Psychotherapy provision declined significantly in recent decades

The number of psychiatrists who provided psychotherapy significantly declined between 1996 and 2016, according to study results published in American Journal of Psychiatry.

Mark Olfson

“Between 1996–1997 and 2004–2005, the proportion of U.S. outpatient psychiatrist visits involving psychotherapy declined from 44.4% to 28.9%,” Daniel Tadmon, MPhil, and Mark Olfson, MD, MPH, both of Columbia University, wrote. “Increases in the use of pharmaceuticals and changing payment methods have been hypothesized to contribute to this decline.

“However, little is known about the state of psychotherapy provision by U.S. psychiatrists from 2006 onward,” they added.

Tadmon and Olfson sought to address this research gap by outlining psychotherapy patterns and trends among U.S. psychiatrists between 1996 and 2016. They conducted a retrospective, nationally representative analysis of 29,673 psychiatrist visits using 21 waves of the U.S. National Ambulatory Medical Survey during this time frame. They modeled provision as risk differences and adjusted for clinical, sociodemographic, geographic and financial characteristics.

Results showed a significant decline in the weighted percentage of visits that involved psychotherapy, from 44.4% between 1996 and 1997 to 21.6% between 2015 and 2016. The researchers observed the most significant declines among patients with social phobia (29% to 8%), dysthymic disorder (65% to 30%) and personality disorders (68% to 17%). Psychotherapy remained stable among patients diagnosed with schizophrenia (10% to 12%). Between 2010 and 2016, 53% of psychiatrists no longer provided any psychotherapy.

Tadmon and Olfson reported a negative association between antidepressant, antipsychotic and sedative-hypnotic prescriptions and psychotherapy provision. Sociodemographic disparities increased during the study period, with older white patients who resided in metropolitan areas in the Northeast or West increasingly becoming the most likely to receive psychotherapy, according to the study findings. Patients who self-paid were more likely to have access to solo-practice psychiatrists who saw fewer patients but more often had a higher likelihood of providing psychotherapy.

“These trends pose a challenge to psychiatrists’ unique role as integrators of biological and psychological dimensions of care, with important implications for the profession and for the delivery of U.S. mental health care as a whole,” Tadmon and Olfson wrote.