Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

中文翻译：

---

美国精神科医生提供的门诊心理治疗趋势：1996-2016

客观的：

以前的工作表明，美国精神科医生提供的门诊心理治疗显着下降。本研究的目的是描述 1996 年至 2016 年美国精神科医生的心理治疗模式和趋势。

方法：

对 1996 年至 2016 年间 21 波美国全国门诊医疗调查 (N=29,673) 的精神科医生就诊进行了一项具有全国代表性的回顾性分析，以评估美国精神科医生提供门诊心理治疗的比率。准备金被建模为风险差异，并根据临床、社会人口、地理和财务特征进行调整。

结果：

1996 年至 2016 年期间，涉及心理治疗的就诊加权百分比从 1996-1997 年的 44.4% 显着下降至 2015-2016 年的 21.6%。在被诊断患有社交恐惧症（29% 至 8%）、心境恶劣障碍（65% 至 30%）和人格障碍（68% 至 17%）的患者中，下降最为显着。对于被诊断患有精神分裂症的患者，心理治疗的提供保持稳定（10%–12%）。在 2010-2016 年期间，大约一半 (53%) 的精神科医生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与心理治疗的提供呈负相关。在研究期间，社会人口差异越来越大，居住在东北部或西部大都市地区的老年白人患者越来越有可能接受心理治疗。

结论：

先前报道的精神科医生提供的心理治疗下降持续到 2016 年，几乎影响了所有临床类别。在 2010 年代，大约一半的精神科医生根本没有进行心理治疗，这给临床护理中神经生物学和心理社会因素的整合带来了新的挑战。