Search

Investigators from minoritized backgrounds are underrepresented in psychiatric research. That underrepresentation contributes to disparities in outcomes of access to mental health care. Drawing on lived experience, scholarly qualitative reports, and empirical data, the authors review how the underrepresentation of minoritized researchers arises from interlocking, self-reinforcing effects of structural biases in our research training and funding institutions. Minoritized researchers experience diminished early access to advanced training and opportunities, stereotype threats and microaggressions, isolation due to lack of peers and senior mentors, decreased access to early funding, and unique community and personal financial pressures. These represent structural racism—a system of institutional assumptions and practices that perpetuates race-based disparities, in spite of those institutions' efforts to increase diversity and in contradiction to the values that academic leaders outwardly espouse. The authors further review potential approaches to reversing these structural biases, including undergraduate-focused research experiences, financial support for faculty who lead training/mentoring programs, targeted mentoring through scholarly societies, better use of federal diversity supplement funding, support for scientific reentry, cohort building, diversity efforts targeting senior leadership, and rigorous examination of hiring, compensation, and promotion practices. Several of these approaches have empirically proven best practices and models for dissemination. If implemented alongside outcome measurement, they have the potential to reverse decades of structural bias in psychiatry and psychiatric research. [ABSTRACT FROM AUTHOR]

Dr. A, a Black woman researcher and clinician-educator in the Department of Psychiatry at a prestigious academic institution, was appointed chair of the Diversity, Equity, and Inclusion (DEI) committee in 2017, in the context of public complaints and media coverage concerning sexism and racism. Following recent high-profile murders of Black people by police, Dr. A is called upon by the department chair to develop "antiracist programming." As a first step, Dr. A drafts a strong message against racismandexcessive police force.Despite the statement being vetted by all senior leadership, the department chair insists thatDr.Aplace only her name on it, in case it is not "well received." Dr. A receives negative e-mails in response to the statement, with minimal support from the department. Not to be dismayed, Dr. A assembles a DEI committee to plan an "antiracist" strategy for the entire department, without financial support, protected time, or additional resources. The DEI committee progress is slowed by the lack of institutional and departmental commitment. Additionally, several well-meaning non- Black colleagues in the department organize responses to the murders-including protests, town hall events, and public statements-without concerted coordination with the DEI committee, implying that "nothing was being done." In parallel, Dr. A is tasked with organizing and dispatching the limited number of Black psychiatrists, psychologists, and social workers in the department to deliver care to the entire Black community at her institution. Feeling overwhelmed by the number of tasks she has been asked to initiate-while navigating a tense climate, with minimal financial or administrative departmental support-Dr. A requests a meeting with the department chair and executive committee. At the meeting, Dr. A, a tenured faculty memberfor the past 10 years, is addressed by another colleague's name-the only other Black professor in the department. When Dr. A points out this microaggression, a senior colleague tells her she is being "too sensitive," and is "overreacting." Despite this interaction, Dr. A highlights multiple institutional barriers, including the structural racism that minimizes the work of DEI initiatives in the department. She presents her proposal for protected time and resources to successfully execute robust antiracist programming but is toldmoneyis tight and to "scale back" and "do the best you can.".

Psychiatry residency programs with robust research training can prepare physician-scientists to make contributions that advance the mental health field. Our psychiatry residency developed a chief resident for research position to help provide mentorship, community building, and advising around scholarly activities for residents. We present the process of implementing this new position in our residency to offer a model for engaging psychiatry residents in research.

The regular analysis of publication trends, including gender aspects, is an important contribution to the identification of gender-specific differences in academic psychiatry. The present study aimed to characterise publication topics in three high-impact psychiatric journals across three time points within 15 years (2004, 2014 and 2019). Publication patterns of female authors compared to their male colleagues were examined. All articles published in 2019 in the three high-impact psychiatry journals JAMA Psychiatry, British Journal of Psychiatry and American Journal of Psychiatry were included and compared with data from the 2004 and 2014 assessments. Descriptive statistics were calculated and Chi-square tests were performed. In 2019, a total of 473 articles were published, 49.5% were original research articles, of which 50.4% were published by female first authors. The results of this study showed a stable trend in the publication of research on mood disorders as well as schizophrenia and psychotic disorders in high-ranking psychiatric journals. Although the percentage of female first authors in the three most common target populations under study (mood disorders, schizophrenia and general mental health) increased from 2004 to 2019, gender equality has not yet been achieved in these fields. However, in the two most frequent subject matters, basic biological research and psychosocial epidemiology, the percentage of female first authors was more than 50%. Consistent monitoring of publication trends and gender distribution by researchers and journals in psychiatric research should be continued to identify and counteract the possibility of the underrepresentation of women in certain fields.

