Editor Raises Psychiatry's Profile on Women's Issues

Susan Kornstein, M.D., of Virginia Commonwealth University's (VCU) School of Medicine in Richmond is the new editor in chief of the Journal of Women's Health, the first psychiatrist to hold the position, and she's trying hard not to think about how one more task will fit into her day.

The journal will continue its interdisciplinary approach to women's health as it addresses wider issues such as “the fragmentation of women's health care, under-funding of research, and the trivialization and politicization of women's health issues,” wrote Kornstein and her VCU colleague and new deputy editor, associate professor of internal medicine Wendy Klein, M.D., in an editorial.

In choosing Kornstein, the journal's board of editors recognized not only her personal skills and abilities but also acknowledged psychiatry's place among obstetrics and gynecology, endocrinology, and internal medicine in the spectrum of women's health, said APA President Michelle Riba, M.D.

“Susan will bring incredible energy, thoughtfulness, and diligence to her role as editor,” added Joel J. Silverman, M.D., chair of the Department of Psychiatry at VCU, in an interview.

Kornstein already holds joint appointments in psychiatry and obstetrics and gynecology at VCU and is the first full-time, tenured woman professor in VCU's psychiatry department. Her day is the familiar round of the academic medical center: meetings, running research protocols, seeing patients, more meetings. She's served as a principal investigator on more than 50 studies of premenstrual syndrome, anxiety disorders, sexual dysfunction, insomnia, or depression and co-edited Women's Mental Health: A Comprehensive Textbook (Guilford Press, 2004).

She is also president-elect of the International Society for Women's Mental Health, director of clinical research for VCU's Department of Psychiatry, executive director of the VCU Mood Disorders Institute, and a co-founder and executive director of the VCU Institute for Women's Health, designated a National Center of Excellence in Women's Health in 2003.

When the Journal of Women's Health began publication 14 years ago, the field focused on reproductive health, and the journal broke new ground in its broader view of women's health. Editors have usually come from internal medicine or ob/gyn. Today, the journal encompasses aspects of health that are expressed differently or respond differently in women, as well as those that are unique to women, said Kornstein in an interview. They include bone and breast health, reproductive health, cardiovascular disease, endocrine disorders, and mental health. Yet information on women's health has been limited because women were too often excluded from clinical trials out of concern for pregnancy or menstrual status.

“We still know far too little about gender differences in health and disease. Such knowledge should permeate all research and medical education and will result in improved health care for both men and women,” said the editorial.

Depression, which is twice as prevalent among women as men, is a good example of those differences, Kornstein said. Men display more classic neurovegetative symptoms such as insomnia and loss of appetite and weight, while women show more reverse vegetative or atypical ones, such as increased appetite and weight gain. As her research has shown, men and women respond differently to treatment, too. However, at this point, she said, there should not be separate formularies for each sex, but rather consideration of both gender and menopausal status among other factors in choosing medications.

The broad, integrative perspective offered by psychiatry may prove valuable to the new editor, said Linda Chaudron, M.D., M.S., an assistant professor of psychiatry, pediatrics, and obstetrics and gynecology at the University of Rochester, in an interview.

“Psychiatrists have the opportunity to look wholly at women's health,” said Chaudron. “Many of women's mental health issues are connected with their physical and social health, so people working in women's mental health have to work as collaborators with ob/gyns, internists, and others.”

Kornstein has been running hard since her undergraduate days. She completed a seven-year combined B.Sc./M.D. program at Brown University, winning two piano competitions in her free time. She had no initial inclination to specialize in psychiatry.

“I thought about surgery and didn't do any psychiatry until my fourth year, but then I loved it,” she said. She did a fellowship in consultation-liaison psychiatry, focusing on plastic surgery, interviewing patients before and after their operations. In plastic surgery (which she calls “psychotherapy with a knife”), psychological evaluation is a key, she said. “It's important to sort out who is and who isn't an appropriate candidate.”

She started a psychiatric society for medical students at VCU to give them the chance to explore the profession earlier in their careers and to help them overcome the same biases about mental illness that are present elsewhere in society.

Kornstein attributes many of the improvements in patient care in recent decades to the influx of women into the profession, changes that benefit both women and men.

“The traditional approach to the doctor/patient relationship was hierarchical; now it's more collaborative,” she said. “We do more now to educate patients about their illnesses and their treatment options and then decide together with the patient about what is the best course.”

That collaborative, integrated approach to patients and their care is intrinsic to psychiatry, she said, and is something her specialty can contribute to the journal's readers across the profession.

“It's important when psychiatry can take a leadership role beyond the confines of psychiatry,” Silverman said.

TheJournal of Women's Healthis published by Mary Ann Liebert Inc. and is posted online at<www.liebertpub.com/publication.aspx?pub_id=42>.▪