal education level and greater income inequality are, to a certain extent, steepest for adolescents with medium family affluence. This study highlights two key findings. Both municipality effects and family affluence account for a relatively small proportion of the total variance in the students' psychological symptoms loads; however, the mental health inequalities we explored between socioeconomic strata on both the individual and municipal levels are not insignificant in a public health perspective. Results are discussed in the context of psychosocial mechanisms related to social comparison and perceptions of social status that may be applicable in egalitarian welfare states such as Norway.
Highlights
Contemporary society and trends in adolescent mental healthThe secular trends in adolescent mental health are, in many Western countries, unclear due to changes in recognition, diagnosis, and how adolescents perceive their health [1,2], and this perception appears to be deteriorating among adolescent girls [3]
This study aims to explore, in the national context of Norway, how the municipal socioeconomic indicators education level and income inequality affect anxiety and depressive symptom scores among students in their later teenage years, as well as to understand to what extent these associations are conditioned by family affluence
We found an effect of education level at the municipal level, it is important to note that we found small variations between municipalities in adolescents’ depressive and anxiety symptom scores which is in line with previous Nordic population studies exploring geographical variations and rural-urban differences in mental health [106,107,108], This might be because Norway has a high-level welfare state which benefits all Norwegians no matter where in the country they live
Summary
Contemporary society and trends in adolescent mental healthThe secular trends in adolescent mental health are, in many Western countries, unclear due to changes in recognition, diagnosis, and how adolescents perceive their health [1,2], and this perception appears to be deteriorating among adolescent girls [3]. Essential aspects of the past year’s societal changes could have affected people’s mental health status through psychological factors. These modern trends include (I) rising income inequality [6,7], (II) changes in family consultations and dynamics [8,9], and (III) among adolescents, the growing use of modern online technology [10,11,12] such as social networking sites, which have created a significant arena for social comparisons that could be psychologically harmful [13,14,15]. The social factors are presented at different levels of society: individual, family, community, and national [6]
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