Introduction: In terms of academic positions and activities, women seem to be disadvantaged in various aspects all over the world. Our study aims to investigate the representation of male and female genders in academic psychiatry journals in Turkey. Method: We included the publications in the academic psychiatry journals indexed in The Scientific and Technological Research Council of Turkey, Turkish Academic Network and Information Center, which were published between 2011 and 2020.12 journals were grouped as SCI-E/ SSCI (n=4), ESCI (n=4), and other international indexes (n=4). A total of 5179 articles were reviewed. Results: The ratios of female authors per article, female first author, female correspondence author, and female last author were found to be lower in the SCI-E/SSCI and ESCI groups compared to the other international index groups (p<0.05). In all article types, the rate of women as the last author was lower than the rate of women as the first author (p<0.05). Conclusion: The paucity of the female authors in the last authorship position and the editorial articles can be interpreted as the glass ceiling effect. To ensure gender equality in academic publications, universities and the editorial boards of journals should fight against gender-based bias and discrimination. [ABSTRACT FROM AUTHOR]

Alison R Hwong,1 Stefana Morgan,1 Chelsea Anne Young,2 Aaron D Besterman,3 Michael Jacob,1 Jody Williams,1 Victor I Reus,1 Carol A Mathews,4 Erick Hung,1 Susan Voglmaier1 1Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; 2Department of Psychiatry, Stanford University, Palo Alto, CA, USA; 3Department of Psychiatry, University of California, San Diego, CA, USA; 4Department of Psychiatry, College of Medicine at the University of Florida, Gainesville, FL, USACorrespondence: Alison R HwongUniversity of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143-0983, USATel +1 406 414 7185Email alison.hwong@ucsf.eduAbstract: Psychiatry residency programs with robust research training can prepare physician-scientists to make contributions that advance the mental health field. Our psychiatry residency developed a chief resident for research position to help provide mentorship, community building, and advising around scholarly activities for residents. We present the process of implementing this new position in our residency to offer a model for engaging psychiatry residents in research.Keywords: academic psychiatry, residency training, research career

The authors make the case for using a written instead of a spoken supervision agreement at supervision's outset in order to provide clarity and education about supervision, supply an accessible document that supervisees can readily reference, sidestep memory issues that negatively affect the supervision process, and enable dyadic collaboration that sets an immediate positive tone for supervision. The invitational, clarifying, educational, empowering, and transparent (ICEE-T) supervision agreement approach is described, with emphasis on the essential elements to put in place at the outset of supervision. A written agreement, which is valuable at any supervisee developmental stage, can be invaluable when working with novice supervisees (e.g., because of the anxieties and self-doubt of first-time supervisees) and is explored with that group foremost in mind., Competing Interests: The authors report no financial relationships with commercial interests.

Gender parity and authorship diversity are declared goals in the publishing world. This study assessed the progress of authorship gender distribution over a quarter of a century and geographic diversity over the last 15 years in high-impact psychiatric journals. All articles published in 2019 in the American Journal of Psychiatry, the British Journal of Psychiatry, and JAMA Psychiatry were included and compared with data from three points in time starting in 1994. Descriptive statistics were gathered, and chi-square tests were performed. All tests were conducted as two-tailed, and p-values < 0.05 were considered to be statistically significant. Inter-rater reliability was calculated via Cohen's kappa. In 2019 a total of 473 articles were published. Forty percent of all authors, 42.3% of first authors, and 29.4% of senior authors were female. Counting original research articles only, female first authorship reached 50.4%. In the 25-year period between 1994 and 2019, female first (p <.001), female senior (p <.001), and female overall (p <.001) authorship has increased. In the specific period between 2014 and 2019, overall female senior authorship in all articles (p =.940) as well as first (p =.101) and senior (p =.157) in original research plateaued. In non-original research articles, female first authorship was higher in 2019 compared to 2014 (p =.014), whilst female senior authorship plateaued (p =.154). Geographic diversity was low and did not change over time. Gender parity in the subcategory original research articles was reached for the first time in 2019. Senior female authorship and geographic diversity remain areas of concern that need further investigation and specific interventions. [ABSTRACT FROM AUTHOR]

An editorial is presented on Glucocorticoids such as cortisol being essential for guiding normal brain development. Topics include glucocorticoid release from the adrenal glands constituting a primary component of the physiological response to stress; and neurotypical controls from two brain regions strongly implicated in the pathophysiology of both disorders the prefrontal cortex and the amygdala.

