Socioeconomic Differences in Student Mental Health Following a Nationwide Curriculum Reform

Background

Universal school curriculum reforms may affect adolescent mental health inequalities, but evidence on socioeconomic heterogeneity is limited.

Objectives

Norway introduced a nationwide curriculum reform in 2020 (LK20), including health and life skills as a mandatory cross-curricular theme. We examined whether LK20 exposure was associated with the incidence of mental disorders and whether associations differed by family socioeconomic status(SES), school SES, or their combination.

Methods

We conducted a quasi-experimental cohort study using linked Norwegian registry data (2020–2023), including ∼1.3 million student-year observations across 548,406 students and 2,584 schools. Poisson models with school, year, and grade fixed effects estimated incidence rate ratios (IRRs). Effect modification was assessed by household income, wealth, parental education, working hours, and immigrant background, with additional analyses stratified by school SES.

Preliminary Results

Each additional year of LK20 exposure was associated with a lower incidence of mental disorders (IRR = 0.980, 95% CI: 0.961–0.999). Sensitivity analyses suggested a non-linear pattern, with stronger associations after ≥3 years of exposure. Household income, wealth, and parental education did not modify the associations. An interaction with parental working hours was observed (IRR = 1.008, p = .005) but was not replicated in sensitivity analyses. The association between LK20 exposure and disorder incidence was broadly similar across school SES strata, although among immigrant-background students, the inverse association was stronger in low-SES than high-SES schools (p for difference = .007).

Conclusions

LK20 was associated with a lower incidence of mental disorders among adolescents. Associations were largely similar across family and school SES indicators; however, the stronger association observed among immigrant-background students in low-SES schools warrants further investigation.

Key messages

• LK20 exposure might be associated with a slightly lower incidence of adolescent mental health disorders, with limited evidence of socioeconomic differences.

• Universal school reforms may improve adolescent mental health without widening socioeconomic inequalities.