For as long as psychiatric journals have been published, researchers have analyzed their content to assess the state of psychiatric knowledge and practice as well as the zeitgeist of the profession through analyses of the scientific methods applied, the content of the published work, and the advancements and changes over time.1–7 One important change observed within the field of medicine and specifically within psychiatry is that, during recent decades, women's mental health and gender issues have become topics of special interest.8–10
Likewise, the growing number of female psychiatrists has attracted some research and policy interest.11 Researchers have studied the increasing importance of women in practice, teaching, and research positions as well as possible barriers to their career advancement during the past 40 years12,13 and compared their findings with those in other fields of medicine and society.14–17 Despite the clear advances in general of women in medicine, and especially in psychiatry, with women constituting at least 50% of the field for the past 25 years in the United States, women are still underrepresented in leadership positions and in academic medicine.18
An important measure of academic productivity is publication in scientific journals. Here, a “gender gap” in the authorship of scientific articles has been reported for different medical fields.19 However, to the best of our knowledge, the present study is the first to examine the gender distribution of authors of articles published in prestigious psychiatric journals. We set out to assess the characteristics of psychiatric research and their development across 13 years with respect to the gender of the authors as represented in the articles published by three high-impact general psychiatric journals in 1994 and in 2007.
From the ISI Web of Science database, we chose the two highest-ranking general psychiatry journals—the Archives of General Psychiatry and The American Journal of Psychiatry—both of which are published in the United States, as well as the highest-ranking non-U.S. journal—The British Journal of Psychiatry. We covered two 1-year periods, 1994 and 2007.
Inclusion of articles
We considered for analysis all articles published in the above journals in 1994 and in 2007, with the exception of (1) editors' introductory notes, (2) book reviews, (3) American Psychiatric Association issues and presidential addresses, (4) regular columns such as “Psychiatry in Pictures,” “Images in Neuroscience,” “Art and Images in Psychiatry,” “One Hundred Years Ago,” and “Psychiatry Around the World,” (5) corrections, and (6) authors' replies to letters.
We used a subsample of two months of each journal for each year to develop the coding scheme. To improve comparability of the findings, we used a list of relevant categories of articles that we had developed by analyzing previously published articles.1–7 Two authors (B.S., M.A.) repeatedly applied the coding scheme to a proportion of the articles and improved the scheme until the interrater reliability was considered satisfactory.20 One author (B.S.) then coded all the articles in the sample while the other author (M.A.) coded 10% of the articles, chosen at random, for the overall assessment of interrater reliability.
We distinguished between (1) original research and (2) nonresearch articles. We classified original research articles according to the research methods used: cohort studies, case–control studies, cross-sectional studies, controlled/uncontrolled clinical trials, and “other” (including, for example, case series, ecological studies, qualitative studies, and modeling studies). The nonresearch group included five subcategories: reviews, case reports, commentaries or discussions, editorials, and letters.
Gender of authors.
We identified from his or her first name the gender of each first author as well as the gender of each coauthor for all articles. Where first names were not stated or not clearly indicative of gender, we sought out further publications from the same group of authors to find the first names. We also consulted colleagues known to us in the academic field, who had cooperated with the authors in question, as well as personal or institutional Web sites. We checked CVs in several instances, some of which included photographs, which we very much appreciated.
Academic degrees of authors.
We recorded the MD and PhD degrees of the first authors as stated in the bylines of the respective articles.
Mental health conditions/target populations.
For all articles except letters, we recorded the mental health conditions to which the authors referred. For each article, we assigned a maximum of two codes referring to conditions. We assigned the code “general mental health” to research on three or more diagnostic categories and to articles that did not provide an exact description of the target population.
For all research articles, we distinguished the subject matter under investigation as (1) basic research: either (a) biological or somatic variables or (b) psychosocial variables, (2) clinical research, or (3) interventions: either (a) pharmacotherapy, (b) psychotherapy, (c) combined or complex intervention, or (d) somatic therapies. In addition, we coded for (4) epidemiology, (5) measure development and validation, and (6) economic evaluations.
Subspecialty areas and special interests.
We recorded a total of 12 special interest areas for all articles, excluding letters.
