Does mental health science perform better than other STEMM topics?

The results from our regression analysis revealed that 29.7% of women are first authors of scientific publications between 1975 and 2020, with an increase of 6.4% in proportions every 10 years. The results for last authors were disappointing, but perhaps not a surprise: only 21.3% of last authors are women, and this increased by only 4.2% every 10 years. These levels are unaffected by the potential confounding effects of methods of classification and use of gender or sex. The results of slower growth in last author publications likely reflect poorer career progression, even in countries with higher rates of gender equality. ^{Reference Komlenac, Gustafsson Sendén, Verdonk, Hochleitner and Siller22,Reference Sarkiss, Riley, Hernandez, Oermann, Ladner and Bederson23} So, although there has been some progress, increased representation as first author does not inevitably lead to more women as senior authors.

For journals in mental health, the figures improved, but not considerably, and the proportion of women first authors in 2020 was similar to their rate of employment (40.8%). ^{Reference Dhingra, Killaspy and Dowling10} This first author rate was consistently higher than medicine throughout the observation period, and the change in rate of women first authors was 8.56% every 10 years, which was also 2.35% larger than for medicine, perhaps because of the increase in employment of women academics in psychiatry. Similarly, the proportion for last authors in psychology and psychiatry was 36.7% in 2020, which was higher than medicine, and the rate of change was also higher at 6.86% (2.65% higher than medicine). Hart et al. ^{Reference Hart, Frangou and Perlis24} found that women first authors in academic psychiatry approached 50% in 2018 but, like our study, found slower rates for the transition to senior authorship. For comparison, the 2024 issues of the British Journal of Psychiatry show that women first authors are at 47% and women last authors are at 32%, similar to the figures in our review. The increased representation in the academic community is still not reflected in similar improved rates of last author research output, suggesting a continuing ‘leaky pipeline’ of women not reaching senior levels. ^{Reference Barrios, Villarroya and Borrego25} As a result, choosing any scientific field does not appear to boost your career chances of getting to the top, even when women are well represented at the earlier stages.

Does the classification method affect the results?

Despite the potential limitations of classification methods, neither classification using gender and/or sex, nor type of classification method (i.e. assigning gender/sex by algorithm or manually), influenced the proportions of first or last authors, in this meta-analysis. Although the methods did not affect the actual proportions for past papers, it is still important to consider standardisation for future work, to avoid classification inconsistencies. This is especially important given that there is an increase in non-Western authors of science publications, and it may be difficult to capture sex or gender given the current algorithmic methods.

What barriers remain that affect women’s representation in STEMM publications?

The barriers are general and affect all women irrespective of choice of scientific topic, although there may be some nuances that depend on the topic. We highlight three main areas with evidence that universities might consider in more detail. First, in employment – as the slower improvement in senior authorship shows that women tend to end their academic career at the postdoctoral stage. ^{Reference Cidlinská26} There are institutional barriers, such as gender biases during recruitment, fewer opportunities for collaboration and inflexibility about accommodating career and family life. ^{Reference Eaton, Saunders, Jacobson and West27–Reference Sattari and Sandefur29} These seem to have been addressed – especially in psychology and psychiatry, with its increased and higher employment rates – and has been achieved through flexible working, mentoring, inclusive leadership and projects such as Athena SWAN and ADVANCE programmes. ^{Reference Coe, Wiley and Bekker30–Reference Rosser, Barnard, Carnes and Munir33}

Second, the contribution of women may be less valued. In a recent study, women made up just under half the workforce (48.25%), but only 34.85% were authors. ^{Reference Ross, Glennon, Murciano-Goroff, Berkes, Weinberg and Lane34} After contributing, they were either not named or not given priority in the author list.

The final barrier is the visibility of women’s research after publication, with women first or last authors in high-impact medical journals having far fewer citations than men. One explanation might be that men are more likely to self-cite. ^{Reference Chatterjee and Werner35,Reference Grover36} This needs further consideration for those investigating issues in mental health, as it might explain some of the variance in the poor rate of conversion from junior to senior positions.

Gender equity research in the future – it is going to get more complicated

Our review stopped at the point where the COVID-19 pandemic started to have effects on publications, as it provided a potential disruption to the trajectories. This has been notable and was detrimental to women’s representation in authorship. ^{Reference Nguyen, Trinh, Kurian and Wu37–Reference Son and Bell39} This slowed pace is despite the media presence, at least in the UK, of notable women scientists such as those in the Oxford–AstraZeneca Vaccine Team (Sarah Gilbert, Catherine Green and Teresa Lambe), experts in airborne diseases like Cath Noakes, and the epidemiologist Devi Sridar. They are likely to be role models in the future. Similar role models in psychiatry and psychology need to be advanced, and perhaps the presence of women at the top of the Royal College of Psychiatrists will increase visibility in the media post-COVID-19.

Although classification methods had no effect on our estimates of women authorship, any future conversation about equality will soon require discussions of the additional challenge of intersectionality. ^{Reference Crenshaw40} How identities intersect (e.g. a Black woman or gay Muslim woman) can form unique barriers that are not simply additive. ^{Reference Corneille, Lee, Allen, Cannady and Guess41} A growing body of research reflects this by demonstrating that many women’s experiences fail to be captured if issues of gender and race are analysed in separate silos. ^{Reference Miriti42–Reference Wilkins-Yel, Hyman and Zounlome44} Understanding trends in intersectionality goes beyond the scope of our paper, but warrants future research, especially in mental health topics because it may be a potent factor in understanding and removing the barriers to women’s pursuit of an academic career.

Strengths and limitations

We discovered many studies, mostly published post-1975, that examined the representation and trajectory of authorship for women academics. We followed PRISMA methods, checked our data quality via different sensitivity analyses, performed analyses to identify if any of our assumptions had affected the overall results and checked all potential confounders. This included consideration of the corpus of studies, interval length, interactions and removal of sampling periods before 1975. We are therefore confident that the overall results are robust and makes us confident in our baseline estimates. However, many publications did not provide sufficient information for a meta-analysis, especially the total sample size, which affected our ability to assess potential publication bias – although it seem unlikely that there was a bias. Finally, we assumed that last authors are typically senior authors, which is common in mental health research, but may differ in other disciplines.

In conclusion, this paper is unique in developing a robust baseline for the discipline of psychology and psychiatry, as we investigated potential methodological confounders. The story is half full or half empty, as mental health science performed better than other topics, but there was still a slow transition to senior authorship like other studies of STEMM publications. In the future, research investigating a growing trend upward or inertia for women in STEMM publications will need to update its methodologies if it is to prove useful in tackling existing social inequalities in academia. In terms of measurement, perhaps it is also time for academic journals to exercise humility, and reflect on their own processes of article selection. ^{Reference Wykes and Evans45}

Our study shows that change continues to occur, but at a snail’s pace. It is time to be ambitious and set our sights on increasing the rate of change over the next 10 years, including initiatives for more visible role models of women. We have noted that this was achieved during the COVID-19 pandemic and, together with systemic changes within universities, could begin to accelerate the trajectories. But we know there is still a long way to go.