Perceived consequences and worries among youth in Norway during the COVID-19 pandemic lockdown

Aims: To examine perceived consequences for everyday life, learning outcomes, family relations, sleep problems and worries for infection, for friends and their future, among youth aged 12–19 years during weeks 7 to 9 of the COVID-19 lockdown in Norway. We examine variations by age, gender, socioeconomic status and country of birth. Methods: Youth within the municipality of Bergen were invited via SMS to participate in a 15-minute online survey. A total of 2997 (40%) youths participated. The mean age was 17 years (standard deviation 1.7). Results: Overall, 28% reported feeling somewhat to a lot impacted by schools closing, 63% reported learning less. In total, 62% reported improvement of everyday life. The youth’s situation in their family was worse for 13%. Regarding sleep problems, 19% reported difficulties initiating and maintaining sleep, 12% had more nightmares, while 90% reported later bedtime and rise time. Seven per cent worried about getting infected, while 53% worried about infection among family members. A total of 19% worried that the outbreak would lead to a more difficult future, and 32%worried that friends were facing a difficult situation at home. Perceived consequences and worries related to the lockdown varied across sociodemographic groups. Conclusions: The perceived consequences and degree of worries varied by age, gender, socioeconomic status and to a certain degree country of birth. Girls, older youth, youth with lower socioeconomic status and with a migrant background from developing countries seemed to experience the lockdown as more difficult, and thereby possibly accentuating the need for services in these groups.

and many parents became directly involved, by assisting with home schooling routines. Social support and time spent with friends and teachers decreased, and around half of the parents were working from home [5]. Inevitably, families were spending more time together. youth were also exposed to media coverage of a potentially life-threatening disease, and warnings of enormous economic consequences for society. However, information that COVID-19 symptoms appeared less severe among youth were available early [6]. Still, they could be infectious and were thereby seen as a threat for older family members.
The level of worries and stress were raised in the world due to the COVID-19 pandemic [7], especially among women, youth and students. These findings are in line with results from Norway [8]. uNICef has raised concern that schools closure measures may cause mental health problems and psychological distress among children [9]. A recent rapid review [10] identified three studies with parents reporting adverse psychological effects of physical distancing during the COVID-19 outbreak on their children, especially an increase in depressive symptoms, anxiety, irritability, boredom and stress. Among adults, delayed sleep phase and poorer sleep quality have been reported during the COVID-19 outbreak [11], with similar patterns among preschool children [12]. research on sleep for adolescents during the pandemic has been called for [13].
Meanwhile, the Norwegian context may also have protected youth from some of the stressors related to the outbreak. The lockdown was not complete but was an effort to balance between regulation and advice, prioritising health. During the first weeks, people's trust in government, parliament and the health authorities increased [14]. Christensen and Laegreid [15] concluded that Norway performed well in handling the crises, due to competent politicians and reliable bureaucracy, a strong public sector and a well-developed welfare state. On the individual level, youth entered the crisis with overall good health, strong family relations, high levels of wellbeing and school satisfaction, and relatively high family wealth compared to other european countries [16][17][18]. These factors are considered important resources for resilient outcomes for youth [19,20].
However, not much is known about the impact of pandemics accompanied by severe restrictions such as schools closing for youth. The present paper focuses on perceived consequences and worries due to the lockdown caused by COVID-19, among youth in Norway.

Aims
During weeks 7 to 9 of the COVID-19 lockdown: To examine perceived consequences of lockdown for everyday life, learning outcomes, family relations, sleep; and worries about contamination, for friends and their future, among youth aged 12-19 years. We examined variations by age, gender, socioeconomic status and country of birth.

