The number of psychological cases in Norway was high relative to prior years in late spring and early summer 2020, consistent with evidence from other countries (1,2,3,4), but then fell back towards pre-2020 levels during July and August, as depicted in Figure 1. Our main finding is the acceleration of cases starting September 2020 and still present end-of-year, also depicted in Figure 1 and Table 1. At a per-capita level, the increase in weekly cases relative to prior years was about 1 per 1000 capita in July-August and doubled to 2 per 1000 capita in December, as depicted in Figure 2. The acceleration of psychological cases during fall 2020 suggests that the accumulated effects of stress in the fall of 2020 outweighed the development of better coping strategies in the population.
As Norway had low incidence of Covid-19 cases and deaths during fall 2020 compared to many other countries, it seems plausible that the acceleration in cases during fall was due to accumulated effects of lockdowns and movement restrictions (rather than stress due to fear of infection). As lockdowns and movement restrictions have been implemented worldwide, our findings should be of global interest to policy makers who contemplate the difficult trade-offs of continued lockdown policies. Our findings also have broader interest, in providing detailed population-level documentation of the mental health effects of prolonged shutdowns and limits to social interaction.
The main cities have been hubs for Covid-19 cases and lockdowns, as many metropolitan areas globally, and experienced larger increases during September-December than more rural areas, both at a per-capita and percentage level. The increases were also large for females. The adolescents (11-17 age) experienced a large percentage increase relative to other groups (but a lower per-capita increase).
As can be seen in Figure 1, the number of psychological cases in Norway were unusually high in January 2020. We are not aware of institutional changes that could explain this spike. One explanation could be that the unusually foul weather in January 2020 led to a “lockdown” created by nature. In Table 1 we control for a possible “2020 effect” unrelated to COVID-19 by comparing the increase in average weekly cases during weeks 40-51 in 2020 to the corresponding increase during weeks 1-10 of 2020 (i.e., prior to the outbreak). The estimate from this approach (Panel A of Table 1) implies that the extra increase in P-cases during weeks 40-51 in 2020 was 9%, i.e., substantial.
As can be seen from Figure 1 (black line), Norway is characterized by a “long winter” effect, in that the number of P-cases are typically increasing during the fall months (9), possibly due to lack of sun exposure (10). To investigate whether the “long winter” effect possibly interacts with the COVID-19 effects, in Panel B of Table 1 we analyzed the increases in P-cases for the three northern-most counties (Nordland, Troms, and Finnmark) where the population live close to or above the arctic circle. The percentage increase, about 9% (95% CI, 0.04-0.15), is lower than the increase for the overall population (the first row), which suggest that the long winter effects are not driving our results.