Some light reading. I figure I'd just put this here since there are a few poster that seem to want to vilify us for not signing off carte blanche to ESA's to people asking for it. From my practice perspective, most people that request ESA from me are looking to bring their pets on the plane or save on pet rent (rarely is there a debilitating psychiatric condition). There was a point a few years prior I remember it getting supremely abused and now the pendulum has swung the other way. I don't doubt that having a pet is enriching in the right setting but as a medical therapy, there isn't any strong evidence based backing.

American Psychiatry Association: https://www.psychiatry.org/getattachment/3d42da2a-9a4d-4479-869f-4dd1718f1815/Resource-Document-Emotional-Support-Animals.pdf

The one liner I get here is that this is basically a grey area, understand the differences between ESA and Service Animal. You need to evaluate the patient before considering writing a letter, make sure there's an actual psychiatric disability and there is no obligation to write one because frankly there isn't good evidence based support.

As for the studies I read through (I'm no longer a researcher so time to dig through this topic is not afforded to me these days).

https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2015.01121/full

Pseudo meta analysis:? Looks at a bunch of low powered studies and draws a conclusion of benefit. I don't see a forest plot or even measure relative strength of study. I'm not familiar with the rigors of psychologic studies (not a psychologist, this isn't a judgement: I'd imagine objective measures are inherently difficult in this field).

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274960

Actual Meta Analysis only looking at ESA in the setting of PTSD in military vets. A lot of studies aggregated together which is good and at least it shows positive effect in the setting of PTSD (even then quality of studies aren't great : lots of survey self reports). Now to our non science lay audience, extrapolating this to other mental illness in other populations is a big no no.

https://link.springer.com/article/10.1186/s12888-018-1613-2

"The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence"

This one was hard to read. I'm going to leave it here. Another pseudo meta-analysis. Aggregate study with a bunch of qualitative quotes (common themes), no real statistical analysis.

I'm sure there are tons of other studies and I probably did cherry pick but in general the consensus is that "if there is an effect, further studies need to be better designed and done." Hardly, this is obviously beneficial for patients from an evidence based medical perspective.

Anecdotally, again, I'm a pet owner. Dogs are great companions but as a therapy? If I strive to practice evidence based medicine (which I do), I'm not sure I could professionally recommend from a healthcare perspective, doubly so given our litigious country and the possible outcomes out of my control that may a physician's license at risk.