A new study suggests depression in childhood or adolescence may increase the risk of illness and early death. The link between depression early in life and later risk of illness and death may be explained by other mental health disorders such as substance use and anxiety, the researchers said.

The study of almost 1.5 million people included more than 37,000 who were diagnosed with depression at least once between the ages of 5 and 19. Participants were followed for 12 years. Those who had a history of early depression were more likely to be diagnosed with 66 medical conditions including type 2 diabetes, sleep disorders, viral hepatitis and liver diseases, HealthDay reports.

They were also significantly more likely to have injuries from self-harm, and almost six times more likely to die prematurely.

“Our study shows that children and teenagers diagnosed with depression have a significantly higher risk of premature death, self-harm and suffering from other diseases later in life,” study co-author Sarah Bergen said in a news release. “It underscores how important it is that these children and teenagers receive the help they need and that medical personnel monitor for subsequent psychiatric and somatic diseases.”