Methods
Design, procedure, and participants COVID-19 young is an epidemiological study of youth aged 12-19 years within the municipality of Bergen. It comprises two samples: cohort 1 were youth aged 12-15 years in Bergen municipality whose parents had participated in the study Bergen in Change and consented that their child could be invited to the study. These parents were more often women (Cramérs V: 0.069, P<0.001), older (Cramérs V: 0.092, P<0.001), had higher educational attainment (Cramérs V: 0.155, P<0.001) and household income (Cohen's D: 0.19, P<0.001) and had less often shared residence for the child (Cramérs V: -0.054, P=0.006) when compared to non-consenting parents. The differences observed ranged between very small and small effect sizes. On consent, parents provided contact information for the youth. A total of 1565 youth were contacted. Cohort 2 was youth aged 16-19 years, attending high schools in Bergen municipality. The county provided phone numbers from their contact registers. A total of 5947 youth was contacted in cohort 2.
The data collection started on 27 April, during the 7th week of lockdown, and closed on 11 May. The invitation procedures were the same for cohorts 1 and 2. youth were recruited via SMS and a link to a secure online platform, containing an information letter and a 15-minute online survey. Two SMS reminders were given. Participants were included in a lottery for a new cell phone. A total of 7512 youth was invited to participate. Of these, 843 (54%) in cohort 1 and 2154 (36%) in cohort 2 responded, yielding a total of 2997 (40%) youths completing the survey. The mean age was 17 years (standard deviation (SD) 1.7), 57.7% were girls, and most participants reported living with both parents (77.5%), being born in Norway (93%) and living with siblings (71%).

Measures
Demographic information was measured by youth self-report on gender, age, country of birth and living arrangements.
Socioeconomic status (SeS) was measured by self-rated family affluence for cohort 2 with the following question: 'How well off do you think your family is compared to others'? for cohort 1, aged 12-15 years, we used parental report on household income as indicator for SeS. Parental reported data were not available for cohort 2, while data on selfrated family affluence were not available for cohort 1.
Perceived consequences of the COVID-19 pandemic shutdown were measured by self-report of: being impacted by schools closing; learning outcome; possible positive consequences of schools closing; whether the youth themselves or their family had been infected; and whether they perceived their own family situation as changed, for the better or worse during this period.
Worries due to the COVID-19 pandemic shutdown was measured with youth self-report on: whether the youth worried about COVID-19 infection, for themselves, their family or close ones; whether friends faced a difficult situation in their family during the shutdown; and worried that they themselves would face a harder future as a consequence of the COVID-19 pandemic.
Sleep problems and patterns were assessed with four items: (a) experiencing difficulties initiating and maintaining sleep (DIMS); (b) nightmares more often; (c) later bedtime; and (d) later rise time.
The phrasing of all items may be found in Supplemental Table I.

Statistical analyses
In the present analyses we excluded all that did not have valid responses on age and gender (n=64; 2.1%). for all tables, the following statistics are presented: n (%) and P values for chi-square test of independence, as well as variable-specific number of missing. We show results stratified by gender (Table I), age groups (Table II), socioeconomic indicators (Table III) and country of birth (Table IV). Due to some missing information on the stratification variables (ranging from n=7 to n=40), the overall number of valid responses in the tables varies between 2933 and 2893. To retain the maximum level of information, pair-wise deletion was used throughout the analyses.
Ethics youth consented to participate by ticking the consent form at the start of the survey. The regional Committee for Medical and Health research ethics, Western Norway approved the study (project number 131560).

COVID-19-related consequences and worries
for the total sample, 54% reported being 'somewhat', 'a lot' or 'very much' impacted by schools getting closed, and 63% reported learning less. In total, 62% reported that parts of everyday life had improved in this period. Calmer days at home (75% of those reporting improvement), more time with their family (63%), more time outdoors (49%) and social contact with more people online (43%) were the most frequently reported improvements. The youth's own situation in their family was reported as better for 20% of the sample, and worse for 13%. regarding sleep problems, 19% reported DIMS, 12% had more nightmares, while nine out of 10 reported one hour or more later bedtime and rise time after schools closed. few of the youths reported that they themselves had been infected (N=22; n=12 boys and n=10 girls).
Seven per cent were worried that they would get infected, while 53% were worried that someone else in their family would get infected. A total of 19% were worried that the outbreak would lead to a more difficult future for themselves, and 32% were worried that some of their friends were facing a difficult situation at home after schools closed.

