Psychotherapy Trends in the United States

Abstract

Objective: The authors investigated recent national trends in outpatient mental health care and psychotherapy. Method: Service data from four representative surveys of the U.S. household population, the 2018-2021 Medical Expenditure Panel Survey, were analyzed focusing on adults with outpatient mental health visits (N=17,821) including psychotherapy visits (N=6,415). The authors present trends in age, sex, and Kessler-6 distress adjusted percentages of mental health patients receiving psychotherapy only, psychotropic medications, or their combination. They describe mean annual number of psychotherapy visits of persons receiving psychotherapy; providers delivering psychotherapy; psychotherapy expenditures; and other characteristics. Results: Among adults receiving outpatient mental health care, an increase occurred in use of only psychotherapy (11.5% and 15.4% in 2018 and 2021, respectively; age, sex, and distress adjusted difference=2.8%, 95% CI=0.6, 5.0), but not in psychotherapy and psychotropic medication together (20.8% and 22.5%; adjusted difference=1.3%, 95% CI=−0.7, 3.4), while use of only psychotropic medication declined (67.6% and 62.1%; adjusted difference=−4.5%, 95% CI=−6.9, −2.1). Increases occurred in psychotherapy visits per psychotherapy patient (means, 9.8 and 11.8; adjusted difference=2.1, 95% CI=0.6, 3.7) and total national psychotherapy expenditures ($30.8 and $51.0 billion in constant 2021 dollars, trend, p=0.03) with a decrease in patients receiving psychotherapy from psychiatrists (41.2%-34.2%, adjusted difference=−6.7%, 95% CI=−11.0, −2.4). Conclusions: Between 2018 and 2021, psychotherapy assumed a larger role in outpatient mental health care while psychotropic medication without psychotherapy, though the modal treatment, became less common. Psychiatrists provided psychotherapy to a decreasing percentage of mental health outpatients, which may have increased the need for psychiatrists to refer patients to and collaborate with non-physician psychotherapists.