MedicalResearch.com Interview with: Alexa T. Diianni, MBS Department of Medical Education Geisinger College of Health Sciences Scranton, PA 19409 MedicalResearch.com: What is the background for this study? During a previous study, my research team and I examined the financial conflicts of interest (COIs) between industry and academia- namely those that exist between authors of The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and industry (1). The DSM is a diagnostic tool widely used for the diagnosis of psychiatric disorders, and is thus of interest in assessing COIs (1,2). We previously found that authors of the DSM-5-TR had received over $14.2m in undisclosed payments from industry (1). Our current study examines the gender and geographic disparities of the DSM-5-TR authors, in relation to these payments. While previous investigations have evaluated financial COIs in recent editions of the DSM (3,4), the demographic information of its authors has not yet been examined. Equitable representation of DSM authors is paramount as this manual serves a diverse population across the United States and beyond. It is important that the authorship of this manual be reflective of the population in which it serves, as there have been reported differences in both the type and prevalence of psychiatric care sought out by gender, as well as varying clinical treatment by geographic location (5-8). MedicalResearch.com: What are the main findings? Of the 225 physicians that were identified as contributors to the DSM-5-TR task force, panels, and cross-cutting review groups, 116 contributors met the inclusion criteria of being a US-based physician with an active National Provider Identifier. Of these included individuals, 69.8% were men and 30.2% were women. Just three states accounted for 43.9% of contributors (New York, 17.2%; California, 14.7%; Massachusetts, 12.1%), while twenty-three states received no author representation. Of the total $14.6m in industry payments received by contributors, $13.2m (91.8%) was received by male contributors. Male contributors thus received an average of $287k in payment, while female contributors received $72k. MedicalResearch.com: What should readers take away from your report? Due to the prevalent use of the DSM, it is important that transparency regarding financial conflicts of interest exists, with COIs minimized moving forward to avoid implicit bias and pro-industry thought (1,9-15). Furthermore, it is important that future editions of the DSM be representative of the population in which it serves. This can be attained by selecting an adequate proportion of male and female contributors for the DSM, which may provide more robust perspectives on current diagnoses. Additionally, representation of contributors from all regions across the US will allow for a more diverse and informed perspective on diagnostic criteria, allowing for improved public health and patient care within the United States. MedicalResearch.com: What recommendations do you have for future research as a result of this study? As gender and geographic disparities were shown to be significant through this study, I believe it would be interesting to address additional areas of demographic disparities among authors. Additional areas to examine may include non-US-based physicians, non-MD/DO authors, as well as ethnic and racial disparities among authors. Finally, similar studies may be applied to additional clinical and diagnostic tools. Diagnostic manuals, such as the DSM, written by a diverse set of individuals, would provide unique perspectives that best reflect the population as a whole, and in turn, benefit patient care. For this reason, it is important that diagnostic manuals, such as the DSM, include a diverse set of authors that can provide adequate input regarding the patient population it serves. MedicalResearch.com: Is there anything else you would like to add? This research received no external funding. First author (AD) is employed by PerkinElmer, working on assignment at GlaxoSmithKline (2023-Present), outside of the submitted work; Last author (BP) contributed to an osteoarthritis research team supported by Pfizer and Eli Lilly (2019-21) and received grants from the Pennsylvania Academic Clinical Research Center, outside of the submitted work. New Paper Diianni AT, Davis LC, Piper BJ. Gender and geographic disparities among DSM-5-TR authors in relation to financial conflicts of interest and industry payments: cross-sectional analysis. BMJ Mental Health. 2025;28:e301913. https://doi.org/10.1136/bmjment-2025-301913 References: 1. Davis LC, Diianni AT, Drumheller SR, Elansary NN, D’Ambrozio GN, Herrawi F, Piper BJ, Cosgrove L. Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ. 2024;384. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2022. 3. Cosgrove L, Krimsky S, Vijayaraghavan M, Schneider L. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychother Psychosom 2006;75:154-60. doi:10.1159/000091772. Pmid:16636630 4. Cosgrove L, Krimsky S. A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Med2012;9:e1001190. doi:10.1371/journal.pmed.1001190. Pmid:22427747 5. Piper BJ, Ogden CL, Simoyan OM, Chung DY, Caggiano JF, Nichols SD, et al. (2018) Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE 13(11): e0206100. https://doi.org/10.1371/journal.pone.0206100 6. Bareis N, Olfson M, Wall M, Stroup TS. Variation in Psychotropic Medication Prescription for Adults With Schizophrenia in the United States. Psychiatric Services. American Psychiatric Publishing; 2022;73(5):492–500. https://doi.org/10.1176/appi.ps.202000932 7. Tedstone Doherty D, Kartalova-O'Doherty Y. Gender and self-reported mental health problems: predictors of help seeking from a general practitioner. Br J Health Psychol. 2010;15(Pt 1):213-28. 8. Terlizzi EP, Schiller, Jeannine S. Mental health treatment among adults Aged 18–44: United States, 2019–2021. Report. Hyattsville, MD: National Center for Health Statistics; 2022. 9. Grande D, Frosch DL, Perkins AW, Kahn BE. Effect of exposure to small pharmaceutical promotional items on treatment preferences. Arch Intern Med. 2009;169(9):887-893. doi:10.1001/archinternmed.2009.64 10. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. In: Graham R, Mancher M, Miller Wolman D, et al., eds. Clinical Practice Guidelines We Can Trust. Washington (DC). National Academies Press, 2011, https://www.ncbi.nlm.nih.gov/books/NBK209539/?report=classic, doi:10.17226/13058. 11. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373-80. doi:10.1001/jama.283.3.373. Pmid:10647801 12. Moore DA, Tanlu L, Bazerman MH. Conflict of interest and the intrusion of bias. Judgm Decis Mak 2010;5:37-53. doi:10.1017/S1930297500002023 13. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252-5. doi:10.1001/jama.290.2.252. Pmid:12851281 14. Nejstgaard CH, Bero L, Hróbjartsson A, et al. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ 2020;371:m4234. doi:10.1136/bmj.m4234. Pmid:33298430 15. Thompson DF. The challenge of conflict of interest in medicine. Z Evid Fortbild Qual Gesundhwes 2009;103:136-40. doi:10.1016/j.zefq.2009.02.021. Pmid:19554887

