Adolescent Perspectives on Parental Consent Requirements for Depression Treatment: A Mixed-Methods Investigation

Depression incidence in adolescents is increasing, yet most do not access treatment. Policies requiring parental consent to initiate care may influence adolescent treatment access. In a convergent mixed methods study, we investigated adolescent perspectives toward accessing treatment with and without parental consent (i.e., self-consent) across four modalities: therapy (in-person and online) and self-guided supports (in-person and online). We explored differences in attitudes amongst sub-samples, demographics, and depression severity. An online survey and qualitative interviews were conducted with 43 adolescents; one sub-sample required parental consent (n = 29), and one self-consented (n = 14) (i.e., parental consent requirements waived). We used a multi-step analytic approach. Using content analysis, we qualitatively coded a positive, negative, or mixed valence to indicate attitudes toward parental consent or self-consent, and calculated frequencies. Using thematic analysis, themes were informed by self-determination theory. Three themes were identified: Factors that Influence Adolescent (1) Autonomy, (2) Competence, and (3) Relatedness. Generally, adolescents viewed self-consent positively, seeing it as preserving their autonomy and decision-making. Self-consent attitudes were consistently positive for self-guided supports and more mixed for therapist-delivered treatments. The ‘waived parental consent’ sub-sample expressed more positive self-consent attitudes overall; younger adolescents described more negative attitudes and adolescents with less severe depression symptoms described more negative and mixed attitudes. Perspectives on parent consent requirements were not monolithic, and were shaped by developmental needs for self-determination. Results suggest supporting adolescents' competence to navigate treatments; preserving autonomy in decision-making; and strengthening parent-teen communication and relatedness to encourage help-seeking.