Furthermore, for all research articles, we coded the age group of the participants under investigation, distinguishing three categories: (1) children and adolescents up to the age of 18, (2) adults aged 18 to 65, and (3) elderly participants over the age of 65. If case studies included individuals ranging from adolescents to elderly participants, we included them in the adult category.
Women's participation on the editorial boards of the three journals
We also calculated the percentages of women on the editorial boards of the three analyzed journals in 1994 and in 2007.
We used PASW Statistics 18 software (Chicago, Illinois) for all analyses. We assessed interrater reliability on a 10% random subsample of all eligible articles. We achieved excellent kappa values between 0.82 and 0.97 for all variables. We summarized each article's characteristics using descriptive statistics. Finally, we compared the results between male and female authors in 1994 and 2007 using chi-square tests. We considered P values < .05 to be statistically significant.
For the 950 articles published in 1994 in all three investigated journals, we could not identify the gender of 32 of 950 (3.4%) first authors and that of 128 of 2,467 (5.2%) coauthors. In 2007, the gender of 66 of 782 (8.4%) first authors and that of 226 of 3,059 (7.4%) coauthors remained unclear. The following results relate to all articles for which we established the gender of all authors.
Gender of authors
Of all 918 first authors in 1994 with an identified gender, 157 (17.1%) were women, whereas in 2007, among 716 overall first authors, 253 (35.3%) were women (P < .01). In both years, the percentages of women as first authors were comparable for all three journals (Archives of General Psychiatry, 1994: 20 of 121 [16.5%], 2007: 48 of 153 [31.4%]; The American Journal of Psychiatry, 1994: 76 of 428 [17.8%], 2007: 122 of 342 [35.7%]; The British Journal of Psychiatry, 1994: 61 of 401 [15.2%], 2007: 83 of 287 [28.9%]).
When we considered all authors (first authors and coauthors), we found 801 of 3,257 (24.6%) female authors in 1994 and 1,269 of 3,775 (33.6%) female authors in 2007 (P < .01). When we considered only coauthors, we found 644 of 2,339 (27.5%) female coauthors in 1994 and 1,016 of 3,059 (33.2%) female coauthors in 2007 (P < .01).
Percentages of male and female authors of original research versus nonresearch articles
In 1994, the percentage of female first authors of original research articles (85 of 462; 18.4%) was comparable to the percentage of female first authors of nonresearch articles (72 of 455; 15.8%). By contrast, in 2007, the percentage of female first authors of original research articles, as well as the ratio of original research articles to nonresearch articles, was markedly different, with 178 of 417 (42.7%) original research articles and 75 of 296 (25.3%) nonresearch articles being first-authored by women. See Table 1 for the results of the original research and nonresearch article subcategories.
Academic degrees of first authors
Overall, 201 articles did not state the academic degrees of the first authors. Hence, we conducted the following calculations excluding these articles, leaving 756 articles in 1994 and 677 articles in 2007.
The percentage of first authors holding an MD decreased from 1994 to 2007 among women and men, but the decrease was more prominent in women (in 1994, 63 of 134 [47%] women and 349 of 622 [56.1%] men held an MD degree; in 2007, 73 of 246 [29.7%] women and 207 of 431 [48%] men held an MD degree; P < .01). At the same time, the percentage of first authors holding a PhD increased significantly more among women than among men (from 28 of 134 [20.9%] women in 1994 to 100 of 246 [40.7%] women in 2007, and from 94 of 622 [15.1%] men in 1994 to 141 of 431 [32.7%] men in 2007; P < .01). The percentage of first authors holding both an MD and a PhD increased moderately for both genders but to a greater degree among women than men (in 1994, 4 of 134 [3%] women and 41 of 622 [6.6%] men held both degrees; in 2007, 15 of 246 [6.1%] women and 37 of 431 [8.6%] men held both degrees; P < .05). Other first author degrees included a variety of medical and nonmedical degrees, such as MPhil, MSc, BSc, BA, MA, BM, BS, or DSC, with small numbers in each category.
