Edited by Anushree Chaphalkar
TOPLINE:
Use of psychotherapy without medications increased among US outpatients between 2018 and 2021, while psychotropic medication–only treatment declined, new research showed. In addition, social workers and counselors assumed a larger role in mental health care as involvement of psychiatrists decreased.
METHODOLOGY:
Researchers analyzed data trends from four representative surveys of the US household population included in the 2018-2021 Medical Expenditure Panel Survey. They focused on nearly 18,000 adult outpatient mental health–related visits, including more than 6000 psychotherapy visits.
Psychotherapy or counseling was defined broadly as treatment for specific mental health disorders, primarily involving talk-based interaction between the patient and a mental health professional.
Participants received either psychotherapy alone, psychotropic medication alone, or both.
The fully adjusted analysis controlled for age, sex, and psychological distress measured using the Kessler-6 scale.
TAKEAWAY:
From 2018 to 2021, the use of psychotherapy without medications by adults receiving outpatient mental health care increased significantly (fully adjusted difference, 2.8%; 95% CI, 0.6%-5.0%), but the use of psychotropic medication alone declined (fully adjusted difference, −3.4%; 95% CI, −6.2% to −0.7%).
The mean number of psychotherapy visits per patient increased (adjusted difference, 2.1%; 95% CI, 0.6%-3.7%), with a significant increase noted among patients with mild or moderate distress.
Social workers and mental health counselors provided psychotherapy to an increased proportion of patients (adjusted difference, 17.7%; 95% CI, 13.0%-22.5%), whereas the involvement of psychiatrists decreased (adjusted difference, −6.7%; 95% CI, −11% to −2.4%).
Among patients receiving psychotherapy, treatment with anxiolytics/hypnotics decreased significantly (adjusted difference, −6.2%; 95% CI, −10% to −2.5%) as did treatment with antipsychotics (adjusted difference, −4.3%; 95% CI, −7.6% to −1%).
IN PRACTICE:
“After years of American mental health care moving toward greater use of psychiatric medications, the pendulum has started swinging back toward psychotherapy….Americans are becoming more willing to seek out and stick with psychotherapy,” lead author Mark Olfson, MD, MPH, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York City, said in a press release.
SOURCE:
The study was published online on May 1 in The American Journal of Psychiatry.
LIMITATIONS:
The study was limited by reliance on self-reported data, lack of diagnostic precision, and exclusion of important populations residing in institutional settings. It could not determine whether psychotherapy trends reflected changes in patients or practice. Additional limitations were the broad survey definition of psychotherapy, unmeasured treatment effectiveness, and lack of adjustment for multiple comparisons.
DISCLOSURES:
The investigators reported having no relevant conflicts of interest.
