Use of depression treatment is lower for adolescents in countries with parental consent laws

According to a cross-sectional study, use of depression treatment among adolescents was significantly lower in states that mandated guardian consent for such treatment.

After adjusting for state-level prevalence estimates of adolescent major depressive episodes, those who had experienced an episode in the past year in states with laws prohibiting independent consent of adolescents to mental health treatment were significantly less likely to receive treatment (P=0.002), Jessica Lee Schleider, PhD, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues reported.

In these states, the average proportion of adolescents with major depressive episodes who received any treatment in 2021–2022 was 37.2%, compared with 46.7% in states with unconditional or limited consent. conditions, they noted in a research letter in JAMA Pediatrics.

Among the 50 states and Washington, D.C., eight have laws that allow teens to consent to mental health treatment without restrictions, 23 allow teens to consent with certain restrictions, and 18 prohibit teens from giving consent .

“In the U.S., most teenagers experiencing depression do not have access to formal treatment,” said Schleider and co-author Amanda Smock, BA, also of Northwestern University’s Feinberg School of Medicine. MedPage Today in an email.

“Some recent research from our team with teenagers suggests this parental consent requirements (ie, public policy requiring parental permission for adolescents to access mental health care) may be one important reason why some adolescents do not access help,” they wrote. “However, to our knowledge, no research has formally examined the relationship between legislation on parental consent requirements, on the one hand, and adolescents’ access to care, on the other.’

“In the end, the results were in line with our prediction,” they added. “Adolescents who lived in states requiring parental consent were less likely to receive mental health treatment.”

Some states require a guardian’s permission for mental health treatment until teens turn 18, with various exceptions for factors such as marital status and type of treatment, the authors note. In other states, teens over the age of 12 “can give consent but still have to identify a guardian to access certain types of care,” they explained.

“All adolescents experiencing depression deserve equal access to safe and effective care, regardless of their location or ability to share their treatment needs with their parents,” Schleider and Smock said. “Clinicians who treat adolescents may want to check whether their clinic’s admission policies are consistent with what state policy allows (ie, whether clinics in states where adolescents can self-access treatment have clear pathways for adolescents to initiate services, even if their parents are unavailable or unwilling to consent)”.

They added that the study also has implications for policymakers. “We hope the findings will spur progress toward renewed youth-focused public policy that supports access to health care across the country,” they said.

For this study, Schleider and team used two legal databases (LexisNexis and Justia) to code all US laws regarding the capacity of adolescents to independently consent to inpatient and outpatient mental health treatment. Two states, North Dakota and Utah, did not have a consent statute and were therefore excluded from further analysis.

The researchers also extracted 2021-2022 state-level estimates of past-year treatment rates among adolescents with major depressive episodes from the National Survey on Drug Use and Health (NSDUH).

Limitations of the study included that NSDUH data limitations made it impossible to assess the effects of individual-level variables such as demographics, comorbidities or caregiver attitudes, Schleider and colleagues said.