Abstract
Abstract
Objective
To assess the prevalence and magnitude of undisclosed financial conflicts of interest (COIs) among physician-authors in high-impact US-based psychiatry journals.
Design
Cross-sectional study comparing the author self-reported disclosures to the journal(s) with payments mandatorily reported in the Open Payments database.
Methods
We examined original research articles published between 1 January 2020 and 31 December 2022 in two prominent US-based psychiatry journals: the American Journal of Psychiatry (AJP) and Journal of the American Medical Association Psychiatry (JAMA-PSY). Of 2872 publications screened, 74 articles authored by 27 eligible US-based physician-authors met the inclusion criteria.
Outcome measures
Total payments received by authors within the 3 years prior to publication and the proportion of undisclosed payments. Additional analyses assessed payment types (research vs general), author demographics and study characteristics associated with undisclosed COIs.
Results
US$4.54 million was paid to authors in the two journals, of which US$645 135 (14.2%) were undisclosed. AJP authors received US$205 943 (7.5% of total payments) in undisclosed payments, while JAMA-PSY authors received US$439 192 (24.8%). Research payments constituted 82.3% of all undisclosed payments. Total undisclosed payments among the top 10 highest-earning authors accounted for 84.8% (AJP) and 99.6% (JAMA-PSY) of all undisclosed payments to journals. Nearly all undisclosed payments, 96.2%, were made to authors conducting randomised controlled trials.
Conclusions
Substantial undisclosed financial COIs were identified among the top 10 earners in high-impact psychiatry journals. These findings highlight potential risks to research transparency and integrity. Further research is needed to evaluate the effectiveness of disclosure policies and develop mechanisms to mitigate COIs in psychiatric research.
Keywords: PSYCHIATRY, Research Design, ETHICS (see Medical Ethics)
STRENGTHS AND LIMITATIONS OF THIS STUDY.
This study systematically analysed financial conflicts of interest of physician-authors publishing original research in two of the highest impact factor psychiatry journals, the American Journal of Psychiatry (AJP) and Journal of the American Medical Association Psychiatry (JAMA-PSY), ensuring relevance to influential research and clinical practice.
The study employed data from OpenPaymentsData.cms.gov, an authoritative—if incomplete—source for studying financial conflicts of interest.
Some authors may have disclosed only conflicts they deemed relevant, but both journals require broad reporting, so our inclusive definition may have classified unrelated payments as undisclosed.
Findings may not generalise beyond AJP and JAMA-PSY, which were chosen for their influence and the availability of US Open Payments, with no comparable systems internationally.
Research payments may be underestimated because manufacturers can delay reporting for up to 4 years, meaning some 2020–2022 payments may not yet be public.
Introduction
Conflicts of interest (COIs) in psychiatric research represent a persistent ethical challenge, heavily influenced by the intricate relationships between biomedical researchers and the pharmaceutical industry.1 These financial ties can unduly influence study outcomes, with industry-funded research frequently showing favourable results for the sponsor’s products compared with non-industry-funded studies.2,4 This bias is particularly concerning in psychiatry research contexts, where there is a lack of objective biomarkers for most mental health disorders.5,7 Additionally, the pursuit of academic promotion and professional recognition, often tied to publication quantity and impact, can contribute to COIs.8 When authors’ financial or professional interests compromise the ethical integrity of their publications, this conflict undermines the legitimacy of the research and its influence on clinical practice and professional advancement.9 10 Academic journals’ COI disclosure policies implemented in response to these concerns are often insufficient to address them fully. Instead, these measures merely may highlight the COIs without necessarily mitigating their impact.7 This interplay of incentives, financial and otherwise, with ethical responsibilities necessitates a robust and transparent approach to managing COIs to maintain public trust and ensure the reliability and validity of psychiatric research and practice.11
In psychiatric research, COIs often manifest as the substantial financial relationships between academic researchers and pharmaceutical companies.12 It is well established that these financial ties can lead to biased research outcomes favouring the sponsors’ products.12 13 Additionally, the influence of pharmaceutical companies extends beyond research to clinical practice and medical education, potentially altering prescribing behaviours and the content of educational programmes.14,15 Despite continued attention to financial COIs in psychiatric research, the prevalence and extent to which financial COIs exist within prominent US-based psychiatric research journals are incompletely understood.16 17
For decades, the American Journal of Psychiatry (AJP) and the Journal of the American Medical Association Psychiatry (JAMA-PSY) have been among the most influential US-based research journals in the field of psychiatry, driving research directions, clinical practice and healthcare policies.18 19 Given these journals’ authoritative status, financial COIs with possible relevance to articles published within them warrant further investigation.20 JAMA-PSY and AJP have policies requiring authors to disclose financial relationships from the past 3 years. JAMA-PSY focuses on relevant activities outside the submitted work, while AJP mandates disclosure regardless of relevance to the study’s subject.21 22 However, the effectiveness of these measures in fully addressing COIs remains unclear.23 Investigating the extent of financial COIs in these leading journals is crucial for ensuring the integrity of psychiatric research and maintaining public trust.2 9 Therefore, our study objectives were: (1) to delineate the prevalence and magnitude of financial COIs in the AJP and JAMA-PSY; (2) to investigate physician-author and study characteristics that are associated with financial COIs and (3) to identify the companies providing payments that were undisclosed by authors and their relationships to the product under investigation.
