Distressing testing: A propensity score analysis of high-stakes exam failure and mental health.

This study used rich individual-level registry data covering the entire Norwegian population to identify students aged 17-21 who either failed a high-stakes exit exam or who received the lowest passing grade from 2006 to 2018. Propensity score matching on high-quality observed characteristics was utilized to allow meaningful comparisons (N = 18,052, 64% boys). Results showed a 21% increase in odds of receiving a psychological diagnosis among students who failed the exam. Adolescents were at 57% reduced odds of graduating and 44% reduction in odds of enrolling in tertiary education 5 years following the exam. Results suggest that failing a high-stakes exam is associated with mental health issues and therefore may impact adolescents more broadly than captured in educational outcomes.

Job loss and psychological distress during the COVID-19 pandemic: a national prospective cohort study.

BACKGROUND: The COVID-19 pandemic caused substantial increases in unemployment; however, the association between these job losses and psychological distress is not well documented. Our study reports on this association from a cohort study, with a particular focus on educational differences in both the likelihood of job loss and its potential implications for mental health. METHODS: Utilizing data from a large prospective cohort study of parents in Norway (n = 58,982), we examined changes in psychological distress within four groups of respondents: those who during the first wave of COVID-19 had (i) no change in their employment situation, (ii) worked from home, (iii) been furloughed, or (iv) lost their job. RESULTS: Psychological distress increased in all groups. In z-scores relative to pre-pandemic levels, the increases were (i) 0.47 [95%-CI: 0.45-0.49] among respondents with no change in their employment situation, (ii) 0.51 [95%-CI: 0.49-0.53] among respondents who worked from home, (iii) 0.95 [95%-CI:0.91-0.99] among those furloughed, and (iv) 1.38 [95%-CI: 1.16-1.59] among those who permanently lost their job, corresponding to increases of 89%, 95%, 170%, and 185%, respectively. While respondents without university education had a 2 to 3 times higher risk of job loss, the negative impact of job loss on psychological distress was similar across educational levels. CONCLUSIONS: Participants exposed to job loss during the pandemic experienced a stronger increase in symptoms of depression or anxiety compared to those who remained employed. Although higher education lowered the risk of losing work, it did not substantially diminish the impact on mental health from losing work.

Impact of the COVID-19 pandemic on sick leave among healthcare workers: a register-based observational study.

OBJECTIVES: To assess the impact of the COVID-19 pandemic on sick leave among healthcare workers (HCWs) in primary and specialist care and examine its causes. METHODS: Using individual-level register data, we studied monthly proportions of sick leave (all-cause and not related to SARS-CoV-2 infection) from 2017 to February 2022 for all HCWs in primary (N=60 973) and specialist care (N=34 978) in Norway. First, we estimated the impact of the pandemic on sick leave, by comparing the sick leave rates during the pandemic to sick leave rates in 2017-2019. We then examined the impact of COVID-19-related workload on sick leave, by comparing HCWs working in healthcare facilities with different levels of COVID-19 patient loads. RESULTS: HCWs had elevated monthly rates of all-cause sick leave during the COVID-19 pandemic of 2.8 (95% CI 2.67 to 2.9) and 2.2 (95% CI 2.07 to 2.35) percentage points in primary and specialist care. The corresponding increases for sick leave not related to SARS-CoV-2 infection were 1.2 (95% CI 1.29 to 1.05) and 0.7 (95% CI 0.52 to 0.78) percentage points. All-cause sick leave was higher in areas with high versus low COVID-19 workloads. However, after removing sick leave episodes due to SARS-CoV-2 infections, there was no difference. CONCLUSIONS: There was a substantial increase in sick leave among HCWs during the pandemic. Our results suggest that the increase was due to HCWs becoming infected with SARS-CoV-2 and/or sector-wide effects, such as strict infection control measures. More differentiated countermeasures should, therefore, be evaluated to limit capacity constraints in healthcare provision.

Mental health benefits of cohabitation and marriage: A longitudinal analysis of Norwegian register data.

The aim is to examine how mental health is affected by cohabitation and marriage. Individual fixed-effects models are estimated from Norwegian register data containing information about consultations with a general practitioner because of mental health conditions in 2006-19. Mental health, as indicated by annual number of consultations, improves over several years before cohabitation. For those marrying their cohabiting partner, there is a weak further reduction in consultations until the wedding, but no decline afterwards. In other words, formalization of the union does not seem to confer additional mental health benefits. However, marriage may be considered a marker of favourable earlier development in mental health. In contrast, there is further improvement after direct marriage, as well as stronger improvement over the years just preceding direct marriage. Patterns are quite similar for women and men. Overall, the results suggest that the mental health benefits of cohabitation and marriage are similar.Supplementary material for this article is available at: https://dx.doi.org/10.1080/00324728.2022.2063933. Note: numbers in brackets refer to supplementary notes that can be found at the end of the supplementary material.

Impact of Omicron on sick leave across industries: A population-wide study.

