Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-16T12:02:17.694Z Has data issue: false hasContentIssue false

Pharmaceutical industry interactions of psychiatric trainees from 20 European countries

Published online by Cambridge University Press:  15 April 2020

F. Riese*
Psychiatric University Hospital Zurich, Division of Psychiatry Research and Psychogeriatric Medicine, Lenggstr. 31, 8032Zurich, Switzerland
S. Guloksuz
Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands Department of Psychiatry, Yale University, New Haven, CT, USA
C. Roventa
University Psychiatry Hospital Pr. Dr. Al. Obregia, Bucharest, Romania
J.D. Fair
Kershaw Unit, Gartnavel Royal Hospital, Glasgow, United Kingdom
H. Haravuori
Hospital District of Helsinki and Uusimaa, Kellokoski Hospital and National Institute for Health and Welfare, Helsinki, Finland
T. Rolko
Psychiatric Clinic, Tartu University Hospital, Tartu, Estonia
D. Flynn
Department of Psychiatry, St. Lukes Hospital, Kilkenny, Ireland
D. Giacco
Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
V. Banjac
Clinic for Psychiatry, University Clinical Center Banjaluka, Banjaluka, Bosnia-Herzegovina
N. Jovanovic
Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
N. Bayat
Arkin Psychiatric Institution, Amsterdam, The Netherlands
C. Palumbo
Department of Neuroscience and Sense Organ, University of Bari, Bari, Italy
M. Rusaka
Riga Stradins University, Riga, Latvia
O. Kilic
Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
J. Augėnaitė
Vilnius University Psychiatric Clinic, Vilnius, Lithuania
A. Nawka
Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
M. Zenger
Central Ostrobothnia Hospital District, Kokkola Central Hospital, Kokkola, Finland
I. Kekin
Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
P. Wuyts
UPC KU Leuven, Leuven, Belgium
E. Barrett
Our Lady's Hospital for Children, Crumlin, Dublin, Ireland
N. Bausch-Becker
Psychiatric University Hospital Zurich, Division of Psychiatry Research and Psychogeriatric Medicine, Lenggstr. 31, 8032Zurich, Switzerland
J. Mikaliūnas
Vilnius University Psychiatric Clinic, Vilnius, Lithuania
E. del Valle
Centre Hospitalier Universitaire de La Tronche, 38700Grenoble, France
K. Feffer
Shalvata Mental Health Center, Hod Hashron, Israel
G.A. Lomax
South West London and St George's Mental Health Trust, London, United Kingdom
J.G. Marques
Centro Hospitalar Psiquiatrico de Lisboa, Lisbon, Portugal
S. Jauhar
Department of Psychosis Studies, Institute of Psychiatry, King's College, London, United Kingdom
*Corresponding author. E-mail (F. Riese).
Get access



Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.


One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.


The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).


There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.