Methods
Inclusion and exclusion criteria
Original research publications by US physician-authors (holding MD and/or DO degrees and whose affiliation was within the USA) in the AJP (2022 Impact Factor=19.2) and JAMA-PSY (Impact Factor=25.9) from 1 January 2020 to 31 December 2022 were identified. These journals were chosen due to their high impact, explicit disclosure policies (table 1) and their influence on clinical practice and psychiatric research. The availability of a comprehensive US database (Open Payments) allowed for systematic comparison between reported payments and self-disclosures.
Table 1. Comparison of disclosure policies in Journal of the American Medical Association Psychiatry (JAMA-PSY) and the American Journal of Psychiatry (AJP), including categories of disclosure, reporting timeframe and policy differences.
| Journal | Categories of disclosure | Timeframe for disclosure | Policy notes/differences |
|---|---|---|---|
| JAMA-PSY | Relevant financial relationships outside the submitted work, including consulting fees, honouraria, research grants, travel support, stock ownership and other financial ties | 3 years prior to submission | Based on ICMJE standards. In the author instructions, authors disclose only relationships deemed relevant to the submitted work. |
| AJP | All financial relationships with industry, regardless of perceived relevance to the submitted work (consulting, honouraria, research funding, speaker fees, equity, etc) | 3 years prior to submission | More consistent than JAMA-PSY: requires disclosure of all relationships, even if unrelated to the study topic. |
ICMJE, International Committee of Medical Journal Editors.
We limited the cohort to US physician-authors (MD/DO). Although Open Payments expanded in 2021 to include additional non-physician covered recipient types, our 3-year look-back (anchored to each article’s publication year from 2020 to 2022) requires payment data back to 2017–2019. Because non-physician payments are not available for those earlier years, including non-physician authors would introduce left-truncation and systematic under-ascertainment of payments. Restricting to physicians ensured uniform ascertainment across the full study period and improved record linkage reliability.
Articles categorised as non-original research by the journal(s) and those with the first and last author holding non-MD and/or DO degrees or whose affiliation was outside the USA were excluded from the analysis. The first and last authors were identified in OpenPayments.CMS.Gov using their full names, specialties and department affiliations.
Data collection
Total payments received by authors for the 36 months preceding their respective publication dates were identified using OpenPayments.CMS.GOV. Data included information on the author’s sex, specialty and annual payment amounts of the main payment types (ie, general payments (GPs) and research payments (RPs)) reported on OpenPayments. For each payment type, the company making the payment was identified and compared with the author’s self-reported disclosures to the journal(s). Total payments were aggregated for each author over a standardised 36-month (3-year) look-back period preceding the publication date, consistent with International Committee of Medical Journal Editors (ICMJE) disclosure guidance and prior BMJ Open analyses. This approach ensured comparability across authors, although the number of years during which authors received payments within that window may have varied. Reported medians, therefore, represent cumulative 3-year totals rather than annualised amounts.
