Teens living in states requiring parent consent for mental health treatment may be less likely to access care, according to a Northwestern Medicine-led study published in JAMA Pediatrics.

An estimated 5 million adolescents aged 12 to 17 in the U.S. – roughly 20 percent of all tweens and teens – have experienced at least one major depressive episode, according to data from the Substance Abuse and Mental Health Services Administration. Teen girls, LGBTQ and biracial youth are most at risk for depression, according to survey data from the organization.

Investigators in the Lab for Scalable Mental Health at Feinberg noticed that mental health programs requiring parental involvement often had lower engagement, said Jessica Schleider, PhD, associate professor of Medical Social Sciences in the Divisions of Intervention Science and Implementation Science, who directs the lab and was the first and corresponding author of the study.

“In qualitative research with our participants, we found that adolescents often cite parents as a key barrier to accessing mental health support both online and in clinics,” said Schleider, who is also an associate professor of Pediatrics. “My research team and I have been curious for a long time about whether it would be possible to quantify what we were hearing from teenagers over and over again, which is that laws or policies that require parental involvement in adolescents’ decisions to start mental health treatment have an impact on actual access to treatment.”

In the study, Schleider and her collaborators analyzed data on the prevalence of major depressive episodes in adolescents and compared the treatment rates in states that require parental consent and those that do not.

Adolescents who lived in a state requiring parental consent were less likely to receive treatment, according to the findings. Only 37 percent of young people who lived in states with parental consent laws received treatment, versus 46 percent of adolescents in states with no parental consent requirements.  

“State policies have a significant impact on whether adolescents can access services when they need them for depression,” Schleider said. “The situation is still very bad in that most adolescents with depression are not accessing treatment. The findings explain a 10-percentage point difference in whether or not adolescents access care and represents a really meaningful opportunity for shifting policies in a way that could have a real impact on adolescent access to treatment.”

Previous research from Schleider’s lab, published in the Journal of Adolescent Health, found that among teens with depression who had difficulty accessing mental health treatment, approximately one-third cited their parents as the primary barrier to accessing care.

“The reasons for that were multiple: Sometimes adolescents didn’t feel like their parents would take them seriously,” Schleider said. “Some of them were concerned that their family wouldn’t be able to afford treatment, so they didn’t want to bring it up. Others were worried about stigma and that their parents would respond potentially in an invalidating manner.”

Schleider said she hopes the new findings will inform more youth-centered policies around mental health treatment and access.

“The results of this study really reinforced the importance of bringing services directly to teens in a safe and responsible manner and also the importance of advocating for change,” Schleider said. “Ultimately, it doesn’t matter how scalable our interventions are if adolescents are structurally disempowered from using them. That message is going to be really important in shaping our efforts towards multi-level intervention, including policy-level intervention, moving ahead.”

The study was supported by the National Institutes of Health Office of the Director under grant DP5OD028123-05S1, with additional funding from Hopelab.