Among the articles for which first authors held an MD, the increase in the percentage of female authors was smaller compared with the overall increase in the percentage of female authors. Similar to the overall results, in 1994, female first authors holding an MD were recorded in 34 of 256 (13.3%) articles in the original research category and in 33 of 188 (17.5%) articles in the nonresearch category. However, in 2007, female first authors holding an MD authored only 46 of 165 (27.8%) original research articles compared with 178 of 417 (42.7%) among the overall female first authors (P < .01). No such difference was observed in the nonresearch category (42 of 171 [24.5%] female first authors held an MD versus 75 of 296 [25.3%] female first authors overall).
Mental health conditions and target populations under study
By far, researchers published most frequently on mood disorders and schizophrenia both in 1994 (mood disorders: 147; schizophrenia: 138) and 2007 (mood disorders: 141; schizophrenia: 152). In articles on mood disorders, the percentage of female first authors was similar to the overall results in 1994 and higher than the overall results in 2007 (1994: 26 of 147 [17.7%]; 2007: 66 of 141 [46.8%]). In articles on schizophrenia, the percentage of female first authors was similar to the overall results in both years (1994: 20 of 138 [14.5%]; 2007: 55 of 152 [36.2%]). The increase in the percentages of female first authors was significant for both mental health conditions (P < .01). Third-highest on the list were articles reporting research on three or more diagnostic categories—hence categorized as general mental health. The percentage of female first authors in this category did not change significantly during the 13-year period (1994: 13 of 86 [15.1%]; 2007: 16 of 71 [22.5%]; P = .23). Percentages of female first authors for other conditions and target populations with an annual number of published articles of at least 20 increased significantly for anxiety disorders (P < .05), alcohol- and drug-related disorders (P < .05), and trauma and victimization (P < .05), but not for personality disorders (P = .85) and suicide (P = .10). Publications on challenging behavior, cognitive disorders, obsessive-compulsive disorders, eating disorders, attention spectrum disorders, children's disorders, and others were rare in both years, with no significant increases in the percentages of female first authors from 1994 to 2007.
Subject matter of articles
See Table 2 for the distribution of female and male first authors by subject matter for the years 1994 and 2007. With regard to basic research (basic biological research), clinical research, interventions, and epidemiology, we found significant increases in the percentages of female first authors. For basic psychological research and psychotherapeutic interventions, a notably different picture emerged. The differences in the percentages of female first authors were smaller and not significant, corresponding to already comparatively high percentages of female first authors in 1994. The percentage of women publishing on pharmacotherapy interventions was relatively low in both years, and we observed no significant difference. For all other subject matters, the increases in percentages of female first authors from 1994 to 2007 were not significant.
Subspecialty areas and special interests
The volume of published research remained similar in most areas between 1994 and 2007 (see Table 3). An area with notable growth was neuroimaging, for which research output more than doubled (1994: 34 articles; 2007: 88 articles). The percentage of female first authors of published articles on neuroimaging almost tripled during the 13-year period (from 5 of 34 [14.7%] in 1994 to 38 of 88 [43.2%] in 2007; P < .01). The number of published articles on genetics grew by over 50%, from 40 in 1994 to 69 in 2007, with a nonsignificant increase in the percentage of female first authors from 7 of 40 (17.5%) in 1994 to 22 of 69 (31.9%) in 2007. In the area of endocrinology, where in 2007 considerably fewer articles were published than in 1994, the percentage of female first authors grew significantly, with women constituting more than half of all first authors in 2007 (from 6 of 36 [16.7%] in 1994 to 7 of 13 [53.8%] in 2007; P < .01). Similarly, in the area of gender issues, the number of articles decreased but the percentage of female first authors increased significantly (from 7 of 38 [18.4%] in 1994 to 18 of 24 [75%] in 2007; P < .01). In all other areas, the percentages of female authors were higher in 2007, but these changes were not significant.
Articles relating to studies on adult and geriatric populations again show a similar pattern, with considerable increases in the percentages of female first authors (adult: 65 of 377 [17.2%] in 1994 and 131 of 321 [40.8%] in 2007; geriatric: 4 of 31 [12.9%] in 1994 and 6 of 22 [27.3%] in 2007). In contrast, articles in the field of child and adolescent psychiatry were first-authored by women to a much higher degree in both investigated years (11 of 27 (40.7%) in 1994 and 37 of 65 (56.9%) in 2007).
