Many studies have examined the effects of sufficient versus insufficient sleep on mental health. A new study, published in February in the Journal of Youth and Adolescence, takes a more nuanced look, attempting to determine just how much each hour less per night really costs—where teenagers are concerned.

The researchers surveyed an ethnically diverse sample of 27,939 suburban high school students in Virginia. Although teenagers need about nine hours of sleep a night on average, according to the National Institutes of Health, only 3 percent of students reported getting that amount, and 20 percent of participants indicated that they got five hours or less. The average amount reported was 6.5 hours every weekday night. After controlling for background variables such as family status and income, the researchers determined that each hour of lost sleep was associated with a 38 percent increase in the odds of feeling sad and hopeless, a 42 percent increase in considering suicide, a 58 percent increase in suicide attempts and a 23 percent increase in substance abuse.

These correlational findings do not prove that lack of sleep is causing these problems. Certainly the reverse can be true: depression and anxiety can cause insomnia. “But the majority of the research evidence supports the causal direction being lack of sleep leading to problems rather than the other way around,” says study co-author Adam Winsler, a psychology professor at George Mason University. Sleep deficits reduce brain function, further disturbing areas in which even well-rested adolescents struggle: executive function, self-control and judgment. “Parents, educators and therapists need to pay attention to the role of sleep in preventing mental illness among youth,” Winsler says. “Its effect is likely larger than most therapies and medications.”