1 - (IOP 31) Impact of State Parental Consent Legislation on Treatment Access and Attitudes Among Adolescents with Depression

Objectives: Adolescents are experiencing alarming rates of depression, with access to evidence-based treatments being particularly limited for those in marginalized communities. While structural barriers to care have been widely investigated, limited research has explored the impact of state legislation on teens’ ability to self-refer into treatment and how this may influence access to care. To understand the impact of parent consent policies, we conducted two studies: one policy-mapping study that examined the link between legislation and state-level teen depression treatment access rates and a qualitative study to investigate teen insights on parent permission requirements for depression treatment.

Methods: U.S. state laws (including D.C.) extracted from Lexis Nexus and Justia were dichotomously coded: parent consent always required or independent minor consent sometimes or always allowed. Estimated state-level depression treatment access rates were retrieved from the publicly available Substance Abuse and Mental Health Services Administration’s 2021-2022 National Drug Use and Health Survey. In the qualitative study, teens (aged 12-17) were recruited through recontacting participants of a longitudinal trial that required parent consent and through advertisements on social media with no parent consent required. Semi-structured interviews (N = 43) explored perspectives on the risks and benefits of accessing treatment with and without parent permission. We inquired about therapist-delivered and self-guided supports (online and in-person). Interview data was coded through MaxQDA and analyzed using inductive thematic analysis, guided by Self-Determination Theory (SDT).

Results: The results of the policy mapping showed teens that reside in states that always required parent consent - one third of states - were significantly less likely to access care, F(1, 46) = 11.18, p = 0.002, η²p = 0.21. In states that always required parent consent, Madjusted= 37.2% of teens with major depressive episodes did not access treatment in 2021-2022, compared to Madjusted = 46.7% in states that sometimes or always allowed teens to consent. Qualitative analysis identified overarching themes corresponding to each motivational driver under SDT with associated subthemes. The most prevalent theme was “Factors that influence adolescent autonomy” (48.6%), in which participants described factors that impeded or promoted their need for autonomy while pursuing treatment. The remaining themes, “Factors that influence adolescent competence” and “Factors that influence adolescent relatedness”, were endorsed across 37.1% and 14.3% coded responses respectively. Further quantitative analysis to compare responses across modality, type of treatment, and parent involvement in study procedures is ongoing and will be completed by November 2025.

Conclusion: Parental consent policies may restrict access to care for many teens, potentially worsening mental health challenges for those with depression who cannot seek help without parent approval. These findings highlight the need for consent guidelines that prioritize teen voices. Creating policies that allow teens to self-refer could significantly improve access to treatment and support.