07 Dec Geisinger study finds inadequate gender and geographical representation in the Diagnostic and Statistical Manual of Mental Disorders

Posted at 01:04h in Author Interviews, Gender Differences, Mental Health Research, Race/Ethnic Diversity by
MedicalResearch.com Interview with:Alexa T. Diianni, MBS Department of Medical Education Geisinger College of Health Sciences Scranton, PA 19409 MedicalResearch.com: What is the background for this study? During a previous study, my research team and I examined the financial conflicts of interest (COIs) between industry and academia- namely those that exist between authors of The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and industry (1). The DSM is a diagnostic tool widely used for the diagnosis of psychiatric disorders, and is thus of interest in assessing COIs (1,2). We previously found that authors of the DSM-5-TR had received over $14.2m in undisclosed payments from industry (1). Our current study examines the gender and geographic disparities of the DSM-5-TR authors, in relation to these payments. While previous investigations have evaluated financial COIs in recent editions of the DSM (3,4), the demographic information of its authors has not yet been examined. Equitable representation of DSM authors is paramount as this manual serves a diverse population across the United States and beyond. It is important that the authorship of this manual be reflective of the population in which it serves, as there have been reported differences in both the type and prevalence of psychiatric care sought out by gender, as well as varying clinical treatment by geographic location (5-8). MedicalResearch.com: What are the main findings? Of the 225 physicians that were identified as contributors to the DSM-5-TR task force, panels, and cross-cutting review groups, 116 contributors met the inclusion criteria of being a US-based physician with an active National Provider Identifier. Of these included individuals, 69.8% were men and 30.2% were women. Just three states accounted for 43.9% of contributors (New York, 17.2%; California, 14.7%; Massachusetts, 12.1%), while twenty-three states received no author representation. Of the total $14.6m in industry payments received by contributors, $13.2m (91.8%) was received by male contributors. Male contributors thus received an average of $287k in payment, while female contributors received $72k. MedicalResearch.com: What should readers take away from your report? Due to the prevalent use of the DSM, it is important that transparency regarding financial conflicts of interest exists, with COIs minimized moving forward to avoid implicit bias and pro-industry thought (1,9-15). Furthermore, it is important that future editions of the DSM be representative of the population in which it serves. This can be attained by selecting an adequate proportion of male and female contributors for the DSM, which may provide more robust perspectives on current diagnoses. Additionally, representation of contributors from all regions across the US will allow for a more diverse and informed perspective on diagnostic criteria, allowing for improved public health and patient care within the United States. MedicalResearch.com: What recommendations do you have for future research as a result of this study? As gender and geographic disparities were shown to be significant through this study, I believe it would be interesting to address additional areas of demographic disparities among authors. Additional areas to examine may include non-US-based physicians, non-MD/DO authors, as well as ethnic and racial disparities among authors. Finally, similar studies may be applied to additional