A Nationwide Study of How a School Reform Differently Affected Adolescents’ Use of Mental Health Services

A Nationwide Study of How a School Reform Differently Affected Adolescents’ Use of Mental Health Services | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A Nationwide Study of How a School Reform Differently Affected Adolescents’ Use of Mental Health Services Siri Folstad, Eivind Ystrom, Ragnhild Nes, Anne Torhild Klomsten, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7780476/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract An adolescent’s school environment is thought to be important for development, yet their influence on use of mental health services remains unclear. Using a national school reform with stepwise implementation, we assessed schools’ contribution to service use. We linked population-wide administrative data - including personal, school and municipal identifiers - with health registry data from 2020 to 2023, covering ≥ 588,111 adolescents across ≥ 2965 Norwegian schools. Reform-by-school interactions were tested using multilevel models with random slopes for schools. On average, the reform reduced service use by 3% but also increased school-level variation: odds of service use increased in some schools and decreased in others. This variation remained significant after controlling for Covid-19 and municipality, increased over time and was stronger for girls. School type, size, and teaching assistant ratio explained 13% of the between-school variation. Future research should examine how individual characteristics interact with schools to shape service use. Biological sciences/Psychology Scientific community and society/Social sciences/Education Scientific community and society/Social sciences/Politics Scientific community and society/Scientific community/Policy Scientific community and society/Social sciences/Society Full Text Additional Declarations There is NO Competing Interest. Supplementary Files SupplementalPDFofExcelFile.pdf A Nationwide Study of How a School Reform Differently Affected Adolescents’ Use of Mental Health Services SupplementaryResults2025091217595887411.xlsx Supplemental Material Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7780476","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":592089893,"identity":"c5bb784e-6ae5-430f-83c8-41febc4a89db","order_by":0,"name":"Siri Folstad","email":"data:image/png;base64,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","orcid":"","institution":"University of Oslo","correspondingAuthor":true,"prefix":"","firstName":"Siri","middleName":"","lastName":"Folstad","suffix":""},{"id":592089894,"identity":"f9741193-5f51-4aa2-bfeb-02ada613d330","order_by":1,"name":"Eivind Ystrom","email":"","orcid":"https://orcid.org/0000-0003-4390-6171","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Eivind","middleName":"","lastName":"Ystrom","suffix":""},{"id":592089895,"identity":"91d977a4-0a43-443a-9bf4-e505f3b43950","order_by":2,"name":"Ragnhild Nes","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Ragnhild","middleName":"","lastName":"Nes","suffix":""},{"id":592089896,"identity":"9fab301a-057d-4925-9c1d-ce9072490a59","order_by":3,"name":"Anne Torhild Klomsten","email":"","orcid":"","institution":"Norwegian University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"Torhild","lastName":"Klomsten","suffix":""},{"id":592089897,"identity":"d68f803f-e718-42b6-9321-33c01d289dce","order_by":4,"name":"Edvoll Maud","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Edvoll","middleName":"","lastName":"Maud","suffix":""},{"id":592089898,"identity":"8f88d644-a9f4-4922-a850-1e47c2609848","order_by":5,"name":"Nikolai Eftedal","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Nikolai","middleName":"","lastName":"Eftedal","suffix":""},{"id":592089899,"identity":"075a0165-370d-41f7-bffe-5743b8dc75e3","order_by":6,"name":"Yuan Fang","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Fang","suffix":""},{"id":592089900,"identity":"328590cf-ce19-4b9c-83cd-3e46a1ce0cd2","order_by":7,"name":"Gunnar Bjørnebekk","email":"","orcid":"https://orcid.org/0000-0003-2176-7393","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Gunnar","middleName":"","lastName":"Bjørnebekk","suffix":""},{"id":592089901,"identity":"0ac1e092-3df1-4db0-9e87-ef6c08fc32c2","order_by":8,"name":"Espen Røysamb","email":"","orcid":"https://orcid.org/0000-0001-5133-7170","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Espen","middleName":"","lastName":"Røysamb","suffix":""},{"id":592089902,"identity":"be3fdbc3-f32f-4cbf-a13a-065b17b29bdc","order_by":9,"name":"Egil Nygaard","email":"","orcid":"https://orcid.org/0000-0002-8865-4265","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Egil","middleName":"","lastName":"Nygaard","suffix":""}],"badges":[],"createdAt":"2025-10-04 14:30:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7780476/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7780476/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104402732,"identity":"5b72046d-4cd6-4817-9590-e99cb76eff23","added_by":"auto","created_at":"2026-03-11 12:16:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":845336,"visible":true,"origin":"","legend":"","description":"","filename":"SiriArticle2MHServiceUse20251004.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7780476/v1_covered_067af51f-c148-4177-9381-f829e85f22bb.pdf"},{"id":104048581,"identity":"fee8e74b-8e82-4413-bc13-070bcede7434","added_by":"auto","created_at":"2026-03-06 06:57:11","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17563177,"visible":true,"origin":"","legend":"A Nationwide Study of How a School Reform Differently Affected Adolescents\u0026#x2019; 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