Nearly a third of teen girls drank alcohol during the past month, and nearly a quarter made a suicide plan in the past year, according to a shocking report published Monday by the U.S. Centers for Disease Control and Prevention.

The Youth Risk Behavior Survey, released each decade, painted an equally grim, if not darker, picture for LGBQ+ teens. Along with teen girls, they fared more poorly than heterosexual males on nearly every metric examined, including substance abuse, experiences of violence, and factors impacting mental and sexual health.

“Our teenage girls are suffering through an overwhelming wave of violence and trauma, and it’s affecting their mental health,” Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, told reporters Monday.

The authors called the differences between female and LGBQ+ teens, and heterosexual teen males, “stark.” While around a fifth of female and LGBQ+ teens experienced sexual violence in the past year, only 5% of males had. And while nearly 60% of female teens and nearly 70% of LGBQ+ teens had experienced “persistent feelings of sadness or hopelessness” during the past year, less than a third of males had.

Teens who identify as LGBQ+ or who have ever had a same-sex partner were more likely than their heterosexual counterparts to have misused substances, including illicit drugs, prescription opioids, alcohol, marijuana, and vapes. They were also “significantly” more likely to be a victim of violence in general.

There were some bright spots in the report, however, which examined trends from 2011 through 2021. Rates of risky sexual behavior and substance use are continuing to drop overall, and rates of school bullying are also on the decline.

But “unfortunately, almost all other indicators of health and well-being in this report, including protective sexual behaviors, experiences of violence, mental health, and suicidal thoughts and behaviors, worsened significantly,” the authors note.

“As we saw in the 10 years prior to the COVID-19 pandemic, mental health among students overall continues to worsen,” the authors wrote, adding that more than 40% of high school student surveyed suffered sadness or hopelessness that prevented them from functioning normally for at least two weeks in the year prior—a potential indicator of depression.

Overall, more students are opting not to go to school due to safety concerns, and males are reporting greater rates of electronic bullying, when compared to the decade prior according to the report—the first of its kind to look at pandemic-impacted data, collected in the fall of 2021.

“Although most schools had returned to in-person induction by that time, the time spent out of school for many students may have impacted” topics participants were surveyed on like mental health, the authors state, noting that “disruptions in daily life also remained common” when the surveys were administered.