Wendy J. Lynch
E. Blair Towers1,2
Emilie F. Rissman- 1Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
- 2Medical Scientist Training Program, University of Virginia, Charlottesville, VA, United States
- 3Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, United States
Editorial on the Research Topic
Women in psychiatry 2022: Addictive disorders
Numbers of women entering the field of academic psychiatry [52.4%; (1)] are on the increase. Women now represent over half of medical students [50.7%; (2)], neuroscience and psychology graduate students [up to 80%; (3)], psychiatry residents [57%; (4)], and post-docs [53%; (5)] in the United States. The proportion of NIH early-career awards to women has also gone up over the last 30 years; particularly over the past 6 years (6). These award mechanisms include pre-doctoral fellowships (F30/31), post-doctoral fellowships (F32), mentored research career awards (K01/7/8/22/23/25/99, KL1/2), and appointment on Kirschstein-NRSA training grants (T32/34/35/36/90, TL1/4, TU2). The proportion of women authoring peer-reviewed papers was approaching fifty percent as of 2018 (7).
However, the pipeline is stalled when it comes to keeping women in science and medicine. Women remain underrepresented among basic science and medical school faculty, particularly at advanced levels, such as among tenured faculty [42.5%; (8)], full professors [32.5%; (8)], and department chairs [18%; (9)], along with members of editorial boards of leading scientific journals in medicine and psychiatry [36%; (10)], which exert considerable power over what is published. Additionally, women post-docs and faculty continue to be paid less than men, and receive lower funding amounts (or dollars) for research grants compared to their male colleagues (5, 6, 11). Women are also under-represented as senior authors on publications and take significantly longer than men to transition from contributing to corresponding author on publications (7). This is an important indicator of independence, and given that publishing and academic success are inherently linked, may translate to the underrepresentation of women in the higher echelons of medical and basic science departments and universities.
In addition to these issues, COVID-19 appears to have disproportionately affected the productivity and scientific output of women vs. men in academia and even reversed some of the positive trends mentioned above. For example, the gender gap in the corresponding authorship position appears to have widened by an additional 10% during the pandemic (12, 13). One likely explanation for this is that during COVID-19 women assumed increased care-giving and home-schooling responsibilities as childcare and schools were shut down during the pandemic. This conclusion is supported by the literature on the division of childcare between women and men [(14, 15); also see (16)]. Thus, long-term investments in and promotion of gender equality are still needed, and if left unaddressed, could reverse or stall the gains made by women over the past several decades. Clark and Horton (17) suggested that the internal structures of both funding agencies and journals such as The Lancet need to be re-organized with the specific needs of women in mind in order to address gender biases in academic psychiatry. While gender biases are observed across many different fields within psychiatry, it is notable that within the addiction field, the long-standing trend for greater funding success rates of men vs. women on renewal applications through the National Institute of Drug Abuse has narrowed over the past decade, and, as of 2019, is equivalent between the genders (18).
The aim of this edition of “Women in psychiatry 2022: addictive disorders” of Frontiers in Psychiatry is to promote valuable contributions of women in the field. Four articles are included, each featuring women scientists as first or senior author. Two of these articles are focused on the impact of COVID-19 on substance use and substance use disorder. The other two examine other aspects of opioid and other substance use in human populations.
In the first article, Brown et al. report on changes in overdose deaths as the result of synthetic opioids, such as fentanyl, after the onset of COVID-19 lockdowns which began in March 2020. They found that while overdose deaths markedly increased across the United States (as compared to pre-pandemic in June 2019), by the end of the study period (November 2021), rates of overdoses plateaued in the majority of the reporting states (in 29 of the 39 states analyzed). The highest plateau was observed in Western states and in 10 states rates of overdose were still on the rise, not yet reaching maximum plateaus (i.e., Alaska, Colorado, Hawaii, Wyoming, Washington, South Dakota, Georgia, Oklahoma, Vermont, and Maine).
In the second article, Malandain et al. explore gender differences in the impact of COVID-19 lockdowns on alcohol, tobacco, and illicit drug use, internet use, and mental health in France. They found that of 263 men and women, 20% reported an increase in alcohol use, whereas 26% reported a decrease in alcohol use. For tobacco, 7% reported an increase in use, whereas 24% reported decreased use. Only 1% reported an increase in illicit drug use (such as cannabis), whereas 28% reported a decrease. Depression, anxiety, and internet use (social media, gambling, and cybersex), all increased in the same period (reported to be up in 26, 30, and 14% of participants, respectively). Surprisingly, gender was not associated with changes in any of the variables.
The third article by Washburn et al. explores knowledge and attitudes about opioid use and addiction among individuals in the Cooperative Extension System (Extension). The Extension is a US-wide network of professionals that provide community-based health education and outreach. Their role has recently been expanded, through substantial federal investments, to respond to the opioid epidemic. They focused on Extension professionals in Tennessee and showed that 90% of the 236 respondents felt that they did not possess adequate knowledge to address the opioid epidemic in their community. Respondents were mixed on their views of punitive approaches for opioid use and addiction, and while most viewed addiction as an illness (~79%), only a minority of respondents (35%) supported laws to protect people from criminal charges for drug crimes if seeking help for themselves or others experiencing a drug overdose. The authors argue that additional efforts that increase knowledge and decrease stigma associated with opioid use and addiction are necessary in order for the Extension to effectively address the opioid epidemic.