Women's participation on the editorial boards of the three journals
In 1994, the average percentage of women on the editorial boards of the three journals under investigation was 16% (the Archives of General Psychiatry included 2 women and 19 men [10% women], The American Journal of Psychiatry included 4 women and 15 men [21% women], and The British Journal of Psychiatry included 6 women and 31 men [16% women]). In 2007, the average percentage of women on the editorial boards was 25% (the Archives of General Psychiatry included 5 women and 23 men [18% women], The American Journal of Psychiatry included 8 women and 14 men [36% women], and The British Journal of Psychiatry included 15 women and 62 men [20% women]). None of the increases are statistically significant.
Female first authors of original research articles
This study provides data for the first time on gender and authorship in high-impact psychiatric journals. The change in the percentages of female authors between the years 1994 and 2007 in the three investigated journals shows an overall increase from about one-fourth (24.6%) to about one-third (33.6%). The increase was especially pronounced among first authors of original research articles (18.4% in 1994 to 42.7% in 2007). The 42.7% for 2007 allows for a comparison with recently published studies from other medical fields. In 2006, the average percentage of female first authors of original articles in three prestigious general dermatology journals was 45%.21 In 2004, the percentage of female first authors of original articles ranged from 15.6% in the British Journal of Surgery to 53.2% in the Archives of Disease in Childhood and 58.3% in the British Journal of Obstetrics and Gynecology, with The Lancet (43.3%), The British Medical Journal (BMJ) (32%), and Gut (26.1%) covering the middle ground.22
Another possible comparison with other medical fields concerns the percentage of first authors holding an MD, which decreased in this study from 1994 to 2007 more noticeably in women than in men. Interestingly, our study showed that, in 2007, the percentage of female first authors of original articles among authors holding an MD (27.8%) was less than the percentage of female first authors of original articles among all authors put together (all academic degrees, 42.7%). These results are in accordance with a study entitled “Women authors of surgical research,”23 which found a greater percentage of female authors than male authors without an MD. The only other comparable study is restricted to U.S. authors holding an MD,19 but it shows that the percentages of female first authors in 2004 in the Journal of the American Medical Association (JAMA) (26.5%) and the Annals of Internal Medicine (31.5%) are similar to the percentage of female MDs as first authors of original articles in 2007 in our study (27.8%). On the low end of the spectrum of female first authors holding MDs sit The New England Journal of Medicine (NEJM) (14.1%) and the Annals of Surgery (16.7%), while on the high end sit the Journal of Pediatrics (38.9%) and the American Journal of Obstetrics & Gynecology (40.7%). However, these comparisons are confounded by the fact that the MD degree has different meanings in different educational systems; for example, in the United Kingdom, in contrast to the United States, an MD indicates a research qualification in addition to medical training.
Female authors in high-impact versus medium- and low-impact journals
Our data are limited to three high-impact journals, and so we cannot generalize our findings to medium- or low-impact journals. However, for such journals, there are indications of similar developments. Data on Revista Neurologica indicated that 42.3% of authors were women (first authors and coauthors) between 2002 and 2006,24 data on Actas espanolas de psiquiatria indicated an increase in the percentage of female authors from 29.9% in 1999 to 38.9% in 2006,25 and data on two German-language social psychiatric journals indicated that 47.7% of first authors in 2008–2009 were women.26
Changes in female authorship patterns relevant to an academic career
It is noteworthy that we found the greatest increases in the percentages of female authors in the areas most relevant to an academic career, that is, original research articles and first authorship. The percentages of female first authors in 2007 are double or more than the percentages in 1994 for most subject matters (e.g., basic research, clinical research, interventions, and epidemiology), except psychological basic research and psychotherapy interventions, for which the increases are smaller and not significant, corresponding to already comparatively high percentages of female authors in 1994. In both years, articles on pharmacotherapy were authored to a lesser degree by women compared with articles on most other subject matters. Topics that might shed some light on this exception include the issue of industry-sponsored studies27 and the problem of authorship resulting from ghostwriting initiated by commercial companies.28 However, to our knowledge, these have never been explored with a focus on gender.
