Individual, Family, and Community Characteristics Associated With COVID-19–Specific Worry and Lack of Worry Among Norwegian High School Students in First Pandemic Year

Research on adolescent mental health during the COVID-19 pandemic tends to focus on individuals with increased anxiety levels,^1,2 overlooking adolescents who may not be worried at all. Understanding heterogeneity of adolescents’ pandemic-specific worries may be especially relevant because these may be associated with differential compliance with health and control measures³ and perhaps necessitate differential public health approaches.

We investigated associations of various characteristics at the individual, family, and community levels with different types and levels of pandemic-specific worries among Norwegian high school students during the initial pandemic year. These worries included excessive worries and no worries at all.

This cohort study was approved by the Norwegian Data Protection Authority after ethical evaluation by the National Committee for Research Ethics in the Social Sciences and the Humanities. Written parental consent was obtained for all participants. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We analyzed data from 2319 Norwegian high school students from the nationwide Monitoring Young Lifestyles (MyLife) study longitudinally conducted in annual assessments since autumn 2017 (ie, the time 1 baseline).⁴ Study details are provided elsewhere^4,5 and in eMethods in the Supplement.

In late 2020 (ie, time 4), study participants reported no worry, moderate worry, or excessive worry concerning their own COVID-19 infection, infection of friends and family, and schooling. These items were adopted from the validated Pandemic Anxiety Scale questions.¹ They are comparable with other brief measures of pandemic anxieties and worries.³

Risk assessments were done at time 1 (ie, 2017; baseline), time 2 (ie, 2018), time 3 (ie, 2019), and time 4 (ie, 2020). Putative factors we investigated were conceptually aligned with other factors previously found to be associated with pandemic anxiety (Table 1; eMethods in the Supplement).^1,3,6 These included students’ prepandemic histories of mental health, physical health, academic, and other health risk (ie, presence vs absence of risk for each area); their families’ immigrant background, education level, and prepandemic history of financial risk and serious illness or death; and their communities’ urbanity, standard of living, and current COVID-19 infection rate.

Associations between studied risk factors and 3 types of pandemic-specific worries were examined using multinomial regressions. The reference group for each question was set as individuals with moderate worries.

A total of 2319 student participants (904 [39.0%] male students and 1415 [61.0%] female students; mean [SD] age, 17.02 [0.84] years) reported pandemic-specific worries in late 2020. Moderate worries were the most common (range, 40.8%-54.6%), but excessive worries (range, 8.4%-17.5%) and no worries (range, 27.9%-43.1%) were also reported; Table 1.

Estimates from the fully adjusted multinomial models are shown in Table 2. Female sex, presence of mental health risk, and residence in a community with high infection rates were associated with decreased odds of no worry about own infection. Female sex, family immigrant background, and residence in high-infection communities were associated with decreased odds of no worry about friends and family infection, while below-college parental education was associated with increased odds. Female sex and older age (grade 12 vs grade 11) were associated with decreased odds of no worry about schooling, while the presence of academic risk was associated with increased odds.

Oldest age was associated with increased odds of excessive worries about own infection. Female sex and presence of mental health risk were associated with increased odds of excessive worries about infection of friends or family. Female sex, oldest age (grade 13 vs grade 11), presence of mental health risk, unknown family immigrant status, history of illness or death in the family, and residence in communities with high infection rates were associated with increased odds of excessive worry about schooling.

In this prospective cohort study, we found that most high school students from our Norwegian sample were moderately worried about COVID-19 infection and schooling during the initial pandemic year. However, many respondents also reported having no worries, and some individuals reported having excessive worries. These responses were largely associated with the current community contagion, while different participant and family prepandemic characteristics were associated with increased or decreased odds of worries or had no associations.

The study has several limitations. The results should be understood in the context of a strong governmental response and relatively low COVID-19 incidence in Norway during 2020, which may limit generalizability. Additionally, the study characteristics included relatively short-term pandemic exposure, reliance on self-reports, and a possibly nonrepresentative sample.⁵ Nevertheless, these findings may be of relevance in identification of diverse at-risk profiles (ie, those at either end of the pandemic-anxiety spectrum) during the COVID-19 pandemic and future public health crises.

Accepted for Publication: January 6, 2022.

Published: February 24, 2022. doi:10.1001/jamanetworkopen.2022.0337

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Burdzovic Andreas J et al. JAMA Network Open.

Corresponding Author: Jasmina Burdzovic Andreas, PhD, ScM, Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213 Oslo, Norway (jabu@fhi.no).

Author Contributions: Drs. Burdzovic Andreas and Brunborg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Burdzovic Andreas.

Critical revision of the manuscript for important intellectual content: Brunborg.

Statistical analysis: All authors.

Administrative, technical, or material support: All authors.

Conflict of Interest Disclosures: None reported.