Psychotherapy use in a privately insured population of patients diagnosed with a mental disorder

Although there is growing evidence demonstrating the effectiveness of psychotherapy in the treatment of mental disorders,
the use of psychotherapy in privately insured populations has not been examined. This study examines utilization rates and
correlates of the receipt of psychotherapy.

A large claims database of US private sector claims was used to examine utilization rates and correlates of receipt of psychotherapy.
Altogether, 860,090 adults who received mental health services in 2005 were identified from the database. Multivariate binary
regression and general linear models were used to assess the association of patient characteristics with use of psychotherapy,
use of group or family therapy and the number of psychotherapy visits based on current procedural terminology (CPT) codes.

Only 32.4% of patients diagnosed with a mental illness received CPT codes indicating receipt of psychotherapy, and of these
96.5% received individual psychotherapy. Almost 75% of individuals diagnosed with posttraumatic stress disorder, 62% with
major depressive disorder, and 54% with bipolar disorder received psychotherapy. Larger numbers of psychotherapy visits were
associated with posttraumatic stress disorder (PTSD), alcohol use and mild depression. Larger numbers of psychotherapy visits
were associated with PTSD, alcohol use and mild depression. Drug use, schizophrenia, bipolar disorder and major depressive
disorder (MDD) were associated with fewer psychotherapy visits.

Substantial differences in use of psychotherapy were observed across diagnoses, perhaps reflecting the availability of alternative
drug therapies. Greater use of psychotherapy in patients with PTSD may reflect weaker evidence of the effectiveness of pharmacological
treatment, while less use in MDD may reflect greater evidence of drug benefits.