Consequences and worries across genders
Table I presents background variables (age, country of birth, household income (cohort 1), relative socioeconomic status (cohort 2) and variations in perceived consequences and worries due to the lockdown across genders. girls reported being more impacted by schools being closed than boys and a higher proportion reported that living with their family was worse after schools closed. girls also reported more DIMS, more nightmares and later rise time than boys. girls reported a higher level of worry compared to boys.  16-19 years). Older youth reported being more impacted by schools getting closed and learning less. They also more often reported that living with their family was worse after schools closed. Older adolescents reported more DIMS, more nightmares and later bedtime and rise time. regarding worries, higher age was associated with more worry about themselves or family members getting infected and more worry about a more difficult future for themselves. No other significant differences between the age groups were identified.  income reported more often that living with their family was worse, and a higher proportion reported an increase in DIMS, as well as later bedtime after schools closed. for cohort 2, lower relative SeS was associated with being more impacted by schools closing, learning less and that living with their family was worse after schools closed. regarding sleep, DIMS and more nightmares were associated with lower subjective SeS. The same was true for worries about themselves or family members getting infected and worry that the outbreak will lead to a more difficult future for them. youth in the lowest SeS group also reported more worry about their friends' situations at home after the schools closed. A description of sample and included variables across genders, age groups, socioeconomic indicators and country of birth, including 95% confidence intervals can be found in Supplemental figures A1-A5.

Discussion
The current study provides an overview of the perceived consequences and worries of youth from a large municipality in Norway during weeks 7 to 9 of the COVID-19 lockdown. Almost half (46.2%) reported that they were not or only a little impacted by schools being closed. However, over 60% reported learning less than normal in this period. Over 60% of the youth reported that parts of their everyday life had improved after the schools closed. Still, 13% reported that their family situation had become worse. Half of the youth reported more DIMS during this period. Three to four out of 10 reported bedtime and/or rise time one hour later than usual or more, signifying a substantial proportion of youth with delayed sleep phase during the lockdown.
While a little fewer than half of the participants worried about contamination for themselves, almost nine out of 10 were worried about their family being infected. A third of the youth reported that they worried that some of their friends faced a difficult situation at home after the schools closed. A little over half of the youth worried that the COVID-19 outbreak will lead to a more difficult future for themselves. Overall, the findings suggest that a considerable proportion of this sample of youth seemed partly to adjust favourably to the lockdown of Norway. However, one important finding is that the perceived consequences and worries related to the lockdown vary across sociodemographic groups.
Overall, a higher proportion of older youth was impacted by schools closing, reported that they learned less, and experienced a worsened family situation. Older youth also worried more about themselves or close ones being infected by the virus. The reasons for these age-related differences are probably multifactored and interrelated. youth in the age group from 16 to 19 years are in a transitional phase to adulthood, in which the relative importance of school achievements is higher, and other important life domains such as sports, relationships and potential work changes might be more impacted by the lockdown. In part due to growing cognitive abilities allowing anticipatory thoughts about negative consequences for the future, worries seem to increase with age during this developmental period [21]. School is the source of the most intense and most frequent worries in everyday life for adolescents [21,22]. This was also evident under the home schooling arrangement during the COVID-19 outbreak. Older youth are also more likely to follow news updates, especially on social media [23], and were more likely to be exposed to news regarding the pandemic, while also being more likely to understand the potential impact of both the pandemic and the  lockdown on society. The fact that 67% experienced a lower learning outcome suggests that the home-school arrangements offered were not adequate for the older youths. from a societal and individual perspective, inadequate home-school arrangements may be of concern, as academic achievement is associated with factors such as students' subjective wellbeing [24] and dropping out of school [25].
Another finding was that a higher proportion of girls reported being impacted by the lockdown, reported a worsened family situation and had worries about themselves or close ones being infected by the

