Background Female representation in academia has increased in recent years, yet gender disparities among high-ranking positions remain prevalent. In academic psychiatry departments, the percentage of women holding high-ranking positions declines with increasing seniority, and previous research on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, revealed an underrepresentation of female authors. We have previously reported on financial conflicts of interest in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR), concluding that nearly 60% of authors received payments from industry, totaling to >$14.2m. Although the DSM-5-TR has international representation, geographic representation within the United States (US) has not been reported. In this study, we evaluated the gender and geographic location (US) of the DSM-5-TR task force, panel, and cross-cutting review group members, with respect to financial conflicts of interest.

Methods We manually entered the names of DSM-5-TR task force, panel, and cross-cutting review group members in the National Provider Identifier (NPI) registry to obtain gender and geographic information, and in Open Payments to determine the type and amount of compensation received from 2016-19.

Results There were 116 contributors (five task force, 83 panel, 28 cross-cutting review group members) that met the inclusion criteria. The 65 contributors (56.5%) received $14.6m from industry. Males accounted for >70% of contributors receiving funding and received >90% of total compensation. Three states were represented by over three-quarters (76.1%) of contributors.

Conclusion Females accounted for less than one-third of all DSM-5-TR contributors and had fewer financial ties to industry. One of the five task force contributors was female. Over three-quarters of contributors represented three states while twenty-three states were not represented. To promote equitable gender and geographic representation in the DSM-6, the equal inclusion of male and female contributors, and contributors from various regions of the US, should be prioritized.

Strengths and Limitations

A primary strength of this study is that it considers the gender and geographic information of DSM-5-TR contributors in relation to financial conflicts of interest, which has not previously been reported.

Our investigation sheds light on the disproportionate gender and geographic representation of DSM-5-TR authors.

This study used the Open Payments database and NPI registry, which consist of mandated and self-reported disclosures, and it is thus possible that information obtained from these sources may have been outdated or absent.

Only US states were considered for geographic analysis despite multiple contributors residing outside the US.

Although there was a subset of contributors who hold medical licensure in multiple US states and/or have medical practices residing in more than one state, only the state of contributors’ primary medical practice was considered in the geographic analysis.

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: AD reports employment by PerkinElmer, working on assignment at GlaxoSmithKline (2023-Present), outside the submitted work; BP reports contributing to an osteoarthritis research team supported by Pfizer and Eli Lilly (2019-21) and reports receiving grants from the Pennsylvania Academic Clinical Research Center, outside the submitted work; no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

This study did not receive any funding.

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All data produced in the present study are available upon reasonable request to the authors.