Trends in Office-Based Mental Health Care Provided by Psychiatrists and Primary Care Physicians

Objective: To assess recent national trends in mental health care provided by office-based psychiatrists and primary care physicians.

Method: Trends in mental health-related visits to psychiatrists and primary care physicians are evaluated with the 1995-2010 National Ambulatory Medical Care Surveys. Rates and percentages of visits with mental health complaints, mental disorder diagnoses, psychotropic medications, and psychotherapy or mental health counseling were calculated for 1995-1998, 1999-2002, 2003-2006, and 2007-2010 by dividing the number of visits of a given type by intercensal population estimates.

Results: Between 1995-1998 and 2007-2010, a significant increase occurred in the rate per 100 population of primary care visits with mental health complaints (5.96 to 8.49) (OR = 0.45; 95% CI, 0.33-0.62, mental disorders (8.75 to 13.23) (OR = 1.40; 95% CI, 1.26-1.56), and psychotropic medications (11.08 to 26.74) (OR=3.43; 95% CI, 2.16-2.71). Significant corresponding increases occurred in psychiatrist visits with psychotropic medications (5.28 to 7.85) (OR = 2.25; 95% CI, 1.49-3.41), but not mental disorders (7.60 to 8.95) (OR = 0.87; 95% CI, 0.34-2.23), and the rate with mental health complaints significantly declined (5.87 to 5.20) (OR = 0.45; 95% CI, 0.33-0.62). During this period, the percentages of visits to primary care physicians that included prescriptions for antidepressants (interaction P = .0001), antipsychotics (interaction P = .03), and anxiolytics/hypnotics (interaction P = .0009) increased significantly faster than the corresponding percentages of visits to psychiatrists. A similar pattern occurred for visits that resulted in a bipolar disorder diagnosis (interaction P = .01).

Conclusions: In recent years, office-based primary care physicians have significantly increased their involvement in providing mental health care. These trends underscore the importance of collaboration between primary care physicians and psychiatrists to help ensure provision of high quality outpatient mental health care.

J Clin Psychiatry 2014;75(3):247-253

© Copyright 2014 Physicians Postgraduate Press, Inc.

Submitted: October 8, 2013; accepted December 30, 2013 (doi:10.4088/JCP.13m08834).

Corresponding author: Mark Olfson, MD, MPH, Department of Psychiatry, New York State Psychiatric Institute Unit 24, Columbia University, 1051 Riverside Drive, New York, NY 10032 (mo49@columbia.edu).