clinical and diagnostic tools. Diagnostic manuals, such as the DSM, written by a diverse set of individuals, would provide unique perspectives that best reflect the population as a whole, and in turn, benefit patient care. For this reason, it is important that diagnostic manuals, such as the DSM, include a diverse set of authors that can provide adequate input regarding the patient population it serves. MedicalResearch.com: Is there anything else you would like to add? This research received no external funding. First author (AD) is employed by PerkinElmer, working on assignment at GlaxoSmithKline (2023-Present), outside of the submitted work; Last author (BP) contributed to an osteoarthritis research team supported by Pfizer and Eli Lilly (2019-21) and received grants from the Pennsylvania Academic Clinical Research Center, outside of the submitted work. New Paper Diianni AT, Davis LC, Piper BJ. Gender and geographic disparities among DSM-5-TR authors in relation to financial conflicts of interest and industry payments: cross-sectional analysis. BMJ Mental Health. 2025;28:e301913. https://doi.org/10.1136/bmjment-2025-301913 References: 1. Davis LC, Diianni AT, Drumheller SR, Elansary NN, D’Ambrozio GN, Herrawi F, Piper BJ, Cosgrove L. Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ. 2024;384. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2022. 3. Cosgrove L, Krimsky S, Vijayaraghavan M, Schneider L. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychother Psychosom 2006;75:154-60. doi:10.1159/000091772. Pmid:16636630 4. Cosgrove L, Krimsky S. A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Med2012;9:e1001190. doi:10.1371/journal.pmed.1001190. Pmid:22427747 5. Piper BJ, Ogden CL, Simoyan OM, Chung DY, Caggiano JF, Nichols SD, et al. (2018) Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE 13(11): e0206100. https://doi.org/10.1371/journal.pone.0206100 6. Bareis N, Olfson M, Wall M, Stroup TS. Variation in Psychotropic Medication Prescription for Adults With Schizophrenia in the United States. Psychiatric Services. American Psychiatric Publishing; 2022;73(5):492–500. https://doi.org/10.1176/appi.ps.202000932 7. Tedstone Doherty D, Kartalova-O'Doherty Y. Gender and self-reported mental health problems: predictors of help seeking from a general practitioner. Br J Health Psychol. 2010;15(Pt 1):213-28. 8. Terlizzi EP, Schiller, Jeannine S. Mental health treatment among adults Aged 18–44: United States, 2019–2021. Report. Hyattsville, MD: National Center for Health Statistics; 2022. 9. Grande D, Frosch DL, Perkins AW, Kahn BE. Effect of exposure to small pharmaceutical promotional items on treatment preferences. Arch Intern Med. 2009;169(9):887-893. doi:10.1001/archinternmed.2009.64 10. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. In: Graham R, Mancher M, Miller Wolman D, et al., eds. Clinical Practice Guidelines We Can Trust. Washington (DC). National Academies Press, 2011, https://www.ncbi.nlm.nih.gov/books/NBK209539/?report=classic, doi:10.17226/13058. 11. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373-80. doi:10.1001/jama.283.3.373. Pmid:10647801 12. Moore DA, Tanlu L, Bazerman MH. Conflict of interest and the intrusion of bias. Judgm Decis Mak 2010;5:37-53. doi:10.1017/S1930297500002023 13. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252-5. doi:10.1001/jama.290.2.252. Pmid:12851281 14. Nejstgaard CH, Bero L, Hróbjartsson A, et al. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ 2020;371:m4234. doi:10.1136/bmj.m4234. Pmid:33298430 15. Thompson DF. The challenge of conflict of interest in medicine. Z Evid Fortbild Qual Gesundhwes 2009;103:136-40. doi:10.1016/j.zefq.2009.02.021. Pmid:19554887

