Reuters surveyed school districts nationwide in February to assess the mental health impacts of full or partial school shutdowns. The districts, large and small, rural and urban, serve more than 2.2 million students across the United States.

Of the 74 districts that responded, 74% reported multiple indicators of increased mental health stresses among students. More than half reported rises in mental health referrals and counseling.

Nearly 90% of responding districts cited higher rates of absenteeism or disengagement, metrics commonly used to gauge student emotional health. The lack of in person education was a driver of these warning signs of trouble, more than half of districts said.

The stresses didn’t affect only students: 57% of responding districts reported an increase in teachers and support staff seeking assistance.