In recent years, psychedelic-assisted therapies have surged to the forefront of mental health research, heralded for their promise in treating a range of psychiatric conditions including depression, post-traumatic stress disorder (PTSD), and anxiety. However, a groundbreaking systematic review now exposes a critical blind spot in these studies: the consistent underreporting of socioeconomic status (SES) data and the lack of socioeconomic diversity among participants. This finding casts a new light on the equity and generalizability of psychedelic research, urging the scientific community to broaden its lens beyond neurochemistry and clinical outcomes to consider the societal context in which these therapies are studied and applied.
From 2006 to 2024, a comprehensive examination of 98 published articles — comprising 49 primary clinical trials and 49 secondary analyses — investigating the effects of classic psychedelics and MDMA for mental health conditions revealed striking patterns. These studies, pivotal in shaping the current renaissance of psychedelic medicine, overwhelmingly neglected the routine reporting of participants’ income and education levels. Only a meager 12% of primary trials disclosed information about participant income, while just 31% reported educational attainment. This sparse data creates a significant barrier to understanding who is represented in these promising studies and who might be excluded.
Delving deeper, the review found that in US-based trials, participants tend overwhelmingly to come from higher socioeconomic backgrounds, a phenomenon that raises concerns about access and equity. Some 93% of American participants in these studies had some college education or above, an impressive deviation from the national average of 62%. Moreover, median incomes reported in major US trials substantially exceeded the median income across the general workforce, suggesting that individuals with lower economic means rarely gain access to participating in or benefiting from these cutting-edge modalities.
There is a stark implication in this skew. Psychedelic-assisted therapy, much like many other medical treatments, risks becoming a privilege primarily accessible to those in higher socioeconomic strata. These imbalances echo broader systemic issues in mental health research and treatment access, where race, geography, and financial status frequently intersect to influence who receives care. When clinical trial populations do not mirror the diversity of the communities they intend to serve, the findings risk limited applicability and may fail to inform interventions that work equitably across socioeconomic divides.
In contrast, psychedelic trials conducted outside the United States exhibited more heterogeneous socioeconomic patterns, though the variability in reporting makes comparative analyses difficult. Non-US studies sometimes reported broader inclusion of participants from varied economic and educational backgrounds. Yet, inconsistent SES data collection and reporting across all geographies impede efforts to fully understand global patterns or to develop universally applicable equity strategies in psychedelic research.
This research underscores a glaring methodological gap in the field: the absence of standardized SES reporting protocols. Without systematic collection of income, education level, employment status, and related factors, the scientific community cannot accurately assess whether trial populations reflect the socioeconomic realities of broader patient populations. This lack complicates the evaluation of trial outcomes and the development of interventions that are effective and accessible for diverse demographic groups.
Moreover, the underrepresentation of lower-income participants in US trials might also inadvertently amplify existing health disparities. Lower SES is strongly associated with higher burdens of mental illness and reduced access to quality healthcare. If these individuals are systematically excluded from psychedelic trials, or if trials fail to address their unique socioeconomic contexts, the resultant therapies might not adequately meet their needs or face barriers to implementation in these populations.
The report’s findings dovetail with broader conversations in mental health and clinical research about inclusion and diversity, spotlighting a need for intentional recruitment strategies that address financial and educational barriers to participation. Such efforts may involve reducing trial-related costs, providing logistical supports, or partnering with community organizations to reach underserved populations who historically have been marginalized in research settings.
Additionally, future research must grapple with how socioeconomic factors interact with the pharmacodynamics and therapeutic outcomes associated with psychedelics. Variables such as education and income can influence treatment adherence, placebo response rates, and even biological stress mechanisms, all of which may modulate efficacy. Without detailed SES data, these nuances remain obscured, limiting precision medicine approaches.
This review also challenges the community to rethink ethics and policy frameworks around psychedelic research. Funding bodies, regulatory agencies, and institutional review boards might incorporate SES diversity metrics in their evaluation criteria, promoting inclusive science as an ethical imperative rather than a secondary consideration. Fostering such institutional shifts could catalyze more robust, socially just research designs moving forward.
Public dissemination of psychedelic research findings must similarly address these issues. Messaging that paints psychedelic therapy as a breakthrough for “all” risks obscuring the socioeconomic barriers still entrenched in access. Transparent discourse acknowledging these disparities can motivate policymakers and practitioners to invest in equitable infrastructures, ensuring that promising therapies do not become yet another chapter in the story of healthcare inequality.
This systematic review by Grossman, Madden, Mehtani, and colleagues thus serves as both a diagnostic and a call to action for the psychedelic research community. By highlighting the urgent need for routine SES data collection and reporting, the study advocates for a deeper integration of social determinants of health in clinical trial design. Only by bridging this knowledge gap can psychedelic-assisted therapies fulfill their potential as tools for widespread mental health improvement.
In conclusion, psychedelic therapy research stands at a crossroads. The promise of these treatments is immense, but so too are the challenges related to inclusion and diversity. Addressing socioeconomic disparities is no longer an optional add-on but a fundamental requirement for science that seeks to be both rigorous and relevant. Future clinical trials will need to embed SES considerations at every stage, from recruitment to outcome assessment, to ensure equitable benefits across society.
As this field continues to evolve, stakeholders from academia, industry, advocacy groups, and patient communities must collaborate to develop and implement standards for SES reporting and equitable trial participation. Only with such concerted efforts can psychedelic research move beyond its current limitations and toward truly transformative mental health care accessible to all.
The time is now to ensure that the future of psychedelic-assisted therapy does not replicate the inequities of the past but instead pioneers inclusive, socially aware research practices that honor the full complexity of human experience in mental health treatment.
Subject of Research:
Psychedelic-assisted therapy trials and socioeconomic status reporting.
Article Title:
A systematic review of income and education reporting in psychedelic clinical trials.
Article References:
Grossman, D.H., Madden, K.R., Mehtani, N.J. et al. A systematic review of income and education reporting in psychedelic clinical trials. Nat. Mental Health 3, 567–574 (2025). https://doi.org/10.1038/s44220-025-00417-3
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s44220-025-00417-3