Alexa T. Diianni

MedicalResearch.com Interview with:
Alexa T. Diianni, MBS
Department of Medical Education
Geisinger College of Health Sciences
Scranton, PA 19409

MedicalResearch.com: What is the background for this study?

Response: During a previous study, my research team and I examined the financial conflicts of interest (COIs) between industry and academia- namely those that exist between authors of The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and industry (1). The DSM is a diagnostic tool widely used for the diagnosis of psychiatric disorders, and is thus of interest in assessing COIs (1,2). We previously found that authors of the DSM-5-TR had received over $14.2m in undisclosed payments from industry (1). Our current study examines the gender and geographic disparities of the DSM-5-TR authors, in relation to these payments.

While previous investigations have evaluated financial COIs in recent editions of the DSM (3,4), the demographic information of its authors has not yet been examined. Equitable representation of DSM authors is paramount as this manual serves a diverse population across the United States and beyond. It is important that the authorship of this manual be reflective of the population in which it serves, as there have been reported differences in both the type and prevalence of psychiatric care sought out by gender, as well as varying clinical treatment by geographic location (5-8). 

MedicalResearch.com: What are the main findings?

Response: Of the 225 physicians that were identified as contributors to the DSM-5-TR task force, panels, and cross-cutting review groups, 116 contributors met the inclusion criteria of being a US-based physician with an active National Provider Identifier. Of these included individuals, 69.8% were men and 30.2% were women. Just three states accounted for 43.9% of contributors (New York, 17.2%; California, 14.7%; Massachusetts, 12.1%), while twenty-three states received no author representation. Of the total $14.6m in industry payments received by contributors, $13.2m (91.8%) was received by male contributors. Male contributors thus received an average of $287k in payment, while female contributors received $72k.

MedicalResearch.com: What should readers take away from your report?

Response: Due to the prevalent use of the DSM, it is important that transparency regarding financial conflicts of interest exists, with COIs minimized moving forward to avoid implicit bias and pro-industry thought (1,9-15). Furthermore, it is important that future editions of the DSM be representative of the population in which it serves. This can be attained by selecting an adequate proportion of male and female contributors for the DSM, which may provide more robust perspectives on current diagnoses. Additionally, representation of contributors from all regions across the US will allow for a more diverse and informed perspective on diagnostic criteria, allowing for improved public health and patient care within the United States. 

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: As gender and geographic disparities were shown to be significant through this study, I believe it would be interesting to address additional areas of demographic disparities among authors. Additional areas to examine may include non-US-based physicians, non-MD/DO authors, as well as ethnic and racial disparities among authors. Finally, similar studies may be applied to additional clinical and diagnostic tools.

