Stress and anxiety have worsened among Minnesota's K-12 students, particularly females, as they have endured the social and academic upheaval of the pandemic along with the usual pressures on children.

Results of the 2022 Minnesota Student Survey were released Friday, with 29% of students reporting mental health problems that lasted six months or longer — up from 23% in 2019. Among female 11th graders, 45% reported long-term mental health, behavioral or emotional problems, up from 35% in 2019.

The statewide survey, conducted every three years, is a vital look at student health and wellbeing — but perhaps never more so than after the coming of the pandemic.

Months of school closures, online learning, mask mandates, sports restrictions and other measures took place in 2020 and 2021 to protect people. The disruptions to everyday life and academic progress reverberated in 2022.

"The pandemic fueled and worsened ongoing trends of our teens reporting long-term mental health problems," said Jan Malcolm, commissioner of the Minnesota Department of Health. "It will take more research to know the interplay of all the factors, but it is clear that this is a crisis."

Among the 135,000 students who took the survey this spring, 43% said they had worried a lot over the prior month and 48% said they sometimes felt sad — even if they didn't understand why.

The results were no surprise to Richfield High School junior Antwane Ruiz. He could see the malaise that COVID-19 wrought on students after in-person learning resumed — for some in spring 2021 while still wearing masks, but for others in the fall.

"Being by yourself, you get so used it," he said. "You're like in this shell, and you don't want to break out."

Ruiz is part of a safe and supportive school committee at Richfield, which uses the survey data to identify problems and offer student solutions. Changes made by the group include a dress code update that allows expression through the wearing of hats and scarves.

An increase in stress and anxiety is disappointing, considering the group's efforts to make students feel safe and included, said Christina Haddad Gonzalez, Richfield's director of student support services. But the survey proves that the right issues are being targeted.

COVID-19 hit students in big ways, including sickening relatives and creating a fear of infection, she said, but it also had an impact in smaller ways. The switch to online learning in spring 2020 meant that eighth-graders missed out on middle school graduation and dance events, then went straight into high school the next year.

"That's why I saw more worry and more sadness," she said, "We are leading with addressing that first, because if our kids don't feel loved, cared for, connected and safe, they're not going to be able to turn their frontal lobes on to learn."

Champlin Park High School senior Hawa Cabdullahi said many peers were tasked with watching their younger siblings or picking up part-time jobs to help with family finances in the early days of the pandemic. Those responsibilities added stress at a time when teens were adjusting to the challenges of remote schoolwork.

"They were balancing classes and taking care of their families. I think it was all compounding," she said.

The survey involved students in grades 11, 9, 8 and 5 from 70% of Minnesota school districts. Minneapolis Public Schools participated but St. Paul Public Schools did not.

Around 2-3% of responses are discarded as mischievous, such as students claiming they take every illicit drug every day. Teachers are trained to create environments in which students feel comfortable answering sensitive questions honestly, said Sharrilyn Helgertz, a senior health department researcher involved with the survey.

Cabdullahi has noticed it's more difficult to get her male peers at Champlin Park to talk about their feelings or admit when they're feeling low.

"So many of them are unwilling to talk to their friends," Cabdullahi said. "They don't have the same support system that girls do."

It's possible female students are more comfortable being truthful and answering survey questions about their mental and social challenges, but the fact that the gender gap in mental health levels widened in 2022 suggests it is not a statistical blip, Helgertz said.

"The girls were just — ugh, I got so sad looking at the data for the girls," she said.

Their college ambitions are higher — with 69% of female 11th-graders planning to attend four-year institutions after high school, compared to 52% of male classmates. That could speak to the pressure heaped on young women.

The pandemic added stress for high school students, upsetting their job prospects or college plans, said Sarah Jerstad, medical director for outpatient mental health services at Children's Minnesota. For grade school students, the stay-at-home periods reduced the social interactions that encourage emotional and developmental growth.

Parent support, large friend groups and social media helped some students, but others lacked those advantages, she added. "Some, if they had already struggled socially, kind of plummeted."

Helgertz was surprised rising stress and anxiety didn't result in more substance abuse. Alcohol and cigarette usage declined, along with sexual activity. E-cigarette usage among 11th-graders had risen from 17% in 2016 to 26% in 2019, but dropped to 14% this year.

"Kids are feeling really crummy, but they're not turning to substances, they're not turning to risky behaviors and they still are trying at school," Helgertz said. "They're still doing their best. I'm so impressed with these kids. This generation is very rescuable."

Ruiz said time management is a challenge — with school, homework, soccer, and work at the M&M store at the Mall of America. The soccer field has been a source of relief and joy for the Richfield varsity star, but he skips practices occasionally to make time for himself and his family.

During the pandemic lockdown, Ruiz made sure his younger sister paid attention to her studies. He feels the pressure of being a role model to his sisters and living up to his parents' expectations. When it feels overwhelming at school, he leaves the classroom.

"Just go in the hall for a couple minutes," he said, "grab a fidget, and just breathe."