Disclosed payments were identified by companies listed in the authors’ self-disclosures. For this study, we defined an undisclosed COI as any financial payment recorded in the Open Payments database that was not disclosed by the author to the journal. In accordance with the ICMJE disclosure policy, which requires authors to report all financial relationships with entities that could be broadly relevant to the work, we did not independently adjudicate whether payments were directly related to the article’s subject matter. This approach aligns with prior cross-sectional analyses of financial COI in biomedical research16 24 and ensures reproducibility and consistency across studies. While we recognise that for some randomised controlled trials (RCTs), determining relevance between a payment and the product studied could appear straightforward, such adjudication was avoided to minimise subjective bias.
Statistics
GraphPad Prism (V.10.2.3) was used for statistical analysis and to create figures. The Mann-Whitney test assessed the difference between journal payment distributions. A 2×2 χ2 analysis was used to evaluate the association between disclosure status (ie, undisclosed vs disclosed) by the journals. A p<0.05 was considered statistically significant. A flowchart was generated using Microsoft PowerPoint (V.2405).
Patient and public involvement
None.
Results
Article selection
Research publications (n=2872) that were published from 1 January 2020 to 31 December 2022 by physician-authors in the AJP (n=1368) and JAMA-PSY (n=1504) were examined. Among these publications, 351 articles in JAMA-PSY and 526 articles in AJP were categorised as original research by the respective journal. Among 697 authors in JAMA-PSY and 1045 authors in AJP, 139 and 110, respectively, met eligibility criteria as US-based physicians. Of these, 14 in JAMA-PSY (10.1%) and 18 in AJP (15.5%) had Open Payments profiles. After removing redundant profiles, 12 JAMA-PSY authors (8.6% of eligible) and 15 AJP authors (13.6% of eligible) remained as unique, matched profiles (figure 1). The remaining eligible physician-authors (91.4% JAMA-PSY, 86.4% AJP) were not listed in Open Payments, which indicates no industry payments reported during the 3-year disclosure window.
Figure 1. Flow chart illustrating the inclusion and exclusion criteria for physician-authors publishing in the Journal of the American Medical Association Psychiatry (JAMA-PSY) and the American Journal of Psychiatry (AJP) and as reported to CMS OpenPayments (OP).
Total payments
All payment totals represent cumulative amounts over the 3-year disclosure period. Because some authors received payments for fewer than 3 years, the reported medians reflect aggregate 3-year totals rather than standardised annual values. Accordingly, variation in payment duration among authors should be considered when interpreting median payment magnitudes.
Combined payments to authors in AJP and JAMA-PSY were US$4 539 207 comprising US$895 000 (20%) in GPs and US$3 644 100 (80%) in RPs. Authors received US$2 766 147 in AJP (US$248 600 GP; US$2 517 500 RP) and US$1 773 060 in JAMA-PSY (US$646 400 GP; US$1 126 600 RP).
The median total payment to AJP authors was US$44 548 (IQR US$4571–213 813), while the median total payment to JAMA-PSY authors was US$49 036 (IQR US$1138–448 194). Stratified by category, the median GP in AJP was US$8140 (IQR US$137–33 394), and the median RP was US$144 204 (IQR US$92 803–223 728). In JAMA-PSY, the median GP was US$2395 (IQR US$761–46 264), and the median RP was US$108 353 (IQR US$31 604–397 306).
Undisclosed payments
Combined undisclosed payments of authors in AJP and JAMA-PSY accounted for 14% (US$645 136) of all payments. Of all undisclosed payments, 83% were RPs (US$532 841). The remaining 13% (US$112 295) were GPs, including consulting fees, honouraria, speaker fees, food and beverage, and travel support. Undisclosed payments accounted for 8% (US$205 943; 17% GP US$34 809; 83% RP US$171 135) of total payments to AJP authors and 25% (US$439 192; 18% GP US$77 486; 82% RP US$361 707) of JAMA-PSY authors (figures2 3). The χ2 analysis did not detect a significant association between undisclosed and disclosed payments between AJP and JAMA-PSY (p=0.098).
Figure 2. Total undisclosed payments among authors publishing in the American Journal of Psychiatry (AJP) and the Journal of the American Medical Association Psychiatry (JAMA-PSY).
Figure 3. Percent of authors’ total compensation that was undisclosed in the American Journal of Psychiatry (AJP) and the Journal of the American Medical Association Psychiatry (JAMA-PSY).
