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Mental health and substance use disorders rose among youth during height of COVID pandemic

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As the COVID-19 pandemic hit one of its most dangerous peaks in 2021, nearly half of young people in the U.S. had a substance use or mental health disorder, a federal survey found. A psychiatry expert says that easier access to illicit drugs and the government’s mishandling of “black box” labeling for psychiatric prescriptions were major contributing factors to the crisis.

The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) conducted its annual survey, released last month, from a pool of 69,850 respondents 12 or older in 2021.

The survey found that 15.3 million young adults age 18 to 25 (45.8%) had either a substance use disorder or co-occurring mental illness in 2021. Additionally, 46.3 million people age 12 or older (16.5%) had a substance use disorder in that year, including 29.5 million who had an alcohol use disorder, 24 million who had a drug use disorder and 7.3 million who had both an alcohol use disorder and a drug use disorder.

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About 57.8% of people 12 or older reported using an illicit drug, alcohol or tobacco in the previous month, which is also defined as someone currently using the drug. Among the 133 million current alcohol users age 12 or older, a little over 45% were past-month binge drinkers. Among current binge drinkers, over 16 million were currently heavy drinkers.

Dr. Arif Khan, a psychiatrist, adjunct professor of psychiatry at the Duke University School of Medicine and medical director at Northwest Clinical Research Center in Bellevue, Wash., told Yahoo News that easy access to substances like cannabis since its decriminalization and legalization in many U.S. states has worsened the substance use crisis among the youth.

“We are going through a social experiment with marijuana with no guardrails,” Khan said. “There are four times as many people smoking or taking marijuana. So it's the children who are suffering, adolescents especially. In some instances, marijuana is easier to access than tobacco for teenagers now. There are a lot of websites that parents don't know about that advocate all kinds of drug use.”

The SAMHSA survey also highlighted findings in mental health disorders among adolescents and young adults, revealing that about 1 in 5 young people between the ages of 12 and 17 had a major depressive episode in 2021, and almost 15% had a past-year major depressive episode with severe impairment.

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Among adolescents 12 to 17 in 2021, 12.7% had serious thoughts of suicide, almost 6% percent made a suicide plan and over 3% attempted suicide. The survey has a disclaimer that these estimates are “conservative” because children 12 to 17 were given the response options “I’m not sure” and “I don’t want to answer,” which were not options for adults.

In 2021, most children 12 to 17 reported that the COVID-19 pandemic had a negative effect on their mental health. About 1 in 5 adolescents in that age range said the pandemic negatively affected their mental health “quite a bit or a lot,” and about 47% perceived “a little or some” negative effect on their mental health. Additionally, about 45% of young people 12 to 17 who had a major depressive episode, and 51% of those who had a major depressive episode with severe impairment, were more likely than those without a major depressive episode to respond that the pandemic negatively affected their mental health “quite a bit or a lot.”

Khan points to the lack of access to mental health care and the isolation of the pandemic as factors that exacerbated social disconnection even more.

“Socialization affected all these children, anywhere from ages 3 and up,” Khan told Yahoo News. “I would say socialization has become much more difficult for them to form relationships. Certainly for adolescents, a sense of belonging is a big issue for them. So that's gonna be some of the things to watch out for. But it's hard to say how different communities and how different regions will handle it.”

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Khan also noted the controversy over the decision by the Food and Drug Administration in 2004 to require a “black box” warning — the strongest warning under FDA regulations — on antidepressants, flagging the risk of suicidality in children and adolescents. The black box warning is a label alerting consumers that an approved prescription medication can have serious and potentially fatal side effects.

“The federal government, certainly the FDA, is inhibiting proper mental health diagnosis and management because they're sort of labeling treatments to be dangerous when they're not,” Khan said. "So when you have a black box on any medicine, then its usage goes down. So some pediatricians refuse to diagnose, and they don't refer kids to proper care. So what happens is that these kids are falling through the cracks.”

Khan pointed to a study published in October 2020 in the journal Psychiatric Research and Clinical Practice that found an uptick in suicide deaths among adolescents and young adults after the FDA issued warnings about antidepressant use and possible suicidal ideation.

“The diagnosis of psychiatric disorders has become very contentious,” Khan said. “It's mostly because the FDA put a label on antidepressants and similar medications on use in children, which is significantly prohibited. The suicide rates have doubled in the last 20 years or so, 18 years since the FDA put the label on medications. It's not that the medications themselves are responsible, it is just that no pediatrician or psychiatrist wants to make the diagnosis of mood disorders because then they'll have to prescribe, and then have to deal with this black label.”

Yahoo News reached out to the FDA for comment.

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“These warnings were well intended,” Stephen B. Soumerai, a professor of population medicine at the Harvard Medical School and Harvard Pilgrim Health Care Institute and one of the authors of the Psychiatric Research and Clinical Practice study, told Yahoo News. “They [the FDA] saw an association between these drugs and suicidal thinking,” he said, adding that the studies are flawed.

Then, Soumerai said, “a slew of papers start[ed] coming out and saying, ‘The risk communication may be worse than the drug.’ You're scaring people away from mental health care. If that's happening, it very well may be that the adverse effects of excessive risk communication may be denying needed mental health care. That, in turn, leads to the very thing they were trying to prevent, which is suicidal behavior.”

According to the National Alliance on Mental Illness, suicide is the second leading cause of death for U.S. citizens between the ages of 15 and 24, with almost 20% of high school students reporting serious thoughts of suicide and almost 1 in 10 kids attempting to take their lives.

“The FDA warnings had a stunning effect on reducing doctor visits for depression, among the diagnosis of depression among youth, and any medication treatment among youth,” said Ross Koppel, a professor of medical informatics and an adjunct professor of sociology at the University of Pennsylvania and a professor of biomedical informatics at SUNY Buffalo. “So the FDA warnings had massive unintended consequences that were terribly deleterious to youth in creating a significant increase in youth suicides.”

Koppel is working with Soumerai on a new study regarding the black box label.

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The SAMHSA survey revealed that of the 40.7 million people 12 or older with an illicit drug or alcohol use disorder in 2021 who did not receive treatment at a specialty facility, almost 97% felt they did not need treatment and just 2% felt they needed treatment but did not seek the help needed. Just over 1% felt they needed treatment and made an effort to get it. About 19% of young adults 18 and older received inpatient or outpatient mental health services or prescription medication or sought help from virtual services.

“One of the most vulnerable periods is your teenage years, when all these things start,” Khan said. “So parents need to be aware and watch for changes. You have to ask the kid, otherwise you would never know. You can't just also say, 'Well, that's part of growing up.' No, it's not. If somebody starts to behave very oddly out of character, then there's something more than just growing up.”