Original article
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Angell, M.. Relationships with the drug industry: keep at arm's length. BMJ 2009;338 :b222. ScholarPubMed
Appelbaum, P.S., Gold, A.. Psychiatrists’ relationships with industry: the principal-agent problem. Harv Rev Psychiatry 2010; 18 2: 255265. ScholarPubMed
Appelbaum, P., Arboleda-Florez, J., Javed, A., Soldatos, C., Tyano, S.. WPA recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry. World Psychiatry 2011; 10 2: 155159.CrossRefGoogle ScholarPubMed
Austad, K.E., Avorn, J., Kesselheim, A.S.. Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS Med 2011;8 :e1001037. ScholarPubMed
Austad, K.E., Avorn, J., Franklin, J.M., Kowal, M.K., Campbell, E.G., et al. Changing interactions between physician trainees and the pharmaceutical industry: a national survey . J Gen Intern Med 2013. Scholar
Goldacre, BenBad Pharma: how medicine is broken and how we can fix it. UK: HarperCollins; 2012. [1 pp.].Google Scholar
Elliot, C.White Coat, Black Hat. Boston, USA: Beacon Press; 2010. [1 pp.].Google Scholar
Epstein, A.J., Busch, S.H., Busch, A.B., Asch, D.A., Barry, C.L. Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing?. Med Care 2012. Scholar
Etain, B., Guittet, L., Weiss, N., Gajdos, V., Katsahian, S.Attitudes of medical students towards conflict of interest: a national survey in France. PLoS ONE 2014;9 :e92858. ScholarPubMed
Freedman, R., Lewis, D.A., Michels, R., Pine, D.S., Schultz, S.K., et al.Conflict of interest – an issue for every psychiatrist. Am J Psychiatry 2009;166 :274. [Available] ScholarPubMed
Grande, D., Shea, J.A., Armstrong, K.Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system. J Gen Intern Med 2011; 27 2: 274279. ScholarPubMed
Guloksuz, S., Oral, E.T., Ulaş, H.Attitudes and behaviours of psychiatry residents and psychiatrists working in training institutes towards the relationship between the pharmaceutical industry and physicians. Turk Psikiyatri Derg 2009;20 :236242.Google ScholarPubMed
Hodges, B.Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks. CMAJ 1995;153 :553559.Google ScholarPubMed
Höschl, C., Fialová, L.European Psychiatric Association guidance on the conflicts of interest. Eur Psychiatry 2012;27 :142146. ScholarPubMed
Insel, T.R.Psychiatrists’ relationships with pharmaceutical companies: part of the problem or part of the solution?. JAMA 2010;303 :11921193. [Available] ScholarPubMed
Jauhar, S., Guloksuz, S., Andlauer, O., Lydall, G., Marques, J., et al.Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?. BMC Psychiatry 2012;12 :27. ScholarPubMed
Korenstein, D., Keyhani, S., Ross, J.S.Physician attitudes toward industry, a view across the specialties physician attitudes toward industry. Arch Surg 2010;145 :570577. ScholarPubMed
Kuzman, M.R., Giacco, D., Simmons, M., Wuyts, P., Bausch-Becker, N., et al.Psychiatry training in Europe: views from the trenches. Med Teach 2012;34 :e708e717. ScholarPubMed
Lexchin, J.Interactions between physicians and the pharmaceutical industry: what does the literature say?. CMAJ 1993;149 :14011407.Google ScholarPubMed
McKinney, W.P., Schiedermayer, D.L., Lurie, N., Simpson, D.E., Goodman, J.L., et al.Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA 1990;264 :16931697.CrossRefGoogle ScholarPubMed
Misra, S., Ganzini, L., Keepers, G.Psychiatric resident and faculty views on and interactions with the pharmaceutical industry. Acad Psychiatry 2010;34 :102108. ScholarPubMed
Rabe-Hesketh, S., Skrondal, A., Pickles, A.Maximum likelihood estimation of limited and discrete dependent variable models with nested random effects. J Econometrics 2005.CrossRefGoogle Scholar
Randall, M.L., Rosenbaum, J.R., Rohrbaugh, R.M., Rosenheck, R.A.Attitudes and behaviours of psychiatry residents toward pharmaceutical representatives before and after an educational intervention. Acad Psychiatry 2005;29 :3339. ScholarPubMed
Schulze, T.G., Treichel, K.C.The European Federation of Psychiatric Trainees (EFPT) – an integral part of the European harmonisation of psychiatric education and practise. Eur Psychiatry 2002;17 :300305.CrossRefGoogle ScholarPubMed
Schwartz, T.L., Kuhles, D.J., Wade, M., Masand, P.S.Newly admitted psychiatric patient prescriptions and pharmaceutical sales visits. Ann Clin Psychiatry 2001;13 :159162.CrossRefGoogle ScholarPubMed
Spurling, G.K., Mansfield, P.R., Montgomery, B.D., Lexchin, J., Doust, J., et al.Information from Pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med 2010;7 :e1000352. ScholarPubMed
Steinman, M.A., Shlipak, M.G., McPhee, S.J.Of principles and pens: attitudes and practices of medicine house staff toward pharmaceutical industry promotions. Am J Med 2001;110 :551557.CrossRefGoogle ScholarPubMed
Understanding and responding to pharmaceutical promotion – a practical guide (n.d.) Understanding and responding to pharmaceutical promotion – a practical guide. First edition. Available: Scholar
Varley, C.K., Jibson, M.D., McCarthy, M., Benjamin, S.A survey of the interactions between psychiatry residency programs and the pharmaceutical industry. Acad Psychiatry 2005;29 :4046. [Available] ScholarPubMed
Wadman, M.Pharma payment probe widens its net. Nature 2008;455 2;1017. ScholarPubMed
Wazana, A.Physicians and the pharmaceutical industry: is a gift ever just a gift?. JAMA 2000;283 :373380. ScholarPubMed
Zheng, X., Rabe-Hesketh, S.Estimating parameters of dichotomous and ordinal item response models with gllamm. Stata J 2007;7 :313333.CrossRefGoogle Scholar
Supplementary material: File

Riese et al. supplementary material

Table S1

Download Riese et al. supplementary material(File)
File 41.5 KB
Submit a response


No Comments have been published for this article.