Undisclosed payment distributions are presented as medians with IQRs. Across all authors, the median (IQR) undisclosed total payment was US$8231 (US$1029–92 816). When stratified by payment type, the median (IQR) undisclosed GP was US$2340 (US$721–28 556) and the median (IQR) undisclosed RP was US$37 110 (US$9884–144 712).
For AJP authors, the median (IQR) undisclosed total payment was US$4358 (US$145–21 548); GPs US$2008 (US$137–5045) and RPs US$38 627 (US$6238–83 486). For JAMA-PSY authors, the median (IQR) undisclosed total payment was US$26 917 (US$13 950–192 188); GPs US$14 283 (US$761–62 442) and RPs US$26 917 (US$13 569–153 825).
Authors
In total, 27 eligible physician-authors across AJP and JAMA-PSY were identified and analysed for payment and disclosure patterns. We examined author demographics, authorship roles, study designs and payment characteristics, including both disclosed and undisclosed amounts. These findings are summarised in table 2, which presents side-by-side comparisons of author characteristics and the distribution of payments across both journals.
Table 2. Characteristics of physician-authors in the American Journal of Psychiatry (AJP) and Journal of the American Medical Association Psychiatry (JAMA-PSY), including demographics, authorship roles, study types, payment distributions and undisclosed conflicts of interest.
| Characteristic | AJP | JAMA-PSY | Combined |
|---|---|---|---|
| Total authors (n) | 15 | 12 | 27 |
| Male (%) | 87% (13) | 75% (9) | 82% (22) |
| Female (%) | 13% (2) | 25% (3) | 19% (5) |
| Specialty—Psychiatry (%) | 93% (14) | 83% (10) | 89% (24) |
| Other specialties (Pathology, Internal Med, OB/GYN) | 1 each | – | 3 total |
| First authorship (%) | 40% (6) | 33% (4) | 37% (10) |
| Last authorship (%) | 60% (9) | 67% (8) | 63% (17) |
| Study types—RCTs (%) | 73% (11) | 75% (9) | 67% (18) |
| Other study types (cohort, diagnostic, etc) | 4 | 3 | 7 |
| Authors receiving payments (n, %) | 13 (87%) | 8 (67%) | 21 (78%) |
| Range of payments received (US$) | 112–1 730 928 | 112–1 730 928 | 112–1 730 928 |
| Authors with undisclosed payments (n, %) | 11 (73%) | 5 (42%) | 16 (59%) |
| Range of undisclosed payments (US$) | 16–182 924 | 14–206 046 | 16–206 046 |
| Top 10 highest-earning authors: share of total payments (%) | 97% | 45% | 77% |
| Top 10 highest-earning authors: share of undisclosed payments (%) | 85% | 100% | 95% |
OB/GYN, Obstetrics and Gynecology; RCT, randomised controlled trial.
Total payments by gender
15 (68.2%) of the 22 men received payments totalling US$4 344 623 (95.7% of 3-year total), US$888 894 (99.3% of GPs) and US$3 455 657 (94.8% of RPs). In contrast, all five (100.0%) of the women received payments amounting to US$194 583 (4.3% of the 3-year total), US$6102 (0.7% of GPs) and US$188 481 (5.2% of RPs).
Undisclosed payments by gender
13 (59.1%) of the 22 men received undisclosed payments totalling US$527 963 (81.8% of the 3-year total), US$111 519 (99.3% of GPs) and US$416 444 (78.2% of RPs). Similarly, three (60.0%) of the five women received undisclosed payments amounting to US$117 173 (18.2% of the 3-year total), US$776 (0.7% of GPs) and US$116 397 (21.8% of RPs).
COI disclosure rates
Of the 27 authors who received payments, 12 made disclosures, the amount of which summed to at least half of the authors’ total payment amounts. Five had a 3-year disclosure rate of 100%; two were published in AJP, and the other three were published in JAMA-PSY. The other eight authors who disclosed at least half of their payments had disclosure rates that ranged from 50.0% to 99.8%. Of the seven authors who disclosed less than half of their payment, the amounts ranged from 7.6% to 39.0%. One author disclosed 50.0% of her total payments. Six authors who received payments each disclosed 0%, or no amount, of their payments received. Of the authors who disclosed 0%, one published in AJP, and five published in JAMA-PSY.
