Our study explored whether adolescents can be grouped by how they perceived the impact of pandemic measures and how these emerging classes were associated with their mental health. The study found three classes of perceived pandemic impact on adolescents’ lives, encompassing a neutral (51%), negative (18%), or positive (31%) perception of COVID-19. We found a quite heterogeneous picture of distribution of the perceived COVID-19 impact both within and across countries, which might be due to local differences in COVID-19 measures within each country or a stronger perception of measures on an individual level. Thereby, we found strong gender, age, and socioeconomic differences in the impact classes of COVID-19 measures. Adolescents with a negative perception of the COVID-19 measures showed worse mental health than peers with a neutral or positive perception, especially in girls, older adolescents, and those with a low socioeconomic status.
Across the 22 countries examined, a third of the participants reported that the COVID-19 measures had a positive impact on different areas of their lives, such as their relations with family and friends. The scientific literature is abundant in documenting the negative consequences of the COVID-19, however, to our knowledge, studies measuring both positive and negative impacts are rare. This study points out that for some adolescents, COVID-19 measures had a positive self-perceived impact. Our results seem to indicate that in the overall evaluation with regards to how the pandemic has affected them (either positive or negative), some of the most important dimensions seem to have been having good relationships with their parents (for positive impact) and having their family financial situation negatively affected (for negative impact). Thereby, the positive impact is especially linked to the quality of close relationships. This result is corroborated by systematic reviews that have shown for some families being able to spend more quality time together has been positive (41, 42). We assume that this positive impact may have counterbalanced out the negative impact of the COVID-19 measures in adolescents’ lives. Further, recent research points out that a good family climate and family cohesion are important for children’s and adolescent’s mental well-being (43).
In our study, approximately one-fifth of the participants reported that the COVID-19 measures had a negative impact in different areas of their lives, especially on their mental health, but also on school performance and physical activity. These findings are in line with international research results pointing out an increase in mental health problems (1), problems with school performance (44) and less physical activity (45, 46). The self-perceived (and reported) impact therefore seems to be a good indicator for the impact of the COVID-19 measures in general and underline adolescents’ ability to reflect the effects of far-reaching measures on their own life.
Our findings have shown that assignment to one of the impact classes is not equally distributed by sociodemographic determinants. Especially girls, older adolescents, and those with a low socioeconomic status reported more often a negative perception of the COVID-19 measures than boys, younger adolescents, and those with a high socioeconomic status. Further, our results showed that girls reported poorer mental health than boys. This is consistent with previous studies showing that the risk for mental health problems during (and also before) the pandemic was higher for girls than for boys (47-49). It can be discussed if females suffered more from COVID-19 measures. Cross-cultural research found that females were more likely to report emotional and behavioural problems lasting longer than one year and had more COVID-19 anxiety, suggesting poorer mental health than males (50, 51). There is evidence that girls are more likely than boys to rely on their social networks for support when dealing with significant life stressors (52). The pandemic constraints (e.g., online schooling, social distancing) affected adolescent females' ability to rely on their social network for emotional support, which could lead to a deterioration in their mental well-being (48). The findings from the study by Halldorsdottir et al. (53), similar to our study, confirm that girls were more likely than boys to perceive that the pandemic had a negative impact on their daily lives.
With regard to age, older adolescents showed a deterioration in all indicators of subjective health and well-being. These results are congruent with those of previous national and international studies, which also showed that girls and older adolescents more often report rather poor health, multiple psychosomatic complaints, as well as lower life satisfaction (8, 54).
The results on socioeconomic status showed an interesting, differentiated picture: Adolescents with a lower socioeconomic status tended to suffer more often from loneliness and had a worse life satisfaction, while no significant differences were found for psychosomatic health complaints within the socioeconomic status groups. This is in line with a study by Jeriček Klanšček & Furman (55), which suggests that self-reported deprivation and economic hardship are significant predictors of poor well-being and the risk for mental health problems. Even before the pandemic, adolescents with a low socioeconomic status were especially vulnerable to worse mental health (56). Recent studies revealed that increased financial worry during the COVID-19 pandemic was significantly associated with increased child mental health problems (57). It can be assumed that they and their families have limited resources to deal with fundamental crisis-related measures such as school closures and social distancing, e.g. due to a low educational level of the parents, limited living space, or a high parental burden.
Strengths and limitations
This research has several strengths and limitations. The main strength of our study is that it uses as one of the first studies in the field a measure of COVID-19 measure impact, which is new and thus fills an important research gap. Another strength is the inclusion of a large sample of adolescents in 22 countries, which allows for a cross-national comparison for assessing the impact of the COVID-19 pandemic measures on adolescent’s mental well-being, and related health-outcomes such as psychosomatic complaints, life satisfaction and loneliness. Moreover, the HBSC uses a standardized protocol for data collection across all countries included which facilitate valid cross-national comparisons across countries. Finally, we systematically used sound methodology, i.e. the non-parametric multilevel latent class analysis among others to deepen the understanding of the actual perceived experience of pandemic measures in adolescents and its relation to mental health from a holistic perspective taking into account different sociodemographic aspects.
This study has several limitations. First, it is a cross-sectional design, which does not allow us to obtain evidence on temporal and cause-effect relationships. Another issue concerns the time range of the HBSC data collection and that the pandemic waves and measures varied across countries. This may have impacted the assessment both on individual and country levels. In most of the countries studied, the data were collected when the war in Ukraine began, which may have had influenced the well-being of adolescents (58). When estimating the association between the COVID-19 pandemic and adolescent mental health outcomes, more studies have used non-probability or convenience samples, and different methodology enables solid cross-study comparisons. However, the unified HBSC methodology of representative adolescent samples ensures valid cross-country comparisons.