A new government survey finds many Americans are struggling with mental health conditions and substance use during the pandemic.

The Centers for Disease Control and Prevention (CDC) surveyed 5,412 adults in late June, and found 41% reported at least one adverse mental or behavioral health condition, according to Yahoo News. The CDC found 31% were suffering from symptoms of anxiety or depression; 26% had symptoms of traumatic disorder; 13% said they had started or increased substance use; and 11% had seriously thought about suicide.

Compared with the second quarter of 2019, the prevalence of anxiety symptoms this June tripled, while the prevalence of depressive disorder quadrupled. One-quarter of respondents reported symptoms of a traumatic disorder related to the pandemic, and about one in 10 reported that they started or increased substance use because of COVID-19. About twice as many respondents reported seriously considering suicide in the previous 30 days compared with adults in the U.S. in 2018.