Undisclosed payments by study topic and company
The top 10 authors receiving the highest undisclosed payment amounts by study topic and company(-ies) are found in table 3 and figure 4. Eight authors were men, and their combined undisclosed payments accounted for 81.7% of the total undisclosed payments received by all 10 authors. The 10 authors contributed to 12 RCTs, and 11 (91.7%) were pharmaceutical interventions. Seven (58.3%) studies focused on depression, including three using an antidepressant, one anticonvulsant, two antipsychotics and one N-methyl-D-aspartate receptor (NMDAR) channel blocker for depression treatment. Other study topics included two (16.7%) on using a vasopressin 1a receptor antagonist for autism spectrum disorder, one (8.3%) on using an antidepressant medication for anxiety, one (8.3%) using cognitive behavioural therapy (CBT) for emotional and behavioural problems and one (8.3%) genetic analysis on completed suicide. The mean±SD of the number of companies from which authors received payments but did not disclose was 2.4 (±2.2), with a range of 1–8.
Table 3. Characteristics of the top 10 physician-authors publishing in the American Journal of Psychiatry (AJP) and the Journal of the American Medical Association Psychiatry (JAMA-PSY) with the greatest undisclosed payments as reported to CMS Open Payments, study topics and companies providing payments to authors. All authors specialised in psychiatry. Percentage for companies indicates the amount of total undisclosed payments that were provided by the specific company.
| Rank | Degree | Sex | Authorship | Journal | Total undisclosed (US$) | Undisclosed GP % | Undisclosed RP % | Companies (with sponsor type*) |
|---|---|---|---|---|---|---|---|---|
| 1 | MD | Male | First | JAMA-PSY | 206 046 | 66% | 38% | Genentech (Pharma; US$84 541, 41%), Neurocrine Biosciences (Pharma; US$83 857, 41%), Sunovion Pharmaceuticals (Pharma; US$27 688, 13%), Greenwich Biosciences (Pharma; US$4264, 2%), Avanir Pharmaceuticals (Pharma; US$4249, 2%), H. Lundbeck A/S (Pharma; US$3197, 2%), Janssen Pharmaceuticals (Pharma; US$2537, 1%), Boehringer Ingelheim Pharmaceuticals (Pharma; US$21, <1%) |
| 2 | MD | Male | Last | JAMA-PSY | 178 330 | 11% | 32% | Janssen Research & Development (Pharma; US$115 912, 65%), Lundbeck (Pharma; US$26 824, 15%), Pfizer (Pharma; US$35 595, 20%) |
| 3 | MD | Female | Last | AJP | 90 144 | 19% | 96% | Medtronic USA (Device; US$90 046, 100%), Boston Scientific Corporation (Device; US$99, <1%) |
| 4 | MD | Male | First | AJP | 65 504 | – | 29% | Boehringer Ingelheim Pharmaceuticals (Pharma; US$65 504, 100%) |
| 5 | MD, MSc | Female | Last | JAMA-PSY | 26 917 | 0% | 50% | Vanda Pharmaceuticals (Pharma; US$26 917, 100%) |
| 6 | MD | Male | Last | JAMA-PSY | 26 256 | 0% | 16% | Genentech (Pharma; US$26 256, 100%) |
| 7 | MD | Male | Last | AJP | 21 548 | 100% | 0% | Sage Therapeutics (Pharma; US$21 548, 100%) |
| 8 | MD, PhD | Male | Last | AJP | 11 750 | 0% | 8% | LivaNova USA (Device; US$11 750, 100%) |
| 9 | MD | Male | Last | AJP | 8352 | 47% | 0% | SK Life Science (Pharma; US$4394, 53%), Merck Sharp & Dohme (Pharma; US$1949, 24%), ITI (Pharma; US$1627, 20%), H. Lundbeck A/S (Pharma; US$382, 5%) |
| 10 | MD | Male | Last | AJP | 4358 | 11% | 0% | Sage Therapeutics (Pharma; US$4358, 100%) |
Sponsor categories were assigned based on the primary business of the company providing payments: pharmaceutical companies (drug development and marketing), device manufacturers (medical device development and marketing) or other (eg, government or non-profit organisations).
