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Use of treatment for depression among adolescents was significantly lower in states that mandate caregiver consent for such treatment, according to a cross-sectional study.

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

In these states, the mean proportion of adolescents with major depressive episodes receiving any treatment in 2021-2022 was 37.2% compared with 46.7% in states that allow adolescents to consent with no or limited stipulations, they noted in a research letter in .

Among the 50 states and Washington, D.C., eight have laws allowing adolescents to independently consent to mental health treatment with no restrictions, 23 allow adolescents to independently consent with some restrictions, and 18 prohibit adolescents to consent.

"Across the U.S., most adolescents experiencing depression do not access formal treatment," Schleider and co-author Amanda Smock, BS, also of Northwestern University Feinberg School of Medicine, told MedPage Today in an email.

"Some of our team's recent research with teens suggests that (i.e., state policies that require parents' permission for their teens to access mental health support) might be one important reason that some teens do not access care," they wrote. "However, to our knowledge, no research has formally explored the link between legislation around parental consent requirements, on the one hand, and adolescents' access to care, on the other."

"Ultimately, the results aligned with our prediction," they added. "Adolescents who lived in states requiring parental consent were less likely to receive mental health treatment."

Some states require caregiver permission for mental health treatment until adolescents reach the age of 18, with variable exceptions for factors such as marital status and treatment type, the authors noted. In other states, adolescents older than 12 "can consent but must still identify a caregiver to access certain kinds of care," they explained.

"All adolescents experiencing depression deserve equal access to safe, effective care, regardless of their location or their ability to share treatment needs with parents," Schleider and Smock said. "Clinicians who treat adolescents might examine whether their clinic's intake policies fit with what their state policy allows (i.e., that clinics in states where teens can access treatment independently have clear pathways for teens to initiate services, even if their parents are unavailable or unwilling to consent)."

They added that this study also has implications for policymakers. "We hope results spark progress toward updated, youth-centered state policies that support access to care nationwide," they said.

For this study, Schleider and team used two legal databases (LexisNexis and Justia) to code all U.S. statutes regarding adolescents' ability to independently consent to inpatient and outpatient mental health treatment. Two states, North Dakota and Utah, did not have a consent law recorded, and were thus excluded from subsequent analysis.

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

Limitations to the study included that constraints of the NSDUH data led to the inability to evaluate the impact of individual-level variables, such as demographics, comorbidities, or caregiver attitudes, Schleider and colleagues said.

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