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The COVID-19 pandemic and the associated containment measures and social restrictions significantly impacted society, transforming individuals’ daily lives. This thesis explores the impact of the pandemic on mental health among Norwegian adults, by examining trends in incidence rates of mental disorders, in the number of primary care consultations for mental health problems, and in self-reported levels of mental distress and life satisfaction. This thesis also examines potential protective factors that could mitigate the negative consequences of the pandemic on mental distress and life satisfaction.
By combining longitudinal data collected from nationwide health registries and a prospective birth cohort study, the present thesis investigates changes in mental health problems and life satisfaction before, during and after the pandemic. Changes were investigated among individuals with and without a prior history of selected mental health problems, as well as among mothers with school-aged children.
The first paper (Paper 1) investigates the incidence rates of first-time diagnosis of depressive disorders, anxiety disorders, obsessive-compulsive disorder (OCD), phobic anxiety disorders, post-traumatic stress disorder (PTSD) and eating disorders among adults aged 18-65 from 2015 to 2021, as reported in primary- and specialist health care settings. The findings of Paper 1 reveal that most of the incidence rates during 2020 and 2021 followed the pre-pandemic trend, with a few notable exceptions. Specifically, the incidence rates of primary care-recorded depression and phobia/OCD and specialist care-recorded phobic anxiety disorders decreased among men and women in some of the age groups during 2020 and 2021. In contrast, the incidence rates of eating disorders diagnosed in both primary and specialist health care and specialist care-recorded OCD increased among women in some of the age groups during 2020 and 2021.
The second paper (Paper 2) examines time trends in weekly primary care consultations from 2017 to 2021 for depressive disorder, anxiety disorder, phobia/OCD, PTSD and eating disorders among adults aged 18-65 with a pre-existing mental health problem. Results of Paper 2 demonstrated that in this group, the weekly number of consultations for anxiety disorder, PTSD and eating disorders increased during the pandemic compared to before the pandemic. The number of weekly consultations for depressive disorder and phobia/OCD largely followed the expected pre-pandemic trend.
The third paper (Paper 3) examines self-reported levels of mental distress and life satisfaction among mothers with school-aged children, measured before, during and after the pandemic. In Paper 3, we found no immediate differences in mental distress or life satisfaction between mothers responding to a questionnaire before versus after the Norwegian lockdown, employing between-person comparisons. However, Paper 3 identified within-person changes over time in mental distress, as mothers responding to a questionnaire during the pandemic reported more mental distress compared to mothers responding before the pandemic. Notably, we found variations in symptom levels of mental distress across different pandemic periods; a decrease in summer 2020, followed by increases in 2021, 2022 and 2023. Further, we only found a post-pandemic change in level of life satisfaction, where mothers responding to a questionnaire in 2023 reported lower life satisfaction than mothers responding before the pandemic.
The fourth paper (Paper 4) investigates self-reported levels of social support, physical activity, employment situation, alcohol consumption and relationship satisfaction, as well as mental distress and life satisfaction among mothers with school-aged children measured before, during and after the pandemic. The findings of Paper 4 indicate that there was generally no significant change in protective factors during the pandemic, except for the mean hours of physical activity per week, which decreased less among mothers who responded to a questionnaire during the pandemic compared to mothers who responded before the pandemic. Furthermore, the study revealed that higher levels of social support, being employed, and relationship satisfaction were associated with lower mental distress and higher life satisfaction, while physical activity was linked only to lower levels of mental distress. Pandemic exposure generally did not moderate the associations between the protective factors, mental distress, and life satisfaction, except for employment situation, as the association between being employed and mental distress was stronger among mothers responding to a questionnaire during the pandemic compared to mothers responding before the pandemic.
In conclusion, the present thesis demonstrates that most of the examined mental health outcomes, including life satisfaction, remained stable or even decreased during the pandemic. These observations suggest that most adults coped relatively well despite the major disruptions to daily life induced by the pandemic. However, for vulnerable subgroups, the pandemic may have been an environmental stressor that triggered or exacerbated mental health problems. This thesis also provides knowledge about protective factors that could potentially reduce mental health problems and improve life satisfaction. Insight into mental health problems and life satisfaction, as well as potential vulnerable individuals and protective factors during a pandemic, is valuable when preparing for a future national crisis.
