Access to psychotherapy has significantly increased among U.S. adults dealing with mild to moderate distress since 2018, as highlighted by a recent study. This trend is particularly pronounced among younger adults, women, those with college degrees, and individuals from higher-income families. Additionally, privately insured individuals have seen a greater rise in psychotherapy utilization compared to those who rely on public insurance or are uninsured.
A recent research study from Columbia University’s Mailman School of Public Health and the Department of Psychiatry at Columbia Vagelos College of Physicians and Surgeons reveals that access to psychotherapy has notably increased among U.S. adults experiencing mild to moderate distress since 2018. This rise is especially evident among younger adults, women, individuals with college education, and higher-income groups. Moreover, those with private insurance have shown more significant increases in psychotherapy use compared to their publicly insured or uninsured counterparts. The complete results are published in JAMA Psychiatry.
By 2021, the use of psychotherapy through telehealth had also risen markedly among adults with higher incomes, higher education levels, and those employed full-time.
“Though psychotherapy access has improved in the U.S., there are worries that these advances may not be equitable, potentially due to the rise of teletherapy,” stated Mark Olfson, MD, MPH, a professor at Columbia Mailman School specializing in Epidemiology and Psychiatry. “The growth in psychotherapy usage, largely prompted by teletherapy, has tended to benefit adults with socioeconomic advantages who experience mild to moderate distress.”
Psychotherapy continues to be one of the most prevalent forms of mental health treatment in the U.S. In an earlier study, Olfson noted that the percentage of adults in the U.S. utilizing psychotherapy increased from 6.5% in 2018 to 8.5% in 2021.
The current research evaluated data from the Medical Expenditure Panel Surveys conducted from 2018 to 2021, which reflect a sample of the civilian, non-institutionalized population in the U.S. The study included approximately 86,658 adults, around 22,000 individuals each year.
In 2021, the highest rate of psychotherapy use was among young adults (12%), followed by middle-aged adults (8.3%), and the lowest among older adults (4.6%). As expected, those experiencing more severe levels of distress had the highest rates of therapy usage, whereas those with mild or moderate distress utilized it at intermediate levels, and those without distress showed the least usage. Almost 40% of adults receiving outpatient psychotherapy in 2021 used at least one session via teletherapy.
The COVID-19 pandemic, which led to widespread social isolation, stress, and economic challenges, accelerated the shift toward telemental health services. While teletherapy offers a convenient and less stigmatizing way to receive care, there are ongoing concerns that certain demographics—such as individuals with severe mental health problems, older adults, low-income groups, and specific minority populations—have not benefited equally from this expansion.
Financial obstacles, including lack of insurance and high costs not covered by insurance, remain significant barriers to accessing mental health care. Furthermore, low Medicaid reimbursement rates can deter therapists from engaging with insurance networks, worsening the availability of therapy services. Research by Olfson indicates that individuals with lower incomes or without private insurance are less likely to use teletherapy compared to wealthier, privately insured individuals.
“Technological issues, preferences for face-to-face treatment, and financial obstacles can restrict access to teletherapy,” Olfson noted. “There is a growing concern that the rise in telemental health could exacerbate existing disparities in care access.”
“The trends we observe highlight the urgent need for focused interventions and health policies that improve psychotherapy access for underserved populations,” added Olfson. “Making sure that those experiencing psychological distress can receive care is a national concern. Tackling technical and financial barriers to teletherapy could help close the access gap and foster equity in mental health services.”
Co-authors of the study include Chander McClellan and Samuel H Zuvekas from the Agency for Healthcare Research and Quality; Melanie Wall from Columbia Mailman School and Vagelos College of Physicians and Surgeons; and Carlos Blanco from the National Institute on Drug Abuse.
