Insurance claims for mental health and substance use conditions have more than doubled in the last decade, a new report found. And the increase is driven largely by teens and young adults.

The report was published this month by FAIR Health, a health care nonprofit. Here are the highlights:

The context

Reported rates of depression and anxiety among Americans have been increasing in recent years, with the most prominent growth seen among youth. More children, teens, and young adults are going to hospital emergency rooms for psychiatric concerns, including self-injury, like cutting. Suicide rates are also up, with rates of self-poisoning particularly surging among teenage girls.

At the same time, the nation has been hit hard by the opioid epidemic. More than 72,000 Americans died from drug overdoses in 2017 — double the number a decade earlier, the report states.

Experts caution that the rising rates of mental illness and substance use could be the result of different data collection methods, and not a true indicator of change. Reduced stigma might lead people to report their conditions more accurately today than in the past, they say.

And with more people insured since the passage of the Affordable Care Act (ACA), individuals might have better access and ability to afford treatment, experts say. The ACA required insurers to cover behavioral health the same way they would medical or surgical care.

Others point to economic uncertainty and the rise of social media as potential factors that could truly be making people, especially youth, more anxious and depressed. The research on this topic is still fiercely debated.

The data

The report is based on FAIR Health’s database of more than 28 billion private health care claim records. The organization said that data represents three-quarters of the private insurance market.

The database does not include public insurance claims.

Researchers analyzed claims for behavioral health care, which includes both mental health and substance use disorder treatment.

The results

Mental health

The most common diagnosis among mental health claims was major depressive disorder, which made up 26 percent of claims in 2017.

There was a significant increase in major depressive disorder among people under 22 during the 10-year study period. In 2007, young people accounted for 15 percent of all claims tied to serious depression. By 2017, they accounted for 23 percent.

Of all mental health diagnoses, generalized anxiety disorder saw the greatest increase from 2007 to 2017, rising from 12 percent to 22 percent of all mental health claims.

Substance use

In 2007, alcohol dependence was the most common substance use disorder diagnosis, accounting for 30 percent of claims. But by 2017, opioid dependence surpassed it, accounting for 37 percent of claims while alcohol accounted for 28 percent.

Children under 18 had the most claims for cannabis abuse, suggesting a growing popularity of marijuana among youth.

The caveats

The report used claims only from private insurers, so it does not represent the entire population. Those with public insurance or people who are uninsured were not included.

Experts caution that the increase in mental health claims does not necessarily indicate an increase in mental illness. A number of factors could be making people more likely to seek care. They include:

  • Increased awareness about mental health issues and how to identify them.

  • Decreased stigma around seeking help for mental health conditions.

  • In 2009, the U.S. Preventive Services Task Force recommended universal screening for depression for adolescents ages 12 and older.

  • In 2008, Congress passed the Mental Health Parity and Addiction Equity Act that required many insurers to cover mental health and addiction treatment the same way they would medical or surgical care.

  • The Affordable Care Act allowed young people to stay on their parents’ insurance through age 26.

Next steps

Researchers are continuing to study the increase in reported mental illness, whether or not it reflects a true change, and what might be causing it.

At the same time, the mental health care field is struggling to meet the need for services. Different groups of providers, like psychiatric nurses, are trying to find ways to help fill the gap.