Observational studies of antidepressant use and suicide risk are selectively published in psychiatric journals

Objectives: To investigate if observational studies showing favorable results for antidepressants on suicidal behavior (reduced risk) are preferably and more easily published in psychiatric journals and cited more often, compared to studies with unfavorable results (increased risk). Study design and setting: Prespecified secondary analysis including 27 original studies selected through a systematic review of observational studies reporting associations between use of newer antidepressant drugs and suicide risk. Results: Independent of study quality, studies reporting favorable results were more frequently published in psychiatric than non-psychiatric journals and were more often conducted by lead-authors with financial conflicts of interest (fCOI). Within psychiatric journals, lead-authors with fCOI published in journals with higher impact factor and ranking. Within psychiatric journals, favorability of results also correlated with citation frequency, impact factor, and journal ranking, but these associations became weaker and inconclusive after adjusting for study quality. Results for ease of publishing were inconclusive. Conclusion: Studies reporting unfavorable results (increased suicide risk with antidepressant-exposure) are less likely published in psychiatric journals. Lead-authors with fCOI report more favorable results and their studies are published in the most prestigious psychiatric journals. This may create a biased evidence-base and an unbalanced dissemination and appraisal of findings within psychiatry