Look who’s talking?

Instead of starting with what is in this months’ ANZJP, let’s look at who is in the journal. In total, 72 authors have contributed to this month’s reading; of these, 40% are women. Fifty percent of the Research and Review papers in the November ANZJP have a female first author - this contrasts favourably with 37% of articles published in the six leading medical journals in 2014 (Filardo et al. 2016). However, we have a sample of six Research or Review papers, so the statistically minded will quickly recognize the need for a larger sample size.

Trainees needing a scholarly project might think about looking at female first authorship in the ANZJP over the last year or two, assuming that first author publications are a valid measure of research participation. Of course, much research is also published in other journals, but there is no reason to expecta specific gender bias in publicationsin the ANZJP. And, the ANZJP mightbe a good reflection of the psychiatry research culture in Australasia. Looking at gender distribution in research grants and university academic appointments is another strategy, but does not include clinician researchers who are unwilling to commit to the current harsh grant-funded research environment. In 2015, across all categories of grants (not just mental health), the National Health and Medical Research Council (NHMRC) funded 17% of grants with a female lead Chief Investigator and 18% of those with a male lead Chief Investigator. However, there were many more applications by men, so overall grants led by women were awarded 35% of the money. The NHMRC are careful to take into account career disruptions such as maternity leave, but even so these grant applications take a lot of work with a low probability of success. The average age of these chief investigators was 42.5 years for women and 46.8 years for men; this is a time of life when there are lots of competing priorities. The ANZJP provides scope for a range of contributions including non-randomized control trial (RCT) clinical research, observation and opinion, so is hopefully more inclusive. Furthermore, the clinical research, ideas and case observations contained in the ANZJP can often be readily translated into everyday psychiatric practice, leading to incremental improvements in clinical care.

Based on the modest sample of this month’s ANZJP, men seem to be more opinionated or perhaps more confident in their opinions. The Debates, Editorials, Letters and Commentaries are much more likely to be led by men.

Where do our authors come from? It’s encouraging that some research papers have authors from prestigious institutions in the United States, United Kingdom, Israel and Scandinavia. Allthese papers have co-authors with Australian affiliations, so they are the outcomes of successful international collaborations – a good sign for Australasian research. One of our authors is from the School of Population Health at the University of Auckland, but as an Australasian Journal, it would be good to have more contributions from Aotearoa.

Leske et al. (this issue) have undertaken a systematic review of interventions for Indigenous adults with mental and substance use disorders in New Zealand, Australia and the United States. New Zealand was well represented, with four New Zealand and four Australian studies meeting the inclusion criteria. Leske et al.’s review concludes that the evidence base is small and methodologically weak. Hunter (this issue) notes that Indigenous Australians experience a higher burden of mental ill health than the wider Australian population, and a New Zealand study by Kake et al. (2008) found a higher rate of schizophrenia in the Maori population, compared to the non-Maori. This is an area where much more research to develop, implement and evaluate effective interventions is needed on both sides of the Tasman.

Oedegaard et al. (this issue) looked at culture-specific values, beliefs and practices in the care of patients with bipolar disorder, using interview data from 19 international experts on bipolar disorder. For many patients, access to medical care was very limited. Systems of financial reimbursement shaped their access to health care, and there was limited opportunity for long-term follow-up, psychotherapy and psychoeducation in some public health-care systems.

Equitable access to services is central to three of the articles in the November ANZJP. ÆSOP is a longitudinal study of first-episode psychosis (FEP), undertaken in London and Nottingham, United Kingdom. Lappin et al. (this issue) looked at data collected before specialized FEP services were established. They found that, at illness onset, 58% of men and 71% of women were too old to be accepted by Australian FEP services. They concluded that such services were age and gender-inequitable. McGorry (this issue) has written a thoughtful Editorial about options in FEP care, and the pros and cons of gatekeeping based on symptoms (psychosis) and/or age (25 years and under).

Bassilios et al. (this issue) report data from Access to Allied Psychological Services (ATAPS) programme, introduced in 2001. In 2010, the Child Mental Health Service (CMHS), the child component of ATAPS, was introduced. Bassilios et al. (this issue) demonstrate an increase in services provided to children with emotional and behavioural issues, and their families, since CMHS was introduced. The services are generally free, and Bassilios et al. (this issue) show an encouraging uptake by low-income and indigenous children and families.

Hayward et al. (this issue) look at the association between adolescent depression and diet, physical activity, screen time, body mass index (BMI) and sleep. The associations were not as strong as one might have expected given the sample size. Sleeping fewer hours was associated with greater rates of depression in both genders. In males, unhealthy diet and inadequate physical activity were associated with depression, while in females excessive screen time (phone, TV, computer) and a higher BMI increased the risk of depression.

Bullying is an important component of workplace psychological stress, and those who have been bullied sometimes find their way to a psychiatrist – via general practitioner (GP) referrals, return-to-work programmes, and assessments for income protection payments or legal compensation. Butterworth et al. (this issue) found that 7% of Australian workers report currently being bullied, and 46.5% report having been bullied at some point in their working life. Being subject to bullying increased the risks of anxiety and depression. Respondents were more likely to be bullied if they were female, did not have a partner, were employed in the public sector and were in professional or semi-professional occupations. In contrast to Australia, only 0.6% of Italian workers and 3–5% of Scandinavian workers report currently being bullied (Dollard and Neser, 2013). This is an obvious area for public mental health intervention, and perhaps when writing reports and liaising with workplace rehabilitation providers, we should pay more attention to the Psychosocial Safety Climate of the workplace (Dollard and Neser, 2013). Allison and Bastiampillai (this issue) describe the need to tackle bullying from the top, ensuring those with power in an organization behave ethically and act decisively against bullying and harassment.

Strauss et al. (this issue) argue that psychedelic drugs have potential in treating a number of psychiatric conditions. They argue that this branch of research is neglected in Australia, and as a result Australia is at risk of being left behind more progressive countries, such as the United States, Canada, Switzerland, Israel and New Zealand. The University of Auckland website tells us that Dr Suresh Muthukumaraswamy is undertaking neuroimaging studies of the effects of numerous compounds including ketamine, lysergic acid diethylamide (LSD) and psilocybin (as reported in Carhart-Harris et al. (2016)); according to Strauss et al. (this issue), there is no such research occurring in Australia. Horgan (this issue), also concerned about the failure to realize the potential of drugs that have acquired a bad reputation, writes about the use of psychostimulants to treat depression. He argues that these drugs are under-utilized and that patients should be informed about this treatment option.

The articles in the November ANZJP describe how gender, culture, age and living and working circumstances impact on the prevalence, nature and severity of psychiatric disorders, and access to services to treat these disorders. Many of the same elements also apply to us as clinicians and researchers. Gender, family circumstances, culture, opportunities, barriers and workplace environment all affect our ability to provide the best possible psychiatric care for our patients, and, for those so inclined, to participate in research, debate and conversation about where we are, how we got here and where we want to go.