Diagnostic manuals, such as the DSM, written by a diverse set of individuals, would provide unique perspectives that best reflect the population as a whole, and in turn, benefit patient care. For this reason, it is important that diagnostic manuals, such as the DSM, include a diverse set of authors that can provide adequate input regarding the patient population it serves. 

MedicalResearch.com: Is there anything else you would like to add?

Response: This research received no external funding. First author (AD) is employed by PerkinElmer, working on assignment at GlaxoSmithKline (2023-Present), outside of the submitted work; Last author (BP) contributed to an osteoarthritis research team supported by Pfizer and Eli Lilly (2019-21) and received grants from the Pennsylvania Academic Clinical Research Center, outside of the submitted work.

Citation:

Diianni AT, Davis LC, Piper BJ. Gender and geographic disparities among DSM-5-TR authors in relation to financial conflicts of interest and industry payments: cross-sectional analysis. BMJ Mental Health. 2025;28:e301913. https://doi.org/10.1136/bmjment-2025-301913

References:

    1. Davis LC, Diianni AT, Drumheller SR, Elansary NN, D’Ambrozio GN, Herrawi F, Piper BJ, Cosgrove L. Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ. 2024;384.
    2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2022.
    3. Cosgrove L, Krimsky S, Vijayaraghavan M, Schneider L. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychother Psychosom 2006;75:154-60. doi:10.1159/000091772. Pmid:16636630
  • Cosgrove L, Krimsky S. A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Med2012;9:e1001190. doi:10.1371/journal.pmed.1001190. Pmid:22427747
  1. Piper BJ, Ogden CL, Simoyan OM, Chung DY, Caggiano JF, Nichols SD, et al. (2018) Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE 13(11): e0206100. https://doi.org/10.1371/journal.pone.0206100
  2. Bareis N, Olfson M, Wall M, Stroup TS. Variation in Psychotropic Medication Prescription for Adults With Schizophrenia in the United States. Psychiatric Services. American Psychiatric Publishing; 2022;73(5):492–500. https://doi.org/10.1176/appi.ps.202000932
  3. Tedstone Doherty D, Kartalova-O’Doherty Y. Gender and self-reported mental health problems: predictors of help seeking from a general practitioner. Br J Health Psychol. 2010;15(Pt 1):213-28.
  4. Terlizzi EP, Schiller, Jeannine S. Mental health treatment among adults Aged 18–44: United States, 2019–2021. Report. Hyattsville, MD: National Center for Health Statistics; 2022.
  5. Grande D, Frosch DL, Perkins AW, Kahn BE. Effect of exposure to small pharmaceutical promotional items on treatment preferences. Arch Intern Med. 2009;169(9):887-893. doi:10.1001/archinternmed.2009.64
  6. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. In: Graham R, Mancher M, Miller Wolman D, et al., eds. Clinical Practice Guidelines We Can Trust. Washington (DC). National Academies Press, 2011,
    https://www.ncbi.nlm.nih.gov/books/NBK209539/?report=classic, doi:10.17226/13058.
  7. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373-80. doi:10.1001/jama.283.3.373. Pmid:10647801
  8. Moore DA, Tanlu L, Bazerman MH. Conflict of interest and the intrusion of bias. Judgm Decis Mak 2010;5:37-53. doi:10.1017/S1930297500002023
  9. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252-5. doi:10.1001/jama.290.2.252. Pmid:12851281
  10. Nejstgaard CH, Bero L, Hróbjartsson A, et al. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ 2020;371:m4234. doi:10.1136/bmj.m4234. Pmid:33298430
  11. Thompson DF. The challenge of conflict of interest in medicine. Z Evid Fortbild Qual Gesundhwes 2009;103:136-40. doi:10.1016/j.zefq.2009.02.021. Pmid:19554887

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Last Updated on December 7, 2025 by Marie Benz MD FAAD

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