Ranging from acupuncture to chiropractic to herbal therapies, complementary and alternative medicine (CAM) accounts for a burgeoning category of healthcare spending, with consumers shelling out over $34 billion in annual out-of-pocket expenditures for such treatments. The use of “mind-body” therapies for treating neuropsychiatric symptoms in particular also appears to be increasing.

Maulik Purohit, MD, MPH
Neurorehabilitation and Traumatic Brain Injury, National Intrepid Center of Excellence: Intrepid Spirit One (NICoE ISO); Fort Belvoir Community Hospital, Department of Defense; Harvard Medical School, Department of Physical Medicine and Rehabilitation


Complementary and alternative medicine (CAM) therapies are popular treatments for a wide variety of conditions. Ranging from acupuncture to chiropractic to herbal therapies, CAM accounts for a burgeoning category of healthcare spending, with consumers shelling out over $34 billion in annual out-of-pocket expenditures for such treatments. The use of “mind-body” therapies for treating neuropsychiatric symptoms in particular appears to be growing, and it is a subject that Dr. Maulik Purohit and colleagues have studied at length.

“The present study1 is our third in a series of studies exploring the use of CAM for treating neuropsychiatric symptoms,” says Dr. Purohit. “Our first several manuscripts2,3 found that CAM use was higher among people with neuropsychiatric symptoms compared to those without, and that there appeared to be a correlation between the number of neuropsychiatric symptoms and the likelihood of CAM use. The present study explores the consumer costs and total expenditure—in other words, the volume of consumer demand—related to CAM specifically for treating neuropsychiatric symptoms.”

METHODOLOGY

Purohit and colleagues analyzed data from an alternative medicine supplement questionnaire of the 2007 National Health Interview Survey. The completed survey included 23,393 adult respondents, of whom 8,696 had neuropsychiatric symptoms. Multivariable logistic regression models were used to compare respondents with and without neuropsychiatric symptoms and accounted for respondents’ sociodemographic and clinical characteristics.

REPORTED SYMPTOMS AND CAM EXPENDITURE

Among those surveyed, 63% did not report any neuropsychiatric symptoms, 18% percent reported 1 symptom, 8.5% reported 2 symptoms, and 10.4% reported ≥3 symptoms. The most commonly reported symptoms included insomnia (18%), regular headaches (15%), anxiety, (11%), depression (11%), excessive sleepiness (6%), and attention deficits (3%).

Among respondents, those with ≥1 neuropsychiatric symptom were more likely to report CAM expenditure within the past year (27.4%) compared to those with no neuropsychiatric symptoms (20.3%). Even after accounting for sociodemographic variables, the neuropsychiatric symptom group—which was more likely to be female, of middle age, non-Hispanic white, lower income, and to have a chronic medical condition—were ~70% more likely to report CAM expenditure (OR 1.34; 95% CI, 1.22–1.48) than the non-symptomatic group. CAM expenditure did not, however, vary greatly among those with fewer or more neuropsychiatric symptoms; 25.5% of those with 1 symptom reported CAM expenditure, and CAM expenditure was virtually identical at 27.2% for both respective groups that reported 2 and 3 neuropsychiatric symptoms.

The neuropsychiatric symptoms most likely to be treated with CAM in this study included anxiety, excessive sleepiness, depression, and insomnia. Perhaps unsurprisingly, CAM therapies in the mind-body category were used most frequently for treating neuropsychiatric symptoms, including biofeedback, energy healing, hypnosis, tai chi, yoga, meditation, progressive relaxation, and deep breathing.

Respondents with ≥1 neuropsychiatric symptom, comprising 37% of the survey population, cumulatively spent $14.8 billion out of pocket on CAM.

“Put into the context of prescription medication, that figure represents about 11% of out-of-pocket costs per year for those with neuropsychiatric symptoms,” says Dr. Purohit. “We did find a correlation between number of symptoms and greater overall use of CAM, but that greater frequency did not translate into greater expenditure on CAM. We attribute that to patients possibly integrating certain therapies into their lifestyle—for example, people who go to yoga studios but then continue to practice at home at no additional cost. On average, those with debilitative neuropsychiatric symptoms spent an additional $250/year (roughly $20/month) compared to those with no symptoms.

“In referring to CAM, I like the term ‘integrative medicine,’ because it’s meant to complement treatments recommended by an allopathic provider,” says Dr. Purohit. “In fact, we looked at some of the reasoning that underlay people’s decision to use CAM, and, interestingly enough, one of the top three reasons was that CAM therapy was recommended by an allopathic provider. This signals not only a growing awareness of CAM in the general population but a high awareness within the medical community as well.”

 

References:

1. Purohit MP, Zafonte RD, Sherman LM, et al. Neuropsychiatric symptoms and expenditure on complementary and alternative medicine. J Clin Psychiatry. 2015;76(7):e870-6.

2. Purohit MP, Wells RE, Zafonte RD, Davis RB, Phillips RS. Neuropsychiatric symptoms and the use of complementary and alternative medicine. PM R. 2013;5(1):24-31.

3. Purohit MP, Wells RE, Zafonte R, et al. Neuropsychiatric symptoms and the use of mind-body therapies. J Clin Psychiatry. 2013;74(6):e520-6.

Disclosure: Dr. Purohit has received support/funding from the National Center for Complementary and Alternative Medicine at the National Institutes of Health.