AIMS: To estimate the industry-specific impact of the COVID-19 pandemic (Omicron wave) on sick leave. METHODS: Using individual-level data from the Norwegian Emergency Preparedness Register, the study covers all workers in different industries (N = 2,733,751 people) on a monthly level in the time periods January-March 2017-2020 (except March 2020) and 2022 (38,199,536 person-months). We estimated the industry-specific increase in monthly average sick leave during the Omicron wave in 2022 compared with the corresponding months in 2017-2020. RESULTS: We found an average increase in monthly sick leave rates of 2.92 percentage points (95% CI 2.9-2.94) during the three first months of 2022. The increases were strongest within food and accommodation (4.42 percentage points increase, 95% CI 4.33-4.51) and administrative support services (3.94 percentage points increase, 95% CI 3.85-4.03). CONCLUSIONS: The Omicron wave resulted in a substantial increase in sick leave, which was unevenly distributed across industries. The results of this study highlight the importance of industry-specific contingency planning when facing the rapid spread of infectious diseases.

The educational burden of disease: a cohort study.

BACKGROUND: Students with health disorders might be at risk of disengaging from education, which can reinforce socioeconomic inequalities in health. We aimed to evaluate the associations between 176 diseases and injuries and later school performance in Norwegian adolescents and to estimate the importance of each disorder using a novel measure for the educational burden of disease (EBoD). METHODS: We used diagnostic information from government-funded health services for all Norwegian inhabitants who were born between Jan 1, 1995, and Dec 31, 2002, were registered as living in Norway at age 11-16 years, and were participating in compulsory education. School performance was assessed as grade point average at the end of compulsory education at age 16 years. We used a linear regression of school performance on disease in a fixed-effects sibling comparison model (113 411 families). The association (regression coefficients) between disease and school performance was multiplied by disease prevalence to estimate the proportional EBoD among 467 412 individuals participating in compulsory education. FINDINGS: Overall, although most diseases were not meaningfully associated with grade point average (regression coefficients close to 0), some were strongly associated (eg, intellectual disability regression coefficients -1·2 for boys and -1·3 for girls). The total educational disease burden was slightly higher for girls (53·5%) than for boys (46·5%). Mental health disorders were associated with the largest educational burden among adolescents in Norway (total burden 44·6%; boys 24·6% vs girls 20·0%), of which hyperkinetic disorder contributed to 22·1% of the total burden (boys 14·6% vs girls 7·5%). Among somatic diseases, those with unknown causes and possibly mental causes were associated with the largest educational burden. INTERPRETATION: The EBoD concept could provide a simple metric to guide researchers and policy makers. Because mental health disorders form a large component of the educational burden, investment in mental health might be particularly important for improving educational outcomes in adolescents. FUNDING: The Research Council of Norway.

Quantifying social segregation in large-scale networks.

We present a measure of social segregation which combines mobile phone data and income register data in Oslo, Norway. In addition to measuring the extent of social segregation, our study shows that social segregation is strong, robust, and that social networks are particularly clustered among the richest. Using location data on the areas where people work, we also examine whether exposure to other social strata weakens measured segregation. Lastly, we extend our analysis to a large South Asian city and show that our main results hold across two widely different societies.

Longitudinal evidence on the development of socioeconomic inequalities in mental health due to the COVID-19 pandemic in Norway.

The economic and health consequences of the COVID-19 pandemic are unequally distributed. A growing literature finds evidence that those with low socioeconomic status have carried a greater burden in terms of both unemployment and infection risk. Against this background, it is natural to also expect increasing socioeconomic inequalities in mental health. We report from a population-based longitudinal study, assessing the mental health of more than 100,000 Norwegian adults during a period of more than 20 years, and into the COVID-19 pandemic. We find substantial, and equally high, increases in depressive symptoms across socioeconomic status. In addition, we show that the increase was particularly strong among women and those with lower levels of depressive symptoms prior to COVID-19.

The ADHD deficit in school performance across sex and parental education: A prospective sibling-comparison register study of 344,152 Norwegian adolescents.

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is associated with impaired school performance, but the impact of ADHD may vary across sex, family background, and school subjects. By using prospective population-wide register data, we describe impairment in academic performance related to ADHD across different school subjects and investigate how this impairment differ across sex and parental education. Methods: We examined grades and Grade Point Averages (GPA) at age ∼16 among 344,152 Norwegian children born between 1997 and 2002. We linked grades with diagnoses from publicly funded general practitioners and with demographic information. Associations between ADHD diagnosed between age 10 and 16 and school performance were estimated with linear models, including sibling-models which control for unobserved variables shared within families. Results: Children with ADHD (4.0%) had -1.11 standard deviations lower GPAs compared to children without ADHD. This difference remained substantial after adjusting for demographic factors (-0.87), comorbid mental disorders (-0.82), early school performance (-0.54), and when comparing full siblings (-0.60). The relative ADHD deficit was 22% larger for girls than for boys and 39% larger for children with highly educated parents than for children of parents without completed high school, but the absolute deficit was smaller. Conclusion: The ADHD deficit in school performance was large and not easily attributable to other factors. Because the ADHD deficit was large in all school subjects, interventions should ideally address factors that affect school performance broadly, although targeting theoretical subjects specifically may be most effective given limited resources.