Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York (Tadmon); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson).
Am J Psychiatry. 2022 Feb;179(2):110-121. doi: 10.1176/appi.ajp.2021.21040338. Epub 2021 Dec 8.
Previous work has demonstrated significant declines in the provision of outpatient psychotherapy by U.S. psychiatrists. The objective of this study was to characterize patterns and trends of psychotherapy by U.S. psychiatrists from 1996 to 2016.
A retrospective, nationally representative analysis of psychiatrist visits from 21 waves of the U.S. National Ambulatory Medical Care Survey between 1996 and 2016 (N=29,673) was conducted to assess rates of outpatient psychotherapy provision by U.S. psychiatrists. Provision was modeled as risk differences and adjusted by clinical, sociodemographic, geographic, and financial characteristics.
Between 1996 and 2016, the weighted percentage of visits involving psychotherapy declined significantly from 44.4% in 1996-1997 to 21.6% in 2015-2016. Declines were most marked among patients diagnosed with social phobia (29% to 8%), dysthymic disorder (65% to 30%), and personality disorders (68% to 17%). For patients diagnosed with schizophrenia, psychotherapy provision remained stable (10%-12%). In the 2010-2016 period, about half of psychiatrists (53%) no longer provided psychotherapy at all. Antidepressant, antipsychotic, and sedative-hypnotic prescriptions were negatively associated with psychotherapy provision. During the study period, sociodemographic disparities grew, with older, White patients residing in metropolitan areas in the Northeast or West increasingly becoming the most likely to receive psychotherapy. Self-pay predicted access to solo-practice psychiatrists, who saw fewer patients but more frequently, and were more likely to provide psychotherapy.
Previously reported declines in psychiatrist provision of psychotherapy continued through 2016, affecting nearly all clinical categories. In the 2010s, about half of psychiatrists practiced no psychotherapy at all, creating new challenges to the integration of neurobiological and psychosocial elements of clinical care.
先前的研究表明，美国精神科医生提供的门诊心理治疗显著减少。本研究的目的是描述美国精神科医生 1996 年至 2016 年心理治疗的模式和趋势。
对 1996 年至 2016 年期间 21 波美国国家门诊医疗调查（N = 29673）中的精神科就诊情况进行了回顾性、全国代表性分析，以评估美国精神科医生提供门诊心理治疗的比例。通过临床、社会人口统计学、地理和财务特征进行风险差异建模和调整。
1996 年至 2016 年间，涉及心理治疗的就诊比例从 1996-1997 年的 44.4%显著下降到 2015-2016 年的 21.6%。在社交恐惧症（29%至 8%）、心境恶劣障碍（65%至 30%）和人格障碍（68%至 17%）患者中下降最为明显。对于诊断为精神分裂症的患者，心理治疗的提供保持稳定（10%-12%）。在 2010-2016 年期间，约有一半的精神科医生（53%）根本不再提供心理治疗。抗抑郁药、抗精神病药和镇静催眠药的处方与心理治疗的提供呈负相关。在研究期间，社会人口统计学方面的差距扩大，年龄较大、白人患者居住在东北部或西部的大都市区，越来越有可能接受心理治疗。自费预测可以获得单人执业的精神科医生的治疗机会，这些医生看诊的患者较少，但看诊频率较高，并且更有可能提供心理治疗。
先前报告的精神科医生提供心理治疗的减少情况持续到 2016 年，几乎影响了所有临床类别。在 21 世纪 10 年代，大约一半的精神科医生根本不进行任何心理治疗，这给临床护理的神经生物学和心理社会元素的整合带来了新的挑战。
