Research Review

Study Paints Alarming Picture of Self-Harm

In March and April 2020, mental health claim lines for individuals aged 13 to 18, as a percentage of all medical claim lines, approximately doubled over the same months in the previous year. (A claim line is an individual service or procedure listed on an insurance claim.) At the height of the spring wave of the COVID-19 pandemic, this rise in mental health claim lines amounted to 97% 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.

In those same months of March and April 2020, all medical claim lines (including mental health claim lines) decreased by approximately one-half (53.3% in March 2020 and 53.4% in April 2020), FAIR Health found. That pattern of increased mental health claim lines and decreased medical claim lines continued through November 2020, though to a lesser extent.

Defining the pediatric population as individuals aged 0 to 22 years, and focusing on the age groups 13 to 18 years and 19 to 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 health care claim records, tracking month-by-month changes from January to November 2020 compared with the same months in 2019. Aspects of pediatric mental health investigated include overall mental health, intentional self-harm, overdoses and substance use disorders, top mental health diagnoses, reasons for emergency department visits and state-by-state variations.

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. It is striking, therefore, that one component of medical care, mental health care, increased significantly even while overall medical care was falling.

Other findings reported in the white paper include the following:

• Comparing August 2019 to August 2020 in the Northeast, for the age group 13 to 18, there was a 333.93% increase in intentional self-harm claim lines as a percentage of all medical claim lines, a rate higher than that in any other region in any month studied for that age group.
• Claim lines for intentional self-harm as a percentage of all medical claim lines in the 13 to 18 age group increased 90.71% in March 2020 compared with March 2019. The increase was even larger when comparing April 2020 with April 2019, nearly doubling (99.83%).
• For the age group 13 to 18, claim lines for overdoses 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 of all medical claim lines in March (64.64%) and April (62.69%) 2020 as compared to their corresponding months in 2019.
• For the age group 6 to 12, from spring to November 2020, claim lines for obsessive-compulsive disorder and tic disorders increased as a percentage of all medical claim lines from their levels in the corresponding months of 2019.
• For the age group 13 to 18, in April 2020, claim lines for generalized anxiety disorder increased 93.6% as a percentage of all medical claim lines over April 2019, while major depressive disorder claim lines increased 83.9% and adjustment disorder claim lines 89.7%.
• In general, the age group 19 to 22 had mental health trends similar to but less pronounced than the age group 13 to 18.

FAIR Health President Robin Gelburd states: "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 payers."

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 health care 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.

Source: FAIR Health