In the fourth article, Tschampl et al. explore associations between adverse childhood experiences (i.e., abuse, neglect, and household disfunction) and risk of drug overdose in individuals (140) in Massachusetts seeking treatment for substance use disorder in a predominantly Latinx population. They observed significant associations between adverse childhood experiences and risk of overdose such that each experience was associated with a 1.3 times higher risk of overdose. Women also reported more adverse childhood experiences than men.
These articles highlight some of the silent costs of social isolation and adverse childhood experiences on drug use and addiction. The contributions offer guidance as we continue to experience limitations on social interactions during COVID-19 and other public health epidemics.
Author contributions
WJL and EBT wrote the editorial. WJL, EBT, and EFR contributed to the review of this editorial. WJL and EFR edited the Research Topic. All authors contributed to the article and approved the submitted version.
Funding
This work was supported by NIDA grants R01DA024716, R01DA052893, and R21DA049992 (WJL) and R01DA048638 (WJL and EFR), a Pharmacological Sciences Training Grant 5T32GM007055-47 (EBT), and a MSTP Training Grant T32 GM007267 (EBT).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Chaudhary AMD, Naveed S, Siddiqi J, Mahmood A, Khosa F. US psychiatry faculty: Academic rank, gender and racial profile. Acad Psychiatry. (2020) 44:260–6. doi: 10.1007/s40596-020-01192-2
2. Association of American Medical Colleges. The Majority of US Medical Students Are Women, New Data Show. Washington, DC: Association of American Medical Colleges. (2019).
3. Fowler G, Cope C, Michalski D, Christidis P, Lin L, Conroy J. Women outnumber men in psychology graduate programs. Monit Psychol. (2018) 49:21. Available online at: https://www.apa.org/monitor/2018/12/datapoint. (accessed March, 2023).
5. McConnell SC, Westerman EL, Pierre JF, Heckler EJ, Schwartz NB. United States National Postdoc Survey results and the interaction of gender, career choice and mentor impact. Elife. (2018) 7:e40189. doi: 10.7554/eLife,.40189
6. Chaudhary AM, Naveed S, Safdar B, Saboor S, Zeshan M, Khosa F. Gender differences in research project grants and R01 grants at the National Institutes of Health. Cureus. (2021) 13:e14930. doi: 10.7759/cureus.14930
7. Hart KL, Frangou S, Perlis RH. Gender trends in authorship in psychiatry journals from 2008 to 2018. Biol Psychiatry. (2019) 86:639–46. doi: 10.1016/j.biopsych.2019.02.010
8. Colby G, Fowler C. Data Snapshot: IPEDS Data on Full-Time Women Faculty and Faculty of Color. Washington, DC: American Association of University Professors (2020).
9. Lautenberger DM, Dandar VM. The State of Women in Academic Medicine 2018-2019: Exploring Pathways to Equity. Washington, DC: Association of American Medical Colleges (2020).
10. Palser ER, Lazerwitz M, Fotopoulou A. Gender and geographical disparity in editorial boards of journals in psychology and neuroscience. Nat Neurosci. (2022) 25:272–9. doi: 10.1038/s41593-022-01012-w
11. Harmon O, Hopkins B, Kelchen R, Persky J, Roy J. The annual report on the economic status of the profession, 2017–18. Academe. (2018) 104:4–10.
12. King MM, Frederickson ME. The pandemic penalty: The gendered effects of COVID-19 on scientific productivity. Socius. (2021) 7:23780231211006977. doi: 10.1177/23780231211006977
13. Pinho-Gomes AC, Peters S, Thompson K, Hockham C, Ripullone K, Woodward M, et al. Where are the women? Gender inequalities in COVID-19 research authorship. Br Med J Glob Health. (2020) 5:e002922. doi: 10.1136/bmjgh-2020-002922
14. Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustainability. (2020) 16:67–73. doi: 10.1080/15487733.2020.1776561
15. Harrop G. Colliding identities during COVID-19: Identifying and addressing the challenges of being an academic mother during a global pandemic. Front Educ. (2021) 6:643221. doi: 10.3389/feduc.2021.643221
16. Lambrechts AA, Larasatie P, Boutelier S, Guta HA, Leonowicz-Bukała I, Prashad S. Why research productivity among women in academia suffered during the early stages of COVID-19 crisis: A qualitative analysis. EdArXiv Preprints. (2021) 2021:3awdq doi: 10.35542/osf.io/3awdq
17. Clark J, Horton RK. What is The Lancet doing about gender and diversity? Lancet. (2019) 10171:508–10. doi: 10.1016/S0140-6736(19)30289-2
18. NIH Data Book,. NIH Data Book, Report ID 131. R01-Equivalent Grants: Success Rates, by Gender Type of Application. (2023). Available online at: https://report.nih.gov/nihdatabook/report/131 (accessed February, 2023).
Keywords: substance use disorder, women, opioids, editorial, gender bias
Citation: Lynch WJ, Towers EB and Rissman EF (2023) Editorial: Women in psychiatry 2022: Addictive disorders. Front. Psychiatry 14:1157677. doi: 10.3389/fpsyt.2023.1157677
Received: 02 February 2023; Accepted: 29 March 2023;
Published: 11 April 2023.
Edited and reviewed by: Saeed Ahmed, Rutland Regional Medical Center, United States
Copyright © 2023 Lynch, Towers and Rissman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wendy J. Lynch, wlynch@virginia.edu