GP, general payment; RP, research payment.
Figure 4. Characteristics of the top 10 physician-authors publishing in the American Journal of Psychiatry and Journal of the American Medical Association Psychiatry reporting the greatest total payments. All studies were randomised controlled trials except number 8, which was a diagnostic report.
When analysed by sponsorship type, industry-sponsored studies (pharmaceutical or device) accounted for 100% of the undisclosed payments among the top 10 authors. Pharmaceutical company sponsorship predominated, representing 92% of the studies and more than 95% of the undisclosed dollar amounts. Device manufacturers contributed to two studies (authors ranked 3 and 8) and represented a smaller share of undisclosed payments. No government-sponsored or non-profit-sponsored studies were associated with undisclosed payments in this sample.
Payments by study type
Three-year total payments to authors of RCTs accounted for 99.4% (US$4 513 574) of all payments, 97.2% (US$870 246) of GPs and 100.0% (US$3 643 255) of RPs reported by all authors. Three-year total undisclosed payments to authors of RCTs accounted for 96.2% (US$620 473) of all undisclosed payments, 78.8% (US$88 515) of undisclosed GPs and 99.8% (US$531 958) of undisclosed RPs reported by all authors.
In AJP, 3-year total undisclosed payments to authors of RCTs accounted for 88.8% (US$182 924) of all undisclosed payments, 33.9% (US$11 790) of undisclosed GPs and 100.0% (US$171 135) of undisclosed RPs reported by all authors. In JAMA-PSY, 3-year total undisclosed payments to authors of RCTs accounted for 99.6% (US$437 549) of all undisclosed payments, 99.0% (US$76 725) of undisclosed GPs and 99.8% (US$360 824) of undisclosed RPs reported by all authors.
Three-year total undisclosed payments to authors of cohort, economic evaluation, cross-sectional, meta-analysis and diagnostic studies combined accounted for 3.8% (US$24 663) of all payments, 21.2% (US$23 780) of GPs and 0.2% (US$883) of RPs reported by all authors.
Undisclosed payments by company
The top 10 companies providing the most undisclosed payments were Janssen Research & Development (US$115 888; 18%), Genentech (US$106 522; 17%), Neurocrine Biosciences (US$83 834; 13%), Medtronic USA (US$67 370; 11%), Biohaven Pharmaceuticals (US$58 511; 9%), Pfizer (US$35 595; 6%), Sunovion Pharmaceuticals (US$27 683; 4%), Vanda Pharmaceuticals (US$26 917; 4%), Lundbeck (US$26 847; 4%) and H. Lundbeck A/S (US$26 595; 4%).
Undisclosed payments by year
Total undisclosed payments reported by year were: 2022 (US$123 540; 18%), 2021 (US$89 856; 13%), 2020 (US$78 341; 12%), 2019 (US$228 370; 34%), 2018 (US$70 629; 11%) and 2017 (US$79 100; 12%) (figure 5). Total percentages of undisclosed payments by journal and year ranged from 0.01% in 2017 to 18% in 2022 in AJP and 0% in 2022 to 34% in 2019 in JAMA-PSY.
Figure 5. Comparison of total undisclosed payments by year (2017–2022) for authors publishing in the American Journal of Psychiatry and Journal of the American Medical Association Psychiatry. Values represent total undisclosed payments in US$ as reported in CMS Open Payments.
Discussion
The novel discoveries of this report were that 41.7% of authors in JAMA-PSY and 73.3% in AJP received undisclosed payments that were in contravention of journal policy. Notably, among these authors receiving undisclosed payments, 80.0% of those authors in JAMA-PSY and 36.3% of those in AJP received substantial undisclosed payments (>US$5000) according to the National Institutes of Health threshold for a Significant Financial Interest.25 These findings help elucidate the prevalence and magnitude of financial COIs within two of the most influential US-based journals in psychiatry.
