Millennials are less healthy than the generation before them, and the difference — particularly in Philadelphia — is driven by mental illness, substance use disorders, and endocrine conditions such as diabetes, according to a report released Wednesday by the Blue Cross Blue Shield Association.
The report, part of the association’s Health of America series that has published more than 25 studies, is the first to focus exclusively on millennials, who were 21 to 36 years old in 2017, when the data were collected.
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Analysts used insurance claims data from 55 million millennials to determine the health index of the population. A score of 100 represents optimal health. Conditions that negatively impact quality of life or lifespan decrease that score.
Although most millennials are relatively healthy, the report found those 34 to 36 had higher prevalence rates for nearly all of the top 10 health conditions than members of Generation X when they were in the same age range. (Generation X refers to individuals born between 1965 and 1980.)
And all of those conditions have become more common among millennials in the last three years.
That means higher rates of major depression, hyperactivity, type 2 diabetes, and substance use disorders — all of which can significantly affect health, the cost of health care, and the nation’s workforce, said Richard Snyder, chief medical officer of Independence Blue Cross.
The impact of those conditions starts taking a toll, on average, as early as age 27.
“It doesn’t suddenly happen at age 50 or 60,” Snyder said. “These things start earlier if you’re not living a healthy lifestyle or are genetically predisposed.”
Millennials in Philadelphia are particularly hard hit by behavioral health conditions, which have a 14 percent greater negative impact here than the nation as a whole.
Snyder said it’s not surprising, since Philadelphia is the poorest major city in the country, and difficult economic conditions have been shown to affect people’s mental health.
“A lot of people here are living in a stressful environment,” he said. They face economic uncertainty, a lack of opportunities, and the impact of crime on their communities.
Nationwide, millennials may be more vulnerable to depression and anxiety due to a decrease in human contact driven by social media, Snyder said. Some studies support that assertion, and others found the same factors that predispose people to depression and anxiety also lead them to use social media more.
There’s also the question of how much of the increase is due to better data collection methods, Snyder said. Doctors used to be reluctant to use billing codes for mental health diagnoses that might embarrass patients, he said. As the stigma around mental health decreases, it’s possible more young people are seeking care and doctors are coding it accurately.
There is also more screening of mental illness today, meaning people who might have fallen through the cracks in previous generations are now being treated, Snyder said.
Greater identification of mental illness has led to its own set of challenges, though. There is a shortage of psychiatrists nationally, and people can often wait weeks or months to get an appointment. Studies have also shown that many insurance plans have few in-network mental-health providers, forcing people to pay high fees for an out-of-network provider or skip treatment altogether.
As demand continues to grow, “we need to reengineer the health-care delivery system to take care of these patients with a small supply of specialists,” Snyder said.
Part of that solution may involve online health platforms, to which millennials are very receptive, he said.
Independence Blue Cross recently launched a program for members called On to Better Health, which provides online screening for anxiety, depression, insomnia, chronic pain, obsessive-compulsive disorder, and substance use disorder.
If patients score from mild to moderate on the screening survey, they are referred to online cognitive behavioral therapy programs. Research has shown these programs can be just as effective as in-person therapy. Those who score in a more severe range get a call from a case manager to discuss other treatment options.
“We think this can fill the space between just looking things up online and seeing a provider,” Snyder said.
But web-based care is not a cure-all, he said. In fact, an overreliance on remote services such as tele-health might be contributing to millennials’ poor health outcomes.
The report found a third of millennials have chronic conditions that significantly impact their health. Women generally have poorer health than men, due to higher rates of major depression, type 2 diabetes, and other endocrine conditions such as polycystic ovary syndrome and thyroid problems.
“For a long time we’ve been talking about the rise in the obesity rate and the rise in diabetes,” Snyder said. “It’s not a surprise we’re seeing this in millennials as well.”
But these illnesses can be prevented or managed through early and consistent care with a primary care provider (PCP), he said.
If patients discover they are overweight or have hypertension at an annual exam, for example, they can have a conversation with their doctor about changes in diet, exercise, or medication that might help reverse it.
“If you don’t know you’re hypertensive because you don’t have a PCP and just make the assumption that you’re OK, you could be walking around with a time bomb,” he said.
The report found 68 percent of millennials have a PCP, compared to 91 percent of those in Generation X.
Although it’s often easier to log onto a tele-health service for a quick consultation when you’re sick, the data show that may not be enough to address the health issues millennials face, Snyder said.