When Parents Can Spare Time: Paid Sick Leave and Adolescent Mental Health

• In Event: The Child Penalty and Work-Family Policy: Paid Family Leave and Paid Sick Leave

Abstract

Adolescent mental health has deteriorated sharply over the past decade, yet fewer than one in six U.S. adolescents receives any mental health care in a given year. A key but underexplored barrier is parental time: mental health appointments require a parent to schedule, consent, transport, and accompany their child, tasks that are difficult or impossible when work schedules offer no flexibility. This paper provides the first causal evidence on whether state paid sick leave (PSL) mandates, by expanding parental time flexibility, improve adolescent mental health outcomes. We link the staggered adoption of PSL mandates across 18 states to two complementary data sources: the National Survey of Children's Health (NSCH, 2016-2022), which captures parent-reported diagnoses and care receipt for adolescents aged 12-17, and the Youth Risk Behavior Surveillance System (YRBSS, 2005-2021), which captures self-reported depressive symptoms and suicidal ideation among high school students. Using the Sun and Abraham (2021) interaction-weighted estimator, which is robust to treatment effect heterogeneity under staggered adoption, we find that PSL mandates increase the probability of receiving any mental health care by 2.3 percentage points (13.6% above baseline) and raise depression diagnoses by 1.5 percentage points. Critically, these increases in clinical identification are accompanied by population-level declines in self-reported depressive symptoms (2.2 pp, 7.2%) and passive suicidal ideation (1.4 pp, 8.6%), ruling out a worsening-mental-health interpretation and supporting a detection-and-treatment channel. Mechanism analyses confirm that PSL adoption increases the probability that a parent reduced or stopped work to care for their adolescent by 1.5 percentage points, with no effect on general family interaction, indicating that the additional time is directed specifically toward medical caregiving rather than broader improvements in family environment. This time flexibility brings more families into the mental health care system: newly entering families report increased difficulty coordinating care and obtaining appointments, consistent with engagement with a supply-constrained system, while the share reporting unmet mental health need rises by only 0.6 percentage points compared to a 2.3 percentage point increase in realized care receipt, indicating that far more families successfully access care than are turned away. The estimated effect on mental health care receipt is comparable in magnitude to gains documented for the ACA Medicaid expansion, while PSL operates without direct government expenditure and disproportionately expands coverage among low-wage and part-time workers. With 32 states still lacking a mandate, the evidence suggests each adoption translates into earlier detection, more treatment, and fewer adolescents experiencing sustained depression and suicidal ideation, positioning PSL as a scalable upstream intervention that simultaneously supports labor market stability and family health.

Author

• Anwar Assamidanov, University of California, Irvine
  Presenting Author