Psychotherapy is one of the standard methods of delivering mental health care and is considered a frontline treatment for many conditions. Recent surveys indicate that the percentage of US adults receiving psychotherapy increased from 6.5% in 2018 to 8.5% in 2021. This increase likely happened partly because of the mental health strain caused by the COVID-19 pandemic and the rapid expansion of telehealth services. However, the extent to which this overall increase was realized across various sociodemographic groups remained largely unknown. In this study, Olfson and colleagues evaluated US national trends in the rate of psychotherapy use across sociodemographic groups. They used data from the Medical Expenditure Panel Surveys in the US, which produced nationally representative service estimates. The study included survey participants 18 years and older from 2018 to 2021. Psychotherapy was defined as a treatment for mental disorders principally based on talk or conversation between a mental health professional and a patient. This included individual, family, or group therapies in person, by telephone, or video (teletherapy). The analysis involved 89,619 participants (47,838 females [51.5%] and 41,781 males [48.5%]) of nationally representative ages from 18 years to >65 years. Between 2018 and 2021, psychotherapy use increased significantly faster for females [7.7% to 10.5%] than males [5.2% to 6.3%], younger [8.0% to 11.9%] than older individuals [3.6% to 4.6%], college graduates [7.6% to 11.4%] than those without a high school diploma [5.5% to 7.0%], adults at 2 to 4 times the poverty level [5.7% to 8.2%] than those below the poverty [9.7% to 10.0%], employed persons [5.7% to 8.9%] than unemployed persons [10.8% to 10.5%]), and urban [6.5% to 8.7%] than rural [6.4% to 5.9%] residents. Results were very similar when looking only at the 40% of adults who received primarily teletherapy.
Practice Implications
This study found that psychotherapy use increased significantly faster among several socioeconomically advantaged groups (younger, well-educated, wealthier, employed, and urban residents). Although some expected the increasing availability of teletherapy to reduce this disparity, this survey showed that a gap still exists when psychotherapy is delivered virtually. Some patient barriers to telemental health include technological challenges, preference for in-person care, low digital literacy, financial constraints, and lack of broadband access. Therapists who provide telemental health services can now access a larger pool of potential patients. These therapists may choose more highly educated and younger patients with less psychological distress, which are characteristics that therapists may associate with better responsiveness to psychotherapy.
Olfson, M., McClellan, C., Zuvekas, S.H., Wall, M., Blanco, C. (2024). Trends in outpatient psychotherapy among adults in the US. JAMA Psychiatry. Published online https://doi.org/10.1001/jamapsychiatry.2024.3903
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