Diagnoses of clinical depression — also known as major depression — have risen by 33% since 2013, according to a new report from health insurer Blue Cross Blue Shield.

The report, which was based on insurance claims filed by 41 million privately insured Blue Cross Blue Shield members, calls depression the “second most impactful condition on overall health for commercially insured Americans,” behind only high blood pressure. That’s because people with depression also tend to have other health issues, such as chronic illnesses and substance abuse, and as a result may have more significant health care needs and experience worse health outcomes over time.

“Some of the literature is already starting to predict that by 2030, depression will be the number-one cause for loss of longevity or life,” says Dr. Trent Haywood, chief medical officer at Blue Cross Blue Shield Association. Women and men with depression may on average lose up to 9.7 years of healthy life, the report says.

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Depression diagnoses were found to be rising in every demographic, but the uptick has been especially dramatic among young people. Since 2013, rates have spiked by 47% among Millennials, by 65% among adolescent girls and by 47% among adolescent boys, the report says. Women of any age are also more likely than men to be diagnosed with clinical depression.

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Certain parts of the country also have more depression cases than others. Maine, Rhode Island, Minnesota and Utah all have depression rates around 6%, according to the research, while Hawaii’s hovers somewhere around 2%. The discrepancy likely relates to different screening standards, as well as environmental and socioeconomic differences across states, Haywood explains.

All of these numbers apply specifically to the privately insured Americans included in Blue Cross Blue Shield’s sample of claims, Haywood says; among the general population, rates may be even higher.

Blue Cross Blue Shield’s report is the latest in a string that have highlighted concerning mental health trends in the U.S. A recent report from the health insurer Cigna, for example, found that most Americans are lonely, and a new American Psychiatric Association poll found that almost 40% of Americans report being more anxious than they were last year.

The prevalence of depression, as well as other mental health conditions, underscores the importance of making behavioral health care a routine part of medical visits, Haywood says. That’s especially true given the link between mental and physical health. Depression has been linked to a higher risk of heart disease, type 2 diabetes, stroke, osteoporosis and Alzheimer’s disease, according to the National Institute of Mental Health.

“They’re intertwined,” Haywood says. “You might start with a condition and then go on to have depression, or you might start with depression and go on to have a chronic condition. It’s bi-directional.”

Write to Jamie Ducharme at jamie.ducharme@time.com.