Pandemic-related changes in anxiety among Finnish adolescents – are there resilient schools?

Abstract Background The COVID-19 pandemic affected adolescent mental health, while the role of school level factors in this effect has studied less. We investigated the trend and pandemic-related changes in adolescent anxiety symptoms in 2013-2023 and the characteristics that identify the most resilient schools. Methods We use data from the Finnish School Health Promotion (SHP) study with 791 lower secondary schools from 2013 to 2023 with 483742 participants (50.2% girls; mean age 15.3). Anxiety was measured with Generalized Anxiety Scale-7. School level factors linked from the national TEAviisari data source included school size, and number of psychologists and school social workers per 100 students. Class atmosphere and perceived teacher attitudes towards students were aggregated from SHP student level responses to school level variables. Analyses were done with linear mixed models. Results There was a linear trend of slightly increasing anxiety symptoms before the pandemic. Against this trend, the pandemic effect on anxiety levels was strong (regression coefficient 1.13, p < 0.001), with no signs of recovery in 2023 (1.38, p < 0.001). The variance of anxiety symptoms attributable to the school level was small, albeit significant (p < 0.001). School size or number social workers did not associate with anxiety symptom levels. Better class atmosphere (-0.24, p < 0.001) and teacher attitudes (-0.23, p < 0.001) were associated with lower levels of anxiety. Interaction analyses indicated a more pronounced pandemic effect on increased anxiety symptoms in students from schools in the lowest quartile on psychologist resources (p = 0.018) or poorer teacher attitudes (p = 0.018). Conclusions The results suggest a relatively modest role for school-related factors to mitigate temporal environmental pressures on adolescent anxiety. Smaller psychologist resources and poorer teacher attitudes seemed to characterize non-resilient schools in the face of a pandemic. Key messages • The pandemic effect on increased adolescent anxiety in 2021 was strong with no signs of recovery in 2023. One contributing factor might have been poor school personnel resources and attitudes. • In times of crises, policy measures need to ensure adequate personnel resources for schools. This contributes to the resiliency of the schools and in turn better mental health of the adolescents.