Peer violence and cyberbullying are huge problems in U.S. schools, and a recent study suggests that they can have devastating effects on teens’ health. According to a report from UPI, a new study has shown that nearly half of teenagers who go to the emergency room report instances of peer violence and online harassment, and 25 percent of them reported symptoms of post-traumatic stress disorder, or PTSD.

Researchers from the Hasbro Children’s Hospital in Rhode Island found that ER doctors typically don’t scan for symptoms of PTSD except for in cases of obvious physical trauma. The study suggests that some teenagers who may be in need of mental health care are not getting the attention they need.

Doctors have recommended that emergency rooms test for psychiatric disorders before, but there is a considerable research gap in examining how the symptoms of PTSD can manifest themselves in adolescents as a result of bullying and exposure to violence and crime.

The American Association of Pediatrics recommended in January that doctors begin screening children for depression at age 11, and associated the need for increased mental health care for an uptick in teen suicides over the past few years.

The study was published in the journal General hospital Psychiatry, and examined 353 teenagers (13-17) that visited the emergency room between August 2013 and March 2014. They surveyed the teens’ mental health disorders and exposure to violence, drugs and alcohol, and stressful situations.

46.5 percent of the teenagers reported being the victim of violence from their peers, 46.7 reported being bullied online, and almost 60 percent of the teens reported being exposed to violence in their neighborhoods. In describing their reactions to these situations, the doctors reported that the symptoms were consistent with those of PTSD.

23.2 percent of the teens reported actual PTSD symptoms, and 13.9 percent had developed moderate or higher depression. 11.3 percent reported considering suicide within the past year.

According to Dr. Megan Ranney, a Hasbro Children’s Hospital researcher and Brown University professor, “Existing literature on PTSD in adolescent emergency patients describes its development after an acute assault or motor vehicle crash. But, this study highlights the need for improved efforts at more standardized mental health evaluation, possibly even screening for PTSD regardless of the reason for a teen’s visit to the emergency department.”