High-Impact Medical Journals Reflect Negative Sentiment Toward Psychiatry

AbstractPsychiatry as a medical specialty has historically been considered less scientifically grounded than other disciplines. Despite progress in understanding the biological basis of psychiatric disease and efforts to diminish stigma associated with mental illness, a negative bias against psychiatry may persist in the medical community. Large language models provide an opportunity to investigate this hypothesis at scale. Our objective was to characterize the extent to which articles published in high-impact medical journals may reflect more negative sentiment about psychiatry compared with those from other medical specialties. We analyzed Entrez/PubMed entries published between 2017 and 2022 relating to psychiatry, neurology, oncology, and cardiology in four high-impact medical journals: British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine. We used the large language model GPT-4 to score each article's title and abstract in terms of valence - that is, whether the abstract and title were likely to increase or decrease optimism about progress in a given medical specialty. Overall, and in each of the four journals, publications in psychiatry were significantly more likely to be negatively valenced than those of other specialties (P<0.001 for all omnibus χ² and post hoc pairwise contrasts). Negative-valence scores were found for 19.5% of publications relating to psychiatry, compared with 6.1% for cardiology, 6.1% for oncology, and 10.7% for neurology. Results were similar in analyses restricted to publications with abstracts, those reporting original research, those published before the Covid-19 pandemic, or those published in 2020 or later. In logistic regression models adjusting for journal, publication year, article type, and presence or absence of abstract, psychiatric publications were significantly more likely to be negatively valenced than all other specialties. Permuting the article specialty did not meaningfully change estimates of valence, indicating that the results were not attributable to psychiatry-specific terms. Published psychiatry articles were on average more likely than other specialty articles to reflect negative valence about the specialty. Whether this difference reflects volume and type of submission, or bias among editors or reviewers, merits further study. Regardless of the mechanism, the potential contribution of these articles to perpetuating negative attitudes toward psychiatry is also worthy of further investigation.