A growing number of Minnesota students report dealing with long-term mental health issues.

The Minnesota Student Survey, which is taken every three years by students in middle and high school, revealed more than a quarter of 11th-graders said they had mental, behavioral or emotional disorders that lasted at least six months. That’s up from 20% three years ago and just under 10% in 2013. Meanwhile, 13% of high school freshmen and juniors said they’d seriously considered attempting suicide in the past year, up slightly from those surveyed in 2016.

The problems were particularly acute among specific groups of students; American Indian students, for example, were more likely to report that they’d missed school because they felt sad, hopeless, anxious, stressed or angry. Girls in 11th grade reported significantly higher rates of mental health problems than boys, and a quarter of the girls who reported missing a school day said they’d been absent because of feelings of sadness, stress and anxiety. LGBT students were about three times as likely to have considered suicide as their heterosexual peers.

Though the survey results released Thursday included a number of bright spots, such as continued declines in teen drinking, cigarette smoking and sexual activity, state Education Commissioner Mary Cathryn Ricker said they indicate many real needs that should be addressed by adults.

“Our students are telling us that they want the sort of support they can get to feel stronger in their lives, to feel like they can succeed in school, emotionally and in their health,” she said. “My big takeaway is that the adults in their lives need to come together and better support all our students.”

Students in grades 5, 8, 9 and 11 took the survey between January and May of this year, with 81% of the state’s school districts participating. It provides a wide-reaching look into students’ self-reported thoughts and behavior on issues ranging from eating and sleep habits to participation in school activities to feeling safe at school. Ricker said she intends to dig deeper into the survey results on an upcoming tour of Minnesota schools at which she — and in some cases, Gov. Tim Walz — will gather with groups of students to get their take on the topics covered in the survey.

On those visits, she’s likely to hear that many students are struggling with stress from a variety of sources. Sue Abderholden, executive director of the National Alliance on Mental Illness (NAMI) Minnesota, said schools are trying a variety of successful approaches to address mental health, ranging from additional training for teachers on suicide prevention and trauma to more health and counseling services that are built into the school day and housed in school buildings. But she said many schools still lack critical resources, like psychologists and nurses, and are grappling with increasingly complex student needs.

“It doesn’t matter who I talk to in the schools — teachers, superintendents, principals — they all say the No. 1 issue really facing them is kids’ mental health,” she said. “Suicide rates have also gone up, and all these things lead me to believe this isn’t just about increased awareness. Kids are suffering more, and having more symptoms.”

Shikha Kumar, a junior at Mayo High School in Rochester and a member of the Minnesota Youth Council, said she sees a long list of factors driving up student stress and anxiety. Social media use can become a “toxic” tool for students to compare themselves with their peers, leading girls in particular to struggle with body image issues, she said. More high-stakes tests and tougher admission standards at college have many students feeling pressure to participate in a long list of classes and activities with little room for mistakes.

Kumar said she’s glad to see a majority of her peers making some healthy choices, like avoiding cigarettes. On this year’s survey, rates of cigarette smoking plunged to their lowest-ever levels, with just 3% of ninth-graders reporting smoking within the past 30 days. That’s down about a percentage point from three years ago, but it’s a striking change from 2001, when nearly 20% of ninth-graders said they’d recently smoked. Alcohol use was also on the decline, continuing a longer trend.

But Kumar said vaping continues to be a major problem, with many students convinced that e-cigarettes are less harmful or addictive than traditional tobacco products. More than a quarter of 11th-graders who took the survey said they’d recently used an e-cigarette, up from 17% three years ago. The jump in vaping was even more pronounced among eighth-graders.

Kumar said she doesn’t think today’s young people are any worse off than previous generations but hopes that adults recognize that issues like mental health and vaping are serious concerns for which young people need more help.

“The things we see are totally treatable; we can fix it with time and resources,” she said. “It’s just that the things we’re seeing today are big issues.”