People Who Are Wealthier Or Have Private Insurance Benefit More From Psychotherapy
Since 2018, access to psychotherapy has increased significantly among adults in the United States with mild to moderate distress, according to a new study.
The spike in psychotherapy use is most prominent among younger adults, college-educated individuals, women, and those with higher family incomes.
In addition, individuals with private health insurance experienced more gains in psychotherapy use than people with public insurance or no insurance at all.
In 2021, psychotherapy use through telehealth was also much higher among adults with higher education, higher incomes, and full-time employment.
“While psychotherapy access has expanded into the U.S., there’s concern that recent gains may not be equally distributed, despite or maybe because of the growth of teletherapy,” said Mark Olfson, a professor of epidemiology and psychiatry at Columbia University’s Mailman School of Public Health.
“This increase in psychotherapy use, driven by the rise of teletherapy, has largely benefited socioeconomically advantaged adults with mild to moderate distress.”
In the U.S., psychotherapy is one of the most common forms of mental health care. The percentage of U.S. adults receiving psychotherapy rose from 6.5 percent in 2018 to 8.5 percent in 2021.
For the new study, the researchers examined data from the 2018 to 2021 Medical Expenditure Panel Surveys. The study included a sample of 86,658 adults, which is about 22,000 individuals per year.
Psychotherapy use in 2021 was highest among young adults at 12 percent, followed by middle-aged adults at 8.3 percent, and lowest among older adults at 4.6 percent.
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Those with the most severe distress had the highest rates of psychotherapy use, which is to be expected.
Almost 40 percent of adults using outpatient psychotherapy attended at least one teletherapy session. The COVID-19 pandemic significantly accelerated the rate at which telemental health services were integrated into the system.
For the most part, teletherapy is a convenient, accessible option for care, with much less stigma surrounding it. However, there are ongoing concerns that it is not benefitting certain groups, such as older adults, individuals with lower income, some minority groups, and those with more severe mental health issues.
Financial barriers, like high out-of-pocket costs and lack of insurance coverage, prevent people from seeking mental health care.
Furthermore, Medicaid has low reimbursement rates, which can discourage therapists from taking part in insurance networks. This only worsens the availability of therapists out there.
The research also demonstrates that adults with lower incomes or those who don’t have private health insurance were less likely to utilize teletherapy compared to wealthier, privately insured individuals.
“Technological challenges, preferences for in-person care, and financial barriers can hinder access to teletherapy,” Olfson said.
“There is growing concern that the rise of telemental health could deepen existing disparities in access to care.”
“The trends we are seeing underscore the need for targeted interventions and health policies that expand psychotherapy access to underserved groups.”
The study was published in JAMA Psychiatry.
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