Teen marijuana use is linked to an increased risk of depression and suicidal behavior in young adulthood, according to a review of studies published in JAMA Psychiatry.

Researchers from McGill University in Montreal analyzed 269 studies on adolescent marijuana use involving more than 23,000 individuals. They found teens who used marijuana were more likely to suffer depression and have suicidal thoughts, and were more than three times as likely to attempt suicide between the ages of 18 and 32, HealthDay reports.

“When we started this study we expected depression to be a factor attributable to cannabis consumption, but we were quite surprised about suicide behavior rates. Indeed, a significant percentage of suicidal attempts are attributable to cannabis,” researcher Gabriella Gobbi said in a news release.

“It is clear that a lot of young people consuming cannabis are at risk of developing depression and suicidal behavior, so it is very important for authorities to be more proactive in campaigning for prevention,” she said. “We hope the findings will spur public health organizations to apply preventative strategies to reduce the use of cannabis among youth.”