A new analysis of U.S. health insurance claims by the independent nonprofit FAIR Health reveals a sharp increase in mental health-related illnesses among teenagers since the onset of the pandemic.

The data analyzed by Fair Health show that while overall medical claims for teens decreased since March 2020, the need for mental healthcare skyrocketed — making it safe to say that America’s teens are not OK.

During the height of the pandemic in March – April 2020, mental health claims among teens increased as a percentage of all medical claims by 97% and 103.5% over the same months the previous year.

Medical claims not related to mental health decreased 53.3% and 53.4% during the same months.

This pattern of increased mental health claims continued through November 2020, though the extent of change in late 2020 compared with late 2019 was lower than in March and April, according to FAIR Health’s new white paper, “The Impact of COVID-19 on Pediatric Mental Health: A Study of Private Healthcare Claims.”

FAIR Health studied the effects of the pandemic on U.S. pediatric health, focusing specifically on age groups 13-18 and 19-22. Researchers analyzed data from the nonprofit’s database of more than 32 billion private healthcare claim records. They tracked month-by-month changes from January 2020 to November 2020 and compared the numbers to the same months in 2019.

Researchers  explored overall mental health, intentional self-harm, overdoses and substance use disorders, top mental health diagnoses, reasons for emergency room visits and state-by-state variations.

“We see [increased] depression and anxiety in all age groups, but in adolescence it’s on steroids,” Robin Gurwitch, psychologist and professor at Duke University Medical Center told TIME: “When kids look into the future now, they’re looking at one that wasn’t what they envisioned before.”

Here are the key findings, as reported in the white paper:

  • Before the pandemic began, females accounted for 66% of total mental health claims in ages 13-18. From March onward, the percentage climbed to 71% in females compared to 29% in males. The results were consistent with established research that females are almost twice as likely as males to be diagnosed with mental illness.
  • Claim lines for intentional self-harm as a percentage of all medical claim lines in the 13-18 age group increased 90.71% in March 2020 compared to March 2019 and nearly doubled to 99.83% in April 2020 as compared to 2019.
  • Month-by-month gender analysis of intentional self-harm claims from January to November 2020 showed that females in the 13-18 age group were 2.5 to 5 times as likely to be treated for intentional self-harm as males and at the height of disparity in August, were 84% of the distribution compared to males at 16%.
  • Claim lines for overdoses in the 13-18 age group increased 94.91% as a percentage of all medical claim lines in March 2020 and 119.31% in April 2020 over the same months the year before. Claim lines for substance use disorders also increased as a percentage in March (64.64%) and April (62.69%) 2020 as compared to their corresponding months in 2019.
  • Anxiety disorder among ages 13-18 increased in April 2020 to 93.6% of all medical claim lines compared to April 2019, major depressive disorder increased 83.9% and adjustment disorder increased 89.7%.
  • The 19-22 age group had similar mental health trends, though less pronounced than the 13-18 group.
  • Fair Health also separated mental health claims into regions. For the 13-18 age group in the Northeast, there was a 333.93% increase in intentional self-harm claim lines as a percentage of all medical claim lines –– a rate higher than any other region.

According to the analysis, the decrease in all medical claim lines was likely due to widespread restrictions on non-emergency medical care in spring 2020 and continued avoidance of care after restrictions were lifted.

The significant increase in mental healthcare while overall medical care was falling suggests the increase in mental health issues was brought on by the pandemic in the 13-18 age group.

A growing number of studies support FAIR Health’s findings:

A study published March 1 in the Official Journal of the American Academy of Pediatrics showed a significantly higher rate of suicide ideation in March and July 2020 and higher rates of suicide attempts in February, March, April and July of 2020 as compared with the same months in 2019. These months correspond to times when COVID-19 stressors and community responses were heightened.

A Danish study in BMC Psychiatry found that children and adolescents showed a worsening of obsessive compulsive disorder symptoms, as well as anxiety and depressive symptoms during the pandemic.

An Italian study published in Frontiers of Psychiatry found a worsening of symptoms, including tics, in children and adolescents with Tourette syndrome during the pandemic.

Since the COVID pandemic began in March 2020 and schools closed their doors, reports of suicidal thoughts, attempts and cries for help among children have increased significantly across the nation, according to numerous studies and media reports, The Defender reported in February.

This is the seventh in a series of studies released by FAIR Health on the COVID-19 pandemic, but the first to focus entirely on the mental health of teens.