COVID-19 virus;
and also worried about their friends and their own future. The finding that the lockdown seems to impact girls more negatively might not be surprising, as girls in general are subjected to more symptoms of anxiety and depression than boys [26]. It is also well documented that girls experience more school pressure and have higher levels of subjective health complaints compared to boys [17]. Still, the findings suggest the need for a gender perspective on the consequences of COVID-19 when assessing the long-term impact of the measures and strategies implemented during the pandemic. youths from families with lower SeS were disproportionally negatively impacted by the outbreak across life domains including learning outcome, their situation in the family and worry about infection. Somewhat surprisingly, we did not find that SeS was associated with variations in everyday life improvement during the lockdown. Our finding is in line with a recent study, concluding that under the COVID-19 pandemic, the social gradient in life satisfaction decreased among youth [27]. Still, we did find a social gradient regarding the youths' situation in their own family, indicating that youth with lower SeS experienced a worsening of their family situation. Our results confirm the stated worry that children from low SeS families will be especially vulnerable to closed schools [28].
Sleep problems were prevalent among youth during the COVID-19 lockdown, with the expected female preponderance of sleep problems, the social gradient of sleep and increase by age, in accordance with pre-pandemic population-based studies [29]. A delay in sleep phase during this period of the COVID-19 outbreak is in line with previous COVID-19 outbreak studies [30]. A substantial minority reported an increase in nightmares, a sleep problem that often presents because of worry and negative life experiences. given the importance of sleep for learning and mental health in this developmental phase, follow-up studies should assess the duration of these sleep problems.
Some differences related to country of birth were also observed. Among migrant youth from developing countries, a higher proportion reported being negatively impacted by schools closing, and they worried more about being infected and about their own future. This finding may be related to several aspects, such as the media coverage of more people from ethnic minority groups getting infected than other groups in Norway. Language problems causing less access to information may also have resulted in more uncertainty and worries among ethnic minority families. While guidelines following the crisis in different languages were posted on webpages during the lockdown, the Norwegian government acknowledged the need for more targeted communication to minority populations. Moreover, differences in worries may be associated with socioeconomic and cultural factors [31]. In particular, more immigrants live in crowded houses and with more intergenerational contact. During the pandemic, there has been a strong increase in unemployed immigrants in Norway because of lay-offs [32]. Thus, many immigrant youths live in families experiencing negative consequences of COVID19.

Limitations
One limitation is that most indicators were based on self-report, and the reliability and validity of many of the items have not been tested. We did not have data on parents' income for cohort 2, and therefore used self-reported family affluence. However, there are indications that subjective assessments of SeS are meaningful measures irrespective of objective family socioeconomic background [33]. furthermore, the characteristics of the parents for the youngest cohort suggest that this was a selected group of youth, whose parents had higher educational level and household income compared to non-consenting parents. This, together with relatively low response rates, warrants caution in interpreting the findings, as they might not be generalisable, and age group differences must be interpreted with caution. On the other hand, a strength of our study is that the sample is populationbased and a probability sample, as opposed to convenience samples. Sleep-related aspects were only assessed in one direction; measuring sleep problems, and not improved sleep quality. One cannot out rule the possibility of improved sleep for some during this period, and this should be assessed in an eventual follow-up study.

Conclusions
Overall, almost half of the youth reported that they were not or only to a little degree impacted by the schools being closed. even so, our results show that a higher proportion of girls, older adolescents, youth with low SeS and youth born outside of Norway experience negative consequences and worries during the first period of the COVID-19 outbreak when schools were closed to limit the spread of the virus. These results may indicate that the need for services for these groups may be accentuated due to ongoing public health measures during the pandemic, especially if these measures impact the daily life of youth; that is, schools closure and physical distancing. given that health and child welfare services for youth and families to a certain extent failed in following up youth during the lockdown, attention to access to relevant services for youth in need is called for in coming waves of a pandemic outbreak.