Mental health visits to complementary and alternative medicine providers Gregory E. Simon, M.D., M.P.H. a, *, Daniel C. Cherkin, Ph.D. a , Karen J. Sherman, Ph.D. a , David M. Eisenberg, M.D. b , Richard A. Deyo, M.D., M.P.H. c , Roger B. Davis, Sc.D. b a Center for Health Studies, Group Health Cooperative, Seattle, WA, USA b Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, USA c Departments of Medicine and Health Services, University of Washington, Seattle, WA, USA Received 29 October 2003; accepted 7 January 2004 Abstract The objective of this study was to examine the characteristics of mental health visits to Complementary and Alternative Medicine (CAM) providers. A representative sample of acupuncturists, chiropractors, massage therapists, and naturopathic physicians in four states reported on 8933 consecutive visits, including demographic characteristics; presenting complaints; referral source; treatments provided; disposition; and other sources of care for the presenting problem. The proportion of visits for a mental health complaint ranged from 7% to 11% for acupuncture, massage, and naturopathic physicians to less than 1% for chiropractors. For acupuncturists, massage therapists, and naturopaths, 69 – 87% of patients making mental health visits were self-referred. The CAM provider discussed care with a conventional medical provider in 6 –20% of cases and was aware of concomitant conventional medical care in an additional 10 –30%. Only 1–5% were subsequently referred to conventional providers. For acupuncturists, massage therapists, and naturopaths, the proportion of visits for mental health concerns is similar to that in conventional primary care. Mental health visits to chiropractors are much less common, but this may reflect differences in true prevalence or differences in presentation. Among those seeking CAM care for mental disorders, concomitant treatment by conventional medical providers is common, but communication or coordination of care is rare. © 2004 Elsevier Inc. All rights reserved. Keywords: Complementary; Alternative medicine; Epidemiology; Mental health; Utilization 1. Introduction The last decade has seen increasing interest in comple- mentary and alternative medicine (CAM), both in the gen- eral public and among conventional medical providers. Representative national surveys find that up to 40% of US adults use some form of CAM treatment each year, with evidence of significant increases in use since 1990 [1,2]. Mainstream medical journals have given more attention to use of CAM treatments for both general medical and mental health conditions [3]. Three US national surveys and one Canadian survey have specifically examined use of CAM therapies for men- tal health conditions. Using data from the 1996 US Medical Expenditure Panel Survey, Druss and colleagues [4] found that approximately 10% of US adults with self-reported mental conditions used some form of practitioner-based CAM treatment during a 12-month period. This study also found that self-reported mental disorder was associated with increased likelihood of using any CAM treatment. Using data from the 1997–1998 Healthcare for Communities sur- vey, Unu ¨tzer and colleagues [5] also found that depressive or anxiety disorders were associated with increased use of CAM treatments (either practitioner-based or self-adminis- tered). Among those with a probable mental disorder who used some CAM treatment, nearly 20% also received con- ventional specialty mental health care and over 45% re- ceived some mental health treatment from a conventional primary care provider. Using data from another national survey in 1997 and 1998, Kessler and colleagues [6] found that approximately 20% of respondents reporting either “anxiety attacks” or “severe depression” had used some * Corresponding author. Tel.: +1-206-287-2979; fax: +1-206-287- 2871. E-mail address: simon.g@ghc.org (G.E. Simon). General Hospital Psychiatry 26 (2004) 171–177 0163-8343/04/$ – see front matter © 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2004.01.002