The Consequences of the Choices We Make

The Consequences of the Choices We Make article by Dr. Sam Goldstein

In March and April 2020, mental health claims for teens aged 13-18 in the United States, as a percentage of all medical claims, approximately doubled over the same months in the previous year. At the height of the spring wave of the COVID-19 pandemic, this rise in mental health claims amounted to 97.0% in March and 103.5% in April! These are among the many findings in FAIR Health's new white paper, the seventh in its COVID-19 studies, The Impact of COVID-19 on Pediatric Mental Health: A Study of Private Healthcare Claims. FAIR Health is a national, independent not-for-profit organization dedicated to bringing transparency to healthcare costs and health insurance information. A white paper is a report or guide that informs readers concisely about a complex issue and presents the issuing body's philosophy on the matter. In those same months of March and April 2020, all medical claims (including mental health claims) decreased by approximately half (53.3% in March 2020 and 53.4% in April 2020). That pattern of increased mental health claims and decreased medical claims continued through November 2020, though to a lesser extent.

In a number of my articles published last year I commented on my thoughts about the mental and physical health challenges facing ourselves and our children as a consequence of the choices made to control the spread of the COVID-19 virus. In March 2020 I wrote about Corona Virus Stress Syndrome (COVIS) and a set of mental health consequences as the fallout of closing schools, shutting down commerce and quarantining all of us. In April 2020 I reviewed the research on the adverse impact to mental and physical health caused by elevated cortisol levels as a consequence of extended stress. Finally, in July 2020 I discussed the research examining the impact of chronic stress on thinking and problem solving. It has been my opinion that the adverse, untoward consequences of our efforts to control this Pandemic will result in the deaths of far more people of all ages than COVID-19 will eventually kill.

Defining the pediatric population as individuals aged 0-22 years, and focusing on the age groups 13-18 years and 19-22 years, FAIR Health studied the effects of the COVID-19 pandemic on US pediatric mental health. To do so, FAIR Health analyzed data from its database of over 32 billion private healthcare claim records, tracking month-by-month changes from January to November 2020 compared to the same months in 2019. Aspects of pediatric mental health investigated included overall mental health, intentional self-harm, overdoses and substance use disorders, mental health diagnoses, reasons for emergency room visits and state-by-state variations.

The initial decrease in all medical claims 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. It is striking, therefore, that one component of pediatric medical care, mental healthcare, increased significantly even while overall medical care was falling.

Other findings reported in this white paper include:

  • Comparing August 2019 to August 2020 in the Northeast United States, for the age group 13-18, there was a 333.93% increase in intentional self-harm claims as a percentage of all medical claims, a rate higher than that in any other region in any month studied for that age group.
  • Claims for intentional self-harm as a percentage of all medical claims in the 13-18 age group increased 90.71% in March 2020 compared to March 2019. The increase was even larger when comparing April 2020 to April 2019, nearly doubling (99.83%).
  • For the age group 13-18, claims for overdoses increased 94.91% as a percentage of all medical claims in March 2020 and 119.31% in April 2020 over the same months the year before. Claims for substance use disorders also increased as a percentage of all medical claims in March (64.64%) and April (62.69%) 2020 as compared to their corresponding months in 2019.
  • For the age group 6-12, from spring to November 2020, claims for obsessive-compulsive disorder and tic disorders increased as a percentage of all medicals from their levels in the corresponding months of 2019.
  • For the age group 13-18, in April 2020, claims for Generalized Anxiety Disorder increased 93.6% as a percentage of all medical claims over April 2019, while Major Depressive Disorder claims increased 83.9% and adjustment disorder claims 89.7%. Keep in mind a large body of research supports that multiple depressive episodes during adolescence increases the risk of multiple depressive episodes life time. This suggests that the current teen generation may be kindling higher rates of depression for their next sixty years.
  • In general, the age group 19-22 had mental health trends similar to but less pronounced than the age group 13-18.

This is the seventh in a series of studies released by FAIR Health on the COVID-19 pandemic. The first study examined projected US costs for COVID-19 patients requiring inpatient stays, the second the impact of the pandemic on hospitals and health systems, the third the impact on healthcare professionals, the fourth key characteristics of COVID-19 patients, the fifth the impact on the dental industry and the sixth risk factors for COVID-19 mortality. FAIR Health President Robin Gelburd stated: "The COVID-19 pandemic has had a profound impact on mental health, particularly on that of young people. The findings in our new report have implications for all those responsible for the care of young people, including providers, parents, educators, policy makers and payors."

Ellen Hopkins wrote “Life is full of choices. We don’t always make good ones.” The next ten years will illuminate whether the choices we’ve made or have been made for us in the past fourteen months will lead our children and ourselves to pay a much higher price than anticipated. For now, we need to ramp up our research while simultaneously calling upon public and private agencies to make sure we and our children have access to mental health care. As of today, I still have not located any monies allocated for increased mental health care in the 1.9 trillion-dollar aide package being debated in Congress. President Biden reiterates that “we are all hurting” but thus far little effort appears to be directed to calm the “hurt”, support our children and get them back into school. Maybe it’s because they don’t vote, but we do. Its’ time for us to write or call our Senators and Congress persons. ◆

Related Articles:

Corona Virus Stress Syndrome

Stress and the COVID-19 Pandemic

Thinking Clearly in Stressful Times