Mental health insurance claims for US teens roughly doubled early in the COVID-19 pandemic over the same period in 2019, according to a Fair Health report released yesterday.
The white paper, the New York nonprofit's seventh in a series on the pandemic, is the result of analysis of more than 32 billion private healthcare claims filed on behalf of people aged 0 to 22 from January to November 2020 compared with those filed during the same period in 2019.
The study found that mental health claims for patients aged 13 to 18 skyrocketed 97.0% in March and 103.5% in April 2020. In contrast, medical claims fell 53.3% in March and 53.4% in April. The pattern of increased mental health claims and lower medical claims held though November 2020, but to a lesser degree. Mental health claims remained at least 19% higher in 2020 than in 2019.
"The decrease in all medical claim lines is likely due to widespread restrictions on nonemergency medical care in spring 2020 and continuing avoidance of such care even after restrictions were lifted in May," a Fair Health news release noted. "It is striking, therefore, that one component of medical care, mental healthcare, increased significantly even while overall medical care was falling."
Self-harm, overdose, schizophrenia
Among the 13-to-18 age-group, claims for self-harm (eg, cutting, crashing a vehicle, attempted suicide) ballooned 333.93% in August 2020 over August 2019 in the Northeast—the highest rate of self-harm seen in the analysis. Overall in the United States in March 2020, self-harm claims in that age-group rose 90.7% over the same month in 2019 and nearly doubled (99.8%) from April 2019 to April 2020.
Compared with March and April 2019, overdose-related health claims among 13- to 18-year-olds climbed 94.9% and 119.3%, respectively, in 2020. Similarly, substance use disorder claims in this age-group rose in March (64.6%) and April (62.7%) 2020, as did claims for generalized anxiety (93.6% increase over April 2019), major depressive disorder (83.9%), and adjustment disorder (89.7%). In 2019, mental health-related conditions were the seventh most common reason for emergency department visits among those 13 to 18 but became the sixth most common reason in 2020.
Nineteen- to 22-year-olds followed similar but less dramatic patterns as for those 13 to 18, with a jump in mental health claims in March (67.1%) and April (74.9%) 2020 and a concomitant decrease in medical claims of 40.1% and 38.1%, respectively. Claims for emergency department visits for schizophrenia among this age-group, however, increased 61.3% in April 2020 over the same month in 2019, as did those for panic disorders (43.8% increase in May 2020 over 2019) and bipolar disorder (63.2% increase in May).
Among 6- to 12-year-olds, claims for obsessive-compulsive disorder increased over 2019 beginning in March (26.8%) and persisted through November, as did claims for tic disorder (28.7%). The authors noted that this age-group was not a focus of this study.
Before the pandemic, females accounted for 66% of mental health claims in 13- to 18-year-olds, but starting in March 2020, claims made on behalf of females rose to account for 71% in November. Likewise, before the pandemic, women aged 19 to 22 accounted for 65% of mental health claims, climbing to 71% in November 2020.
An especially vulnerable time of life
"The COVID-19 pandemic has had a profound impact on mental health," the authors of the report wrote. "Infection-related fears, bereavement, economic instability and social isolation have triggered and exacerbated mental health issues."
And while adults have also reported that COVID-19–related fears and stress have impaired their mental health, young people have been particularly susceptible because of school closures and distance learning, the inability to interact closely with friends, stress, and loneliness.
"The findings in this report have implications for all those responsible for the care of young people, including providers, parents, educators, policy makers and payors," the report said. "Fair Health hopes that these findings will also be starting points for further research in the field of pediatric mental health during the COVID-19 pandemic."