Intention to seek mental health treatment for adolescent girls: Comparison of predictors in mothers and daughters

In most families in the western world, mothers make decisions related to the family’s use of health care (Gross & Howard, 2001), including health care for their adolescent daughters. However, normative changes and realignments in the parent–child relationship lead to greater adolescent behavioral autonomy over time, including the adolescent’s desire for greater involvement in decision making for her health care (Gordon, 1996). The cognitive capacity for autonomous healthcare decision making has been documented among adolescents 15 years of age (Gordon, 1996). In the United States, most states recognize an adolescent’s ability to independently make healthcare decisions for select medical services such as testing and treatment of sexually transmitted infections and obtaining contraception without parental consent (English & Kenney, 2003; Gordon, 1996). However, by law, adolescents cannot independently make decisions to receive mental health treatment (English & Kenney, 2003). Parental consent is required for adolescents under the age of 18 to obtain treatment in nearly all states, making parents the gatekeepers to mental health treatment. As children mature into adolescents, they tend to be more expressive to their mothers about their healthcare needs and desires, and they attempt to exert influences over their mothers’ decisions about their health care (Miller & Harris, 2012). The adolescent’s influence on the mother’s decisions is impacted by characteristics of the mother–adolescent relationship, including parent–adolescent conflict (Kern, Klepac, & Cole, 1996; Prinz, Foster, Kent, & O’Leary, 1979) and parenting style of the mother (Steinberg, Lamborn, Dornbusch, & Darling, 1992). Promoting concordance and shared decision making between mothers and daughters in respect to mental health treatment is not only essential for seeking care, but also for the adolescent’s active engagement in care (Miller & Harris, 2012). Adolescent girls believe that they have tremendous influence on their mothers’ decision making for their health care, and that their perspectives on mental health treatment are similar to that of their mothers (Pinto-Foltz, Hines-Martin, & Logsdon, 2010). Without concurrent and independent assessments of mothers and their adolescent daughters regarding their intention to seek mental health treatment, these assertions by adolescent girls are unfounded. This study fills a gap in scientific knowledge by use of the theory of planned behavior (TPB) and expanded TPB (Hutchinson & Wood, 2006) to examine predictors of intention to seek mental health treatment for adolescent girls, from the perspective of mothers and their adolescent daughters themselves. Roughly 75% of adolescents with mental disorders do not receive mental health treatment at symptom onset, and the usual onset of mental disorders is during the adolescent and young adult years (Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993). Adolescent girls are at highest risk for mood disorders during these early years, and understanding predictors of mothers and daughters’ intentions are necessary to promote early treatment and optimize short- and long-term mental health outcomes (Modi et al., 2012; Logsdon, 2004).