Wider use of antidepressants and other prescription medications has reduced the role of psychotherapy, once the defining characteristic of psychiatric care, according to an analysis published today.
The percentage of patients who received psychotherapy fell to 28.9% in 2004-05 from 44.4% in 1996-97, the report in Archives of General Psychiatry said.
Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects.
Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind.
Psychotherapy is an interpersonal intervention that may involve such things as behavior modification and group discussion. It is recommended -- with or without medication -- for major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.
Besides psychiatrists, a range of mental health professionals not covered in the report also conduct psychotherapy, including psychologists, social workers and marriage counselors.
The study was based on data drawn from the National Ambulatory Medical Care Survey, an anonymous survey of office-based physicians that tracks characteristics of patients and physicians, and records the diagnosis and treatment, during a typical week.
Researchers examined data on 14,108 psychiatric office visits during a 10-year period.
Psychiatrists who said they provided psychotherapy to all of their patients declined to 10.8% in 2004-05 from 19.1% in 1996-97, according to the report. Consistent with previous studies, researchers found that patients who paid out of pocket, generally the wealthiest patient group, were more likely to receive psychotherapy.
Financial incentives were weighted against psychotherapy, the report said. Reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15-minute medication management visits, the report said, citing a 2003 study. Anticipated changes in Medicare reimbursement are expected to bring payments into closer balance, experts said.
