title: Municipal-level differences in depressive symptoms among adolescents in Norway: Results from the cross-national Ungdata study.
abstract: OBJECTIVE
  This study aimed to investigate municipal-level variations and individual- and municipal-level predictors of high levels of depressive symptoms among Norwegian adolescents.
  
  
  METHODS
  We used data from the Norwegian cross-national Ungdata study. We included 77,424 adolescents from 171 municipalities attending junior high school (Grades 8-10; age 13-16 years) from 2011 to 2013. Multilevel (two-level) logistic regression models were applied for the data analyses.
  
  
  RESULTS
  The study revealed that 11% of adolescents reported high levels of depressive symptoms. The median odds ratio without adjusting for any individual- or municipal-level predictors was 1.24, indicating a small between-municipalities variability for high levels of depressive symptoms. All individual-level factors, such as gender, school grade, family income, substance use behaviours, bullying and dissatisfaction with different aspects of life, were significantly associated with high levels of depressive symptoms (p < 0.05). As to municipal-level factors, a low annual budgets for municipal health services was the sole significant predictor of high levels of depressive symptoms between municipalities. Municipal-level factors and variables related to survey characteristics explained a moderate proportion of the variation in high levels of depressive symptoms between municipalities.
  
  
  CONCLUSIONS
  The cluster heterogeneity in high levels of depressive symptoms was small between municipalities in Norway. Further research should examine the geographic clustering of mental health problems at the school and neighbourhood level.
authors.affiliation: Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Norway dawit.s.abebe@nova.hioa.no.
authors.forename: Dawit Shawel
authors.initials: DS
authors.lastname: Abebe
authors.affiliation: Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Lars Roar
authors.initials: LR
authors.lastname: Frøyland
authors.affiliation: Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Bakken
authors.affiliation: Norwegian Social Research (NOVA), Oslo and Akershus University College of Applied Sciences, Norway Department of Psychology, University of Oslo, Norway.
authors.forename: Tilmann
authors.initials: T
authors.lastname: von Soest
mesh_terms: D000293:Adolescent; D002947:Cities; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D055361:Multilevel Analysis; D009664:Norway / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Adolescent; depressive symptoms; geographical inequality; municipal