National trends in the use of outpatient psychotherapy.
OBJECTIVE
This article reports recent trends in the use of outpatient psychotherapy in the United States.


METHODS
Data from the household sections of the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey were analyzed. Trends in the rate of psychotherapy use from these nationally representative samples are presented by age, sex, race/ethnicity, marital status, education, employment status, and income. Psychotherapy users are compared over time by provider specialty, concomitant psychotropic medication use, number of annual visits, and costs. In addition, trends in payment source and primary diagnosis are assessed for psychotherapy visits.


RESULTS
Between 1987 and 1997, there was no statistically significant change in the overall rate of psychotherapy use (3.2 per 100 persons in 1987 and 3.6 per 100 in 1997). However, significant increases were observed in psychotherapy use by adults aged 55-64 years and by unemployed adults. Among psychotherapy patients, there was a marked increase in the use of antidepressant medications (14.4% to 48.6%), mood stabilizers (5.3% to 14.5%), stimulants (1.9% to 6.4%), and psychotherapy provided by physicians (48.1% to 64.7%). A smaller proportion of patients made more than 20 psychotherapy visits in 1997 (10.3%) than in 1987 (15.7%). Over this period, psychotherapy visits for mood disorders became more common. In 1997, 9.7 million Americans spent $5.7 billion on outpatient psychotherapy.


CONCLUSIONS
From 1987 to 1997, access to psychotherapy in the United States remained constant overall but was characterized by increased use by some socioeconomically disadvantaged groups. However, the number of visits per user markedly decreased during this period. Psychotherapy was increasingly administered by physicians and provided in conjunction with psychotropic medications. These changes occurred during a period of expansion in the number of available psychotropic medications and growth in managed behavioral health care.
Olfson
Mark
M
New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and surgeons of Columbia University, 1051 Riverside Dr., New York, NY, USA. olfsonm@child.cpmc.columbia.edu
Marcus
Steven C
SC
Druss
Benjamin
B
Pincus
Harold Alan
HA
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000639:trends; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000191:economics / Q000453:epidemiology; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000191:economics / Q000639:trends*; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use; D014481:United States; D014600:Utilization Review / Q000639:trends
D011619:Psychotropic Drugs