Female authors of hot-topic issues
Among the areas with a pronounced increase in the number of articles published between 1994 and 2007 is neuroimaging, for which output more than doubled (1994: 34 articles versus 2007: 88 articles). The percentage of female authors publishing on neuroimaging almost tripled during the 13-year period. The number of published articles on genetics also grew by over 50% from 40 in 1994 to 69 in 2007, with a nonsignificant increase in the percentage of female authors. Obviously, hot topics are just as hot for female researchers as they are for their male colleagues.
Female first authors versus female coauthors
The increase in the percentage of female authors between 1994 and 2007 was greater among first authors than among coauthors. This progress did take place even though the total number of published articles, and thus the overall number of first authors (women and men), decreased during the 13-year period. At the same time, the overall number of coauthors increased. The increase in the number of authors per article has been described for various medical journals29,30 as well and has been regarded as a reflection of the increasing complexity of medical research.21 In this study, the less pronounced increase in the percentage of female coauthors compared with that of female first authors corresponds to an already greater percentage of female coauthors compared to the percentage of female first authors in the baseline year of 1994.
We should view the fact that the percentage of female coauthors is not higher than the percentage of female first authors in 2007 as a source of worry. Because of the high percentages of female medical students and graduates, it would be fair to assume that the percentage of female coauthors should be on the rise to a greater extent. However, a recent study on the percentage of female authors in two medium-impact German-language social psychiatric journals showed no significant difference between female and male first authors but twice as many male coauthors as female coauthors.26 Unfortunately, we could not find any data for comparisons with other fields regarding the gender of coauthors. This topic would be essential to explore, as targeted interventions to increase gender parity in research address women in the early career stages, where coauthorships are especially important. Without such data, we can only consider the problem of recruitment of women into university settings and the lack of acknowledgment of the role of women as contributors to research as compared with men as two possible explanations and suggest these topics as pressing research questions.
Female authors of editorials
In this study, women substantially lag behind men as authors of editorials (13.5% in 1994 and 26.2% in 2007). In most fields of medicine, the pool of senior female faculty members with international reputations is certainly still small,31 which may affect the percentage of female authors of this particular type of article, which is highly visible and requires a special selection mechanism.
Women's participation on editorial boards
Between 1994 and 2007, the percentage of women sitting on the editorial boards of the three investigated psychiatric journals increased from 16% to 25%. Comparable data show a large increase from 1.4% in 1970 to only 16% in 2005 in the percentage of women on the editorial boards of the major medical journals, such as JAMA, NEJM, The Lancet, and BMJ.32 To our knowledge, however, there are no studies on how changes in rates of female editors might influence publications with regard to the gender of authors.
We cannot answer with certainty at this point whether achieving gender parity in academic medicine is a factor of time or whether a glass ceiling exists. Our findings strongly suggest that the percentage of female first authors of original research articles is clearly on the rise, albeit to a different extent in different fields of medicine. However, at the same time, we are observing a lack of female authors of editorials and a lack of female editors, in conjunction with a lack of women in academic and other leadership positions, probably indicative of a ceiling effect and certainly resulting in a paucity of female role models for the career planning and development of female researchers. There is a deplorable lack of data that could shed light on the surprising results in our study showing that the percentages of female coauthors are not rising at the same rate as, and are not surpassing, the percentages of female first authors. While showing considerable gains in one respect, the overall picture emerging from this study is thus indicative not only of a leaky pipeline regarding senior women in psychiatric academia but alarmingly indicative of the problem of recruiting and retaining women in science after medical school.
Easier access to mentors and mentoring programs might be responsible for the increasing proportion of female authors.33,34 However, the evidence base for mentoring models is still scarce,35 and our data underscore the importance of research into this intervention and its effectiveness with regard to research publications and the careers of women, especially in the early stages. Recent data showing that women's publication rates increase later in their careers36 also suggest that other topics certainly worth exploring with regard to the still existing gender gap in academic medicine are the desire for a better work/life balance37 and developments concerning part-time careers.38 Clearly, ongoing efforts and interventions are required to promote further advances and gender equity.
The authors are grateful to Tanja Fabsits for the proofreading of this manuscript.
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