UMass Boston

Developing a rights-based and social justice approach to global mental health; bias in clinical practice guidelines in psychiatry

PhD, Clinical Psychology, Duquesne University, Pittsburgh

• Cosgrove, L., Bursztajn, H., Krimsky, S. (2009). Developing unbiased diagnostic and treatment guidelines in psychiatry. New England Journal of Medicine, 360, 2035-2037.
• Cosgrove, L., Ling, S., Creasey, D., Anaya-McKivergan, MS; Myers, J. Huybrechts, MS. (2011). Antidepressants and breast and ovarian cancer risk: A systematic review of the epidemiological and pre-clinical literature and researchers’ financial associations with industry. PLoS ONE, 6, 1-8.
• Cosgrove, L., & Krimsky, S. (2012). A comparison of DSM IV and DSM-5 panel members’ financial associations with industry: A pernicious problem persists. PLoS Medicine, 9(3), e1001190.
• Gopal, A., Cosgrove, L., Shuv-Ami, I., Wheeler, E. E., Yerganian, M., & Bursztajn, H. J. (2012). Systematic review of the iatrogenic harms of SSRIs and SNRIs: Implications for the informed consent process. International Journal of Law and Psychiatry, 35, 392-397.
• Cosgrove, L., & Wheeler, E. E. (2013). Drug firms, the codification of diagnostic categories, and bias in clinical guidelines. Journal of Law and Medical Ethics, 14, 644-653.
• Cosgrove, L. et al. (2015). From Caveat Emptor to Caveat Venditor: Time to stop the influence of money on practice guideline development. Journal of Evaluation in Clinical Practice, 20, 809-812.
• Shaughnessy, A. S., Cosgrove, L. Lexchin, J. (2016). The need to regulate clinical practice guidelines. Journal of the American Board of Family Medicine. 29:644–8. doi:10.3122/jabfm.2016.06.160115
• Cosgrove, L., Mintzes, B., Vannoy, S., Shaughnessy A. F., (2016). Under the influence: Industry, publishing, and drug regulation. Accountability in Research, 24, 1-23.
• Cosgrove, L. Shaughnessy, A.S., Shanyefelt, T. (2018). When is guideline not a guideline? The devil is in the details. BMJ EBM.
• Simons, P., Cosgrove, L., Shaughnessy, A. and Bursztajn, H. (2017). Antipsychotic Augmentation for Major Depressive Disorder: A Review of Clinical Practice Guidelines. International Journal of Law and Psychiatry.
• Cosgrove, L. Karter, J. Vaswani, A., Thombs, B. Unexamined assumptions and unintended consequences of routine screening for depression (2018). Journal of Psychosomatic Research.

Professor Cosgrove's work focuses on the ways in which evidence-based medicine can become evidence-biased medicine. Specifically, her research addresses the corruption of scientific knowledge in the mental health field (especially in psychiatry) that can occur when there are financial ties between the pharmaceutical industry and researchers.

Bio:  Dr. Cosgrove was a Research Fellow at the Edmond J. Safra Center for Ethics, Harvard University (2010-2015), and has received numerous external and internal grants for her research (e.g., she was the PI for an NIH grant, “A cross-sectional study of clinical practice guidelines for depression: Is guideline quality associated with independence from industry?”), and was co-chair of the task force on Depression Outcome Measures, Agency for Healthcare Research and Quality (2017-2018). Dr. Cosgrove, along with former doctoral student Emily Wheeler, received the Distinguished Publication Award for their paper “Industry’s colonization of psychiatry,” and is co-author, with Robert Whitaker, of Psychiatry under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. She has co-edited books on mental health issues and her research has been cited and discussed in major media outlets.  Dr. Cosgrove was recently awarded the Florence Denmark Distinguished Mentoring Award (Association for Women in Psychology, 2018).

Select News Coverage:

• Perinatal Mood and Anxiety Screening: Recommendations and Controversies
• Is Grief Mental Illness? With Psychiatric Changes, Maybe
• Study Finds a Link of Drug Makers to Psychiatrists
• Industry ties remain rife on panels for psychiatry manual
• Rewriting the Psychiatrist’s Bible
• Researcher urges review of cancer link to antidepressants

Most Recent Projects:

Moving “Global Mental Health” (GMH) from a Disease Model Toward a Social Justice and Rights-Based Approach. In 2017 the World Health Organization (WHO) developed a campaign to address the under-diagnosis and undertreatment of depression in developing countries. However, this campaign and the disease burden framework reifies Western descriptions of mental disorders and diverts attention away from the political and social factors that contribute to depression. We have been working with the United Nations Special Rapporteur, Lithuanian psychiatrist Dainius Pūras, to develop a framework that emphasizes the right to health and the global burden of obstacles. In October 2018 Dr. Cosgrove was awarded a grant from the Open Society Foundation for her project, “Toward a rights-based and social justice approach to mental health.” The ultimate goal of our project is to effect change in the dominant paradigm in psychiatry as it has been applied to the GMH movement (e.g., the uncritical importation of Western diagnostic tools and treatments, without stakeholder involvement and in some cases violating the rights of those most affected).

Why routine depression screening may be bad for women's rights and health. In 2016 The United States Preventive Services Task Force (USPSTF) recommended routine depression screening for everyone 13 and older, including for the first time during pregnancy and postpartum. On the surface this may seem like a proactive public health initiative. Unfortunately, however the evidence does not support questionnaire based screening because it leads to over-diagnosis and over-treatment and thus does more harm than good. In fact, the UK and Canada, looking at the same evidence, recommended against routine depression screening because of the high risk of false positives.  We are working on various empirical and theoretical projects related to depression screening, and advocating for thorough and contextualized clinical assessments rather than the use of brief questionnaires.

Connecting critical research with the public discourse. Dr. Cosgrove's lab strives to bring research out of the Ivory Tower and into the hands and minds of those receiving and delivering mental health services. To further this aim, the psychological ethics research team has initiated a collaboration with the social justice oriented mental health webzine Mad in America. Five doctoral students in counseling psychology are writing news and analysis on recently published critical psychology and psychiatry research each week. Their experiences are also being used toward an academic exploration of university/internet partnerships which will be submitted for publication later this year. You can read all of the team’s articles here: www.madinamerica.com/category/in-the-news

Challenging 'disease mongering' and medicalization. Our research team addresses the medicalization of human experiences (i.e., viewing normal human experiences or experiences of distress as a disease or disorder), with an emphasis on how the widening of disease categories creates a larger market for pharmaceutical companies and may result in overdiagnosis and overtreatment that do not improve well-being. Current projects include the medicalization of subthreshold depressive symptoms, posttraumatic experiences (e.g., after sexual assault), and Premenstrual Dysphoric Disorder (PMDD).

Please refer to https://www.researchgate.net/profile/Lisa_Cosgrove for scholarly works.