Undisclosed financial COIs are particularly concerning as they may undermine the validity of psychiatric research.16 In our study, 14.2% of the total payments in AJP and JAMA-PSY, amounting to $645 135.7, were undisclosed. These undisclosed payments predominantly comprised RPs (82.6%), with a smaller proportion being GPs (12.6%). The high prevalence of undisclosed payments suggests that existing disclosure policies are insufficient to ensure full transparency.24
In our sample, most authors with Open Payments entries were men, and male authors received higher total payments compared with their female counterparts. These results are consistent with prior studies showing gender disparities in senior authorship and financial relationships with industry in academic medicine.26,29 However, it is important to emphasise that our analysis was limited to first and last physician-authors with COIs reported in Open Payments from two US psychiatry journals. Therefore, our findings do not reflect gender representation across all psychiatry clinical trials but rather highlight that, within the subset of authors receiving industry payments, undisclosed COIs were concentrated among men. Future studies should expand to include a broader sample of authors and journals to better evaluate how gender, authorship roles and COI disclosure practices intersect in psychiatry research.
An association between the type of study conducted and its authors receiving undisclosed financial COIs was detected. Authors involved in RCTs accounted for 99.44% of total payments and 96.2% of undisclosed payments, emphasising the considerable funding associated with these studies. RCTs inherently require larger budgets than secondary analyses or economic evaluations, given their complexity, sample size and regulatory requirements. Therefore, it is not surprising that industry-sponsored RCTs are associated with larger financial relationships, both disclosed and undisclosed. Our study cannot establish whether pharmaceutical companies intentionally prioritise RCTs with market potential, but it does underscore the importance of transparency when industry support is concentrated in trials most likely to influence prescribing and clinical guidelines.
Developing normative benchmarks for managing industry-funded research could help distinguish between appropriate financial support and undue influence. These benchmarks would not restrict research funding but instead establish expectations for transparency and investigator independence. Examples include full disclosure of all sponsor involvement, independent oversight of data analysis and mandatory cross-verification with Open Payments. Such measures could help mitigate research influence while maintaining clinician-investigators’ autonomy to pursue meaningful scientific questions. By contrast, establishing limits on GPs—such as consulting fees and honouraria—may be more feasible and consistent with existing recommendations to reduce COI affecting clinical decision-making and education.
While our findings indicated that nearly all undisclosed payments were associated with authors of RCTs, it is important to recognise that study sponsorship by industry is likely the more relevant predictor of undisclosed COIs. Our additional analysis confirmed that 100% of undisclosed payments to the top-earning authors originated from industry sponsors, with pharmaceutical companies responsible for more than 95% of undisclosed dollar amounts and device manufacturers accounting for the remainder. This suggests that the apparent association between study type (eg, RCTs) and undisclosed COIs may largely be driven by the concentration of industry sponsorship in such studies, which often test marketable products with high commercial potential. Therefore, industry sponsorship should be considered a stronger determinant of undisclosed COIs than study design alone. Future research should directly compare disclosure practices between industry-sponsored and non-industry-sponsored studies to further clarify these relationships.
Our analysis of undisclosed payments by study topic and company highlights potential issues regarding financial COIs in psychiatric research. The 10 authors who received the highest undisclosed payments collectively accounted for 81.7% of the total undisclosed payment amount reported by all 27 authors. These authors predominantly conducted RCTs, with 11 studies (91.7%) focusing on pharmaceutical interventions. Among the study topics, 7 out of 12 studies (58.3%) centred on depression, examining medications such as antidepressants, anticonvulsants, antipsychotics and NMDAR channel blockers. Other studies included treatments for autism spectrum disorder, anxiety, emotional and behavioural problems treated with CBT, and genetic analysis related to completed suicide.
The undisclosed payments were predominantly sourced from major pharmaceutical companies, including Janssen Research & Development, Genentech and Neurocrine Biosciences. For instance, one author received $206 045 in undisclosed payments, with considerable contributions from Genentech and Neurocrine Biosciences. Another notable case involved an author receiving $178 330.3, primarily funded by Janssen Research & Development (65.0%), Lundbeck (15.1%) and Pfizer (12.0%). Additionally, studies on CBT combined with duloxetine and escitalopram for major depressive disorder received substantial undisclosed payments from Medtronic USA (99.8%) and Boehringer Ingelheim Pharmaceuticals (100%). These undisclosed payments raise concerns about the potential bias in research outcomes, particularly in RCTs where industry funding can influence study design and interpretation.30 31 On the other hand, of the top 10 authors with undisclosed COI, no author neglected to disclose the company of the product they were studying, which attests to at least partial compliance with the journals’ disclosure policies.
