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Abstract Objective To investigate whether changes in youth\'s mental health were dependent on housing conditions during the initial Danish national COVID-19 lockdown. Design Cohort Setting The Danish National Birth Cohort (DNBC) at participants\' 18th year of life and subsequently three weeks into the initial national lockdown (April 2020) Participants 7445 youth aged 18 to 23 Exposure Housing conditions measured as direct access to outdoor spaces, urbanicity, household density, and household composition during the lockdown. Main outcome measures Comparisons of before and during lockdown mental health parameters measured as adjusted mean difference and 95 % confidence intervals (CI) for changes in scores of mental well-being (Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS)) and Quality of Life (QOL; adapted Cantril ladder). Adjusted odds ratios (OR) and 95 % CI for onset of low mental well-being (score [≤]20), low QoL (score [≤]5), and loneliness. Results Participants had a median age of 20 years at lockdown and were predominantly female. Youth without direct access to outdoor spaces had a greater decrease in mental well-being compared to those with a garden, mean difference: -0.83 (95 % CI -1.19,-0.48), and correspondingly greater odds of onset of low mental well-being, OR: 1.68 (95 % CI 1.15, 2.47). Youth in higher density households and those living alone also had greater odds of onset of low mental well-being (OR: 1.23 (95 % CI 1.05, 1.43) and OR: 1.47 (95 % CI 1.05, 2.07), respectively). Onset of low QoL was associated with living in denser households, as well as living alone. Living alone more than doubled odds of onset of loneliness, OR: 2.12 (95 % CI 1.59, 2.82). Conclusion Youth\'s mental health declined from before the pandemic to three weeks into the initial national lockdown. However, not all youth were equally affected and our findings inform policy makers that youth living alone, in denser households, and without direct access to outdoor spaces are especially vulnerable.
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