Children with depression admitted to the hospital for other, physical illnesses stay longer, pay more, and are at greater risk of death, a study from Rutgers New Jersey Medical School found, according to Philly.com.

Depression is among the leading causes of medical complications and death in the U.S. One in five children report episodes of major depression before age 18.

Researchers used data from the Kids Inpatient Database for 2012, a nationally representative database of all inpatient admission in the U.S. for patients younger than 21. They analyzed more than 670,000 cases of children aged 6 to 20. Most were older teens.

Kids with depression stayed in the hospital, on average, nearly one day longer than those without depression. The cost of their care was about $3,000 higher, and they were nearly twice as likely to die in the hospital. Depressed children also had fewer procedures than other pediatric patients in the hospital, even when admitted for non-mental health reasons.

Even when admitted for physical issues, children with depression are more likely to stay in the hospital longer, pay more, and be at greater risk of death.

The average age of patients in the study data was 17.5, so the findings may not represent the needs of younger patients. The study also did not look at readmission rates, though previous studies have shown people with mental health conditions are more likely to return to the hospital within 30 days of discharge. This would need to be studied for a full picture of healthcare utilization and cost.

The findings suggest educating physicians to look for depression in children and screening patients early may be helpful in improving patient care. The authors also suggest providing more timely psychiatric consultations for children can reduce the burden on hospital resources.