Psychotherapy Trends in the United States

The authors investigated recent national trends in outpatient mental health care and psychotherapy.

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.

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).

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.