Outpatient psychotherapy use in the U.S. increased from 6.5% in 2018 to 8.5% in 2021, with notable growth among younger adults and participants with higher socioeconomic status, according to a recent study published in JAMA Psychiatry.
The repeated cross-sectional study examined trends in outpatient psychotherapy use among the civilian noninstitutionalized U.S. adult population from 2018 to 2021 using nationally representative data from the Medical Expenditure Panel Surveys. The analysis included 89,619 participants (47,838 female [51.5%] and 41,781 male [48.5%]; 22,510 aged 18-34 years [29.0%], 43,371 aged 35-64 years [48.8%], and 23,738 aged ≥65 years [22.2%]). Participants were stratified by sociodemographic factors and psychological distress levels measured via the Kessler-6 scale, with distress categorized as serious (score ≥13), mild to moderate (1-12), or none (0). Data analysis occurred from March to August 2024.
The researchers identified significant increases in psychotherapy utilization, rising from 6.5% of participants in 2018 to 8.5% in 2021. The most substantial growth occurred among younger adults aged 18 to 34 years (8.0% to 11.9%), females (7.7% to 10.5%), college graduates (7.6% to 11.4%), and participants at higher income levels. Notably, those at 201-400% of the federal poverty level (FPL) increased from 5.7% to 8.2%, while those above 400% FPL increased from 5.9% to 8.6%. Psychotherapy use among urban residents increased from 6.5% to 8.7%, while rural use declined from 6.4% to 5.9%.
Among adults using psychotherapy in 2021, 39.9% reported at least one teletherapy session. Significant disparities in teletherapy use emerged across multiple demographics. Younger adults showed higher teletherapy rates than those aged 65 years or older (difference, −6.5 percentage points; 95% CI, −8.0 to −5.0 percentage points). Higher rates were also observed among females compared to males (difference, 1.9 percentage points; 95% CI, 0.9 to 2.9 percentage points), college graduates versus those without a high school diploma (difference, 4.9 percentage points; 95% CI, 3.3 to 6.4 percentage points), and urban versus rural residents (difference, 2.7 percentage points; 95% CI, 1.5 to 3.8 percentage points). Additionally, privately insured participants showed higher usage compared to those with public insurance (difference, −2.5 percentage points; 95% CI, −3.4 to −1.5 percentage points).
A significant increase in psychotherapy use was observed among adults with mild to moderate distress (difference, 2.7 percentage points; 95% CI, 1.5-3.9 percentage points). However, adults with serious psychological distress did not experience a significant rise in psychotherapy utilization during the study period. This pattern, combined with the observed socioeconomic disparities, suggests that recent gains in psychotherapy access were concentrated among socioeconomically advantaged groups with mild to moderate distress.
The researchers recommended policy measures to address these disparities and improve equitable access to psychotherapy, including teletherapy, for underserved populations.
Full disclosures can be found in the published study.
