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During the pandemic, teens' mental health services accounted for a much greater proportion of all their medical claims than in the past, especially last March and April, according to .

Mental health claims essentially doubled as a percentage of all medical claims for individuals age 13-18 in March (+97%) and April (+103.5%) of 2020 compared with the same periods a year earlier, the report said. Medical claims overall fell by about half during that time.

"We clearly see a reduction in people accessing medical care, particularly in March and April, but we see a continued utilization of mental health services during that period," Robin Gelburd, president of FAIR Health, told 麻豆传媒. "The need for mental health services persisted and in some ways increased during that period."

That pattern persisted through the end of November 2020 -- the last month examined in the study -- but to a lesser extent, according to the report.

Jess Shatkin, MD, MPH, of the Child Study Center at NYU Langone Medical Center in New York City, said while the data aren't surprising, they "speak to something we've all been concerned about."

"We know that teenagers already have high rates of mental illness," Shatkin told 麻豆传媒. "Now [with the pandemic], their parents are starting to struggle, with relationships, jobs, food security. It just ups the ante. We already see vulnerability and this just makes them more vulnerable."

Gelburd noted that much of mental healthcare delivered to teens was done via telehealth, representing a sea change from pre-pandemic times.

In January of 2020, fewer than 2% of mental health services in this age group were performed via telehealth, but by April telehealth visits surged to 70% of care, remaining at that level through the end of the study period in November.

"It shows the seismic shift in our healthcare system as the result of the pandemic," Gelburd said. "For teens this has probably been a critical lifeline for them."

Shatkin noted that mental health parity policies have made it easier to be reimbursed for mental health visits conducted via telehealth during the pandemic, though it's not clear whether those policies will be sustained long-term.

"There's no question telehealth has, in most cases, made things better," he said. "I've had so many patients say it's amazing, that we're so much more accessible."

The FAIR Health team also found that gender disparities in mental health services that existed before the pandemic were widened. While girls accounted for two-thirds of mental health claim lines prior to the pandemic, the percentage of claims attributed to females climbed from March on, hitting 71% in November 2020.

"These results are generally consistent with other researchers' findings that women are nearly twice as likely as men to be diagnosed with mental illness," the report indicated.

Looking at specific categories of mental health claims, the report showed a huge jump in intentional self-harm claims as a percentage of all medical claims, rising 91% in March and nearly doubling in April of 2020 compared with the year prior.

Again, women were up to 5 times as likely as males to be treated for intentional self-harm, involving means such as drowning, firearms, smoke or fire, sharp objects, and crashing a motor vehicle.

Claims for overdose among teens rose 95% in March and 119% in April of 2020 versus those months in 2019, and substance use increased 65% and 63%, respectively. Those trends are consistent with recent CDC reporting that found the highest number of U.S. overdose deaths ever recorded in a 12-month period (over 81,000) for the 12 months ending May 2020. Overdose deaths were already increasing before the pandemic, but the rate certainly accelerated.

Generalized anxiety disorder claims were up 94%, major depressive disorder claims were up 84%, and adjustment disorder claims rose 90% in April 2020 over the year prior, they reported. While these three conditions were consistently the top three prior to the pandemic, other disorders shifted in prominence. For instance, eating disorders moved from sixth to fifth in August 2020 and stayed there through November, the report said.

Overall trends were similar for adolescents ages 19 to 22, but were less pronounced than for 13- to 18-year-olds.

As well, for kids ages 6 to 12, claim lines for attention deficit hyperactivity disorder (ADHD) dropped off as a percentage of all medical claims from January to November 2020, compared with the year prior.

"Often times, the diagnosis of ADHD results from a teacher recommending to a parent to get a child evaluated based on observations in the classroom," Gelburd said. "But because so much schooling was virtual, it was an interesting sidebar that those recommendations really decreased."

For their analysis, FAIR Health assessed claims data from its database of more than 32 billion claim records from private health insurers.

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