Behind the Paywall: Unreported Financial Conflicts in Eminent Psychiatry Journals

Abstract Research Question To what extent do undisclosed financial conflicts of interest (COIs) exist among physician-authors in high-impact US-based psychiatry journals? Study Design Cross-sectional Objectives The study aimed to assess the prevalence and magnitude of undisclosed financial COIs within high-impact US-based psychiatry journals. The primary research question was determining the extent and distribution of financial COIs among physician-authors in these journals. Design This investigation analyzed financial COIs by comparing self-reported disclosures to journal(s) with payments mandatorily reported in the Open Payments database. Setting The study was conducted across two prominent US-based psychiatry journals: the American Journal of Psychiatry ( AJP ) and the Journal of the American Medical Association Psychiatry ( JAMA-PSY ), covering original research articles published from 1 January 2020 to 31 December 2022. Participants 2,872 research publications published from 1 January 2020 to 31 December 2022 were examined in AJP (n = 1,368) and JAMA-PSY (n = 1,504). Seventy-four original research articles authored by 27 physician-authors ( AJP n=15, JAMA-PSY n=12) met the eligibility criteria. Interventions No interventions were conducted in this observational study. Primary and Secondary Outcome Measures Primary outcomes included total payments received by authors within the three years prior to publication and the proportion of undisclosed payments. Secondary outcomes assessed the payment types (research vs. general payments), demographic characteristics of authors, and study types 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 randomized controlled trials (RCTs). 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. Strengths and Limitations This is the first systematic study of financial conflicts of interest of physician-authors publishing original research in two of the highest impact factor psychiatry journals, the American Journal of Psychiatry and JAMA Psychiatry , suggesting relevance to influential research and clinical practice. The study employed data from OpenPaymentsData.cms.gov , an authoritative if incomplete source for study of financial conflicts of interest. The necessary stringency of subject eligibility criteria that make this study meaningful winnowed the domain of analysis from nearly 3,000 publications to fewer than 30 authors.