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Am J Psychiatry 1994; 151:1281-1288
Copyright © 1994 by American Psychiatric Association
Outpatient psychotherapy in the United States, I: Volume, costs, and user characteristics
M Olfson and HA Pincus
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032.
OBJECTIVE: This article provides an overview of the volume, composition,
and costs of outpatient psychotherapy in the United States. METHOD: Data
were analyzed from the household section of the 1987 National Medical
Expenditure Survey. The authors determined the volume and distribution of
psychotherapy visits by provider specialty, setting, source of expenditure,
and reason for visit. An examination was made of the demographic
characteristics, health status, and mental health utilization profile of
psychotherapy users. RESULTS: In 1987, Americans made 79.5 million
outpatient psychotherapy visits at a total cost of $4.2 billion. Most of
these visits were to mental health specialists (more than 80%) and were
reported to be for the treatment of mental health conditions (63.5%).
However, psychotherapy was not provided in a substantial proportion of the
visits to mental health specialists (21.1%) or the visits to treat mental
conditions (29.8%). Separated and divorced persons, females, whites persons
aged 35 to 49 years, and those with more than 15 years of education had a
greater likelihood of using psychotherapy. Psychotherapy use was also
greater among persons in poor general health and those reporting
health-related functional impairments. General medical costs of
psychotherapy users exceeded those of nonusers. CONCLUSIONS: Psychotherapy
accounts for approximately 8% of outpatient medical care costs. Users of
psychotherapy appear to be more distressed than is commonly assumed: they
report poorer general health, higher general medical costs, and more
functional impairment than nonusers. Although mental health specialists
commonly provide psychotherapy to treat mental disorders, all mental health
care is not psychotherapy.
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