Amoud University in Borama is located in the self‐declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in‐person "teaching missions." This was recently led by a Borama‐native psychiatry resident in Ethiopia. COVID‐19 added further hardships due to restrictions to travel and in‐person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self‐sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020–2021 and will continue in 2021–2022. An international, 'online‐connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty‐led, hybrid‐delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020–2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross‐cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health. [ABSTRACT FROM AUTHOR]

"Mr. A," a 24-year-old man, presents for evaluation of worsening depression. He describes a history of depression since adolescence, although he notes that he suffered a troubled childhood, including emotional neglect. He believes a recent breakup and having been denied a promotion precipitated this episode. "I'm sleeping all the time, and my body feels heavy," he adds. He also reports increased appetite, weight gain, and "urges to cut, which I have not done in years." However, he remains social and actively involved in several hobbies. He discontinued bupropion and escitalopram in the past because of "terrible headaches and irritability." Initially, you consider starting lamotrigine. However, your office recently implemented a clinical decision support system that recommends a trial of phenelzine. The patient's symptoms remit entirely on the medication suggested by the system. Curious as to how the system decided on this treatment, you download several papers on its development. [ABSTRACT FROM AUTHOR]

BackgroundEarly identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.AimsTo develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups.MethodThe Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.ResultsThe six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value.ConclusionsThe Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.

Women are currently underrepresented in academic psychiatry. As publication activity reflects both leadership and participation in academia, we examined temporal trends in women's authorship by conducting a large-scale bibliometric study of psychiatry journals. We examined changes in proportions of women in the first, last, and overall authorship positions over time; relationship to journal impact factor and editorial board makeup; and rates of transition to senior author status using original research articles published in the 24 highest-impact psychiatry journals between January 2008 and May 2018. In 30,934 articles, women represented 40.0% of all authors in 2008 and 44.8% in 2018, with a significant increase in the percentage of women as first authors (2008: 43.5%, 2018: 49.5%; B = 0.64, p =.002) and last authors over time (2008: 30.0%, 2018: 35.7%; B = 0.64, p = 1 × 10−5). Articles with women as last authors were significantly more likely than those with men as last authors to have a woman as first author (χ2 1 = 126.1, p < 2.2 × 10−16). Women exhibited slower rates of transition to the last author position (log rank p = 2 × 10−16); time to 10% transition was 5 years for men and 9 years for women. These results indicate continued improvement in the representation of women authors in psychiatry journals, resulting in near parity in first authors. However, slower rates of transition to the senior author position and continued underrepresentation of women as senior authors suggest ongoing challenges in achieving gender parity in academic leadership. At the present rate of change for last authors (0.64% increase per year), women would achieve parity in senior authorship in ∼20 to 25 years. [ABSTRACT FROM AUTHOR]

Psychotherapy supervision is an essential component of graduate medical education in psychiatry. However, most psychotherapy supervisors have never had training specific to supervision, and the requisite skills have received little attention in the literature. The authors of this article describe the first year of a pilot project that was aimed at fostering interest and skill in psychotherapy supervision among senior residents. In this model, a postgraduate year (PGY)-4 resident supervised a PGY-2 resident's psychodynamic psychotherapy while receiving supervisory support from a senior faculty member. Feedback from the two residents and the residency program director was positive. The PGY-2 resident reported benefiting from near-peer supervision. The PGY-4 resident continued to supervise residents after graduation and felt well prepared to assume that role. The residency program continued to use this model after the pilot period. Other training programs can replicate this model to nurture the next generation of psychotherapy supervisors., Competing Interests: The authors report no financial relationships with commercial interests.

Objectives: To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness.Methods: Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia).Results: A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC "disclosure/help-seeking" subscale were higher compared with the "attitudes towards people with mental illness" subscale. There was no correlation between the OMS-HC and IAT.Conclusions: These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma. [ABSTRACT FROM AUTHOR]

An editorial is presented on the Dismantling Structural Racism in Academic Psychiatry to Achieve Workforce Diversity. The article discusses that the recruitment and retention of Black, Indigenous, and people of color (BIPOC) faculty in academic medicine remains a challenge. Significant changes in the demographic landscape of the United States over the past decade highlight the need for medicine and health care systems to align better with the social and cultural needs of those seeking care.

Objective: This paper gives guidance for developing collaborative clinical research within an academic psychiatry department.Methods: We describe the experience at the Australian National University Medical School, and present three case studies.Results: The results reveal that general principles include, but are not limited to, intellectual curiosity, mentorship, collaboration and protected time.Conclusions: We conclude that a particular strength of a new research department at a medical school may be close collaborative research within clinical settings. [ABSTRACT FROM AUTHOR]