Limitations
Several important limitations should be considered when interpreting the findings of this study.
First, although it may be understandable that some authors disclosed only those conflicts they felt were directly related to their research, each journal’s own disclosure policy emphasises comprehensive reporting. JAMA-PSY requires authors to disclose all relevant financial interests, activities, relationships and affiliations, with JAMA Network mandating complete disclosure of all relevant financial relationships and potential conflicts, regardless of amount or value. Similarly, AJP requires all authors to disclose all financial relationships, whether or not directly related to the subject of their paper, including equity ownership, royalties, patents and research or other industry grants. Our definition of undisclosed COI did not evaluate whether payments were directly relevant to the article topic, recognising the subjectivity of such determinations. By applying an inclusive definition, we sought to capture discrepancies between Open Payments and published disclosures consistently. However, we acknowledge that for RCTs evaluating specific products, relevance may be more objectively adjudicated. Future studies could integrate structured frameworks to classify payment relevance and assess whether observed discrepancies reflect journal policy differences, the scope of author judgement in disclosure practices or both.
Second, our findings may not be generalisable to psychiatry journals beyond AJP and JAMA-PSY. These journals were selected for their influence and the availability of the US Open Payments database. Because there are no comparable databases in most other countries, our study does not capture disclosure practices in non-US or lower-impact journals. Future research should extend to a broader range of journals to determine whether similar patterns exist internationally.
Third, Open Payments groups diverse categories—such as consulting, honouraria and food and beverage—under ‘GPs’. Many journals do not require disclosure of minor food and beverage payments, which can lead to overestimation of non-disclosure. In our dataset, however, the majority of undisclosed GPs were consulting fees and honouraria, which would typically be expected to be disclosed.
Only a small proportion of eligible US physician-authors were matched to Open Payments profiles (8.6% in JAMA-PSY and 13.6% in AJP). Authors without profiles are presumed not to have received reportable industry payments, which may constrain generalisability, though this does not necessarily indicate that they were non-prescribers. The authors did not independently verify which co-authors were US prescribing clinicians eligible for Open Payments reporting, which may affect the accuracy of the denominator used in estimating non-disclosure rates. As such, our estimates may slightly under-represent or over-represent the proportion of prescribers without disclosed financial relationships.
Fifth, our analysis excluded non-physician authors (eg, advanced practice nurses, physician assistants). Because Open Payments only began reporting payments to these groups in 2021, a complete 3-year look-back period was not available for our 2020–2022 study window. This exclusion likely underestimates undisclosed relationships in the broader authorship population.
Finally, an additional methodological limitation involves the potential underestimation of RPs due to delayed reporting allowances in Open Payments. Manufacturers may legally defer reporting of research and development payments for up to 4 years. Consequently, some payments received during 2020–2022 may not yet appear in the database. This well-documented limitation means our findings likely underestimate the true magnitude of research-related payments and undisclosed COIs.
Conclusion
This study highlights the prevalence and magnitude of undisclosed financial COIs within two of the most influential US-based psychiatry journals. Substantial undisclosed financial COIs were identified among authors receiving payments, primarily concentrated in RPs and among a subset of highly compensated authors conducting RCTs. These findings underscore potential gaps in existing journal disclosure policies and their enforcement, which may adversely influence research transparency, integrity and trust in psychiatric literature.
The reliance of leading journals on self-reported disclosures and the high prevalence of undisclosed financial COIs highlight the need for enhanced strategies to mitigate these conflicts since current disclosure policies have proved insufficient in both peer-reviewed literature and academic textbooks.16 32 33 To improve accuracy and accountability, future policies should consider incorporating independent cross-verification mechanisms, such as requiring links to OpenPayments profiles during manuscript submission. Addressing these issues is essential for promoting unbiased clinical decision-making, safeguarding psychiatric research credibility and ensuring patient welfare prioritisation over industry objectives.
Supplementary material
Footnotes
Funding: Geisinger Commonwealth School of Medicine Summer Research Immersion Program supported this work. The funder did not influence the results/outcomes of the study despite author affiliations with the funder.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2025-104955).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
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