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A renewed call for international representation in editorial boards of international psychiatry journals

In a 2003 letter to The Lancet, Saxena et al reported on the international nature of the editorial and advisory boards of the top ten general psychiatry journals (excluding those focused primarily on biological psychiatry). They noted that “most journals claim to be international”, but found that the actual journal leadership was overwhelmingly from high-income and Western countries. Only four editorial or advisory board members were from lowand middle-income countries (LMICs) across the top ten journals. The authors deemed this an “unsatisfactory situation” of underrepresentation and called for increased LMIC presence in those leading international journals. Subsequently, similar observations were made for other areas of medicine, including an editorial in The Lancet questioning whether “widespread systemic bias” in medical journals exemplified “institutional racism” in medicine. Where do we stand now? Hoping to find an improvement in LMIC representation, we reviewed the editorial and advisory boards of the top ten psychiatry journals, ranked by impact factor, in 2016. Given the evolution of journal content, we included the top ten journals by ranking without regard to emphasis. This resulted in the additional inclusion of World Psychiatry (founded in 2002), Molecular Psychiatry, Biological Psychiatry, and Psychotherapy and Psychosomatics, as well as the exclusion of Journal of Clinical Psychiatry, Schizophrenia Research, Psychological Medicine, and Psychosomatic Medicine. Consistent with the methodology of Saxena et al, we used the most recent World Bank country income groupings to identify editorial and advisory board members from LMICs. Our search revealed minimal improvement: 21 editorial board members from LMICs out of a total of 607 (3.46%) in 2016, as compared to 4 out of 470 (0.85%) in 2003. Although this is a small step in the right direction, the increase is largely due to World Psychiatry, which alone has ten LMIC members out of 31 editorial board members (32.26%). Among the remaining nine journals, LMIC representation is 11/576 (1.91%). In contrast, more than 80% of the world population lives in LMICs. Clearly, the situation remains unsatisfactory – indeed, unacceptable. We must address serious inequities as a field if we are to fully advance a global understanding of mental health, and scientific journals provide a critical leadership function. While the publication process is meritocratic in theory, lack of global representation in editorial boards represents a systemic disparity that may perpetuate a limited understanding of international issues, as well as a limited access and guidance for individuals from LMICs. This guidance could facilitate the capacity building necessary to increase research activity aligned with the global standards of those journals. Indeed, it has been reported that “the gap in scientific publications between low-income countries and the rest of the world has widened” and “only about 6% (or less) of [mental health] publications are from lowand middleincome countries”. More diversity among editorial board members can also help to ensure that published research accurately incorporates and represents data from LMICs through better understanding of the communities from which the data are drawn. The lack of representation of LMICs in leadership positions is not unique to scientific journals. The most recent Egon Zehnder Global Board Index, an assessment that tracks and evaluates trends among US Standard and Poor’s 500 companies in terms of board composition, global capability, and business performance, noted in 2014 that while 37% of the revenue of those companies comes from international sources, a mere 7.2% of the directors are foreign nationals. This has led to the development of the Board Global Capability Gap, a measure of the difference between global representation in the boardroom and global footprint of each company, intended to promote board membership that is more closely aligned with the current business market. An analogous metric for scientific journals could serve as an effective tool to help promote LMIC representation in editorial leadership. Successful engagement of individuals from LMICs in editorial boards will require focused attention and intention. Possible steps for scientific journals include: a) setting a minimum goal of having at least 10% of editorial board members from LMICs by 2018; b) including a minimum number of members from LMICs of each of the World Health Organization (WHO) regions; c) inviting experts from LMICs to serve as guest editors for special sections throughout the course of the year; and d) developing a mentorship program to build capacity in editorial skills among individuals from LMICs. This may require journals to increase the number of members in their editorial boards or consider term limits to make room for increased diversity among their membership. The WHO can facilitate this process by identifying suitable advisors from LMICs and working with journals and editors to establish suitable training and mentorship opportunities. It has been over 13 years since the first call to action for greater diversity of membership in the top editorial and advisory boards in our field. Global leaders are entrusted with the responsibility to use their positions of influence to set an example, and the world’s premier international psychiatry journals are poised to demonstrate such leadership. Progress is long overdue, but it is achievable. The time to start is now.