and literature reviews

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

Open Google Slides Download PowerPoint

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved June 9, 2024, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

• UConn Library
• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

• University of Texas Libraries

Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support

What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

• Next: What Is the Literature >>
• Last Updated: Jan 11, 2024 9:48 AM
• URL: https://libguides.wesleyan.edu/litreview

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Dissertation
• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

Instantly correct all language mistakes in your text

Be assured that you'll submit flawless writing. Upload your document to correct all your mistakes.

Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

Prevent plagiarism, run a free check.

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list if you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can use boolean operators to help narrow down your search:

Read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models and methods? Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible, and make sure you read any landmark studies and major theories in your field of research.

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

You can use our free APA Reference Generator for quick, correct, consistent citations.

The only proofreading tool specialized in correcting academic writing

The academic proofreading tool has been trained on 1000s of academic texts and by native English editors. Making it the most accurate and reliable proofreading tool for students.

Correct my document today

To begin organising your literature review’s argument and structure, you need to understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly-visual platforms like Instagram and Snapchat – this is a gap that you could address in your own research.

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarising sources in order.

Try to analyse patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organise your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text, your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, discussing the significance of findings in relation to the literature as a whole.
• Critically evaluate: mention the strengths and weaknesses of your sources.
• Write in well-structured paragraphs: use transitions and topic sentences to draw connections, comparisons and contrasts.

In the conclusion, you should summarise the key findings you have taken from the literature and emphasise their significance.

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarise yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2022, June 07). What is a Literature Review? | Guide, Template, & Examples. Scribbr. Retrieved 7 June 2024, from https://www.scribbr.co.uk/thesis-dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, how to write a dissertation proposal | a step-by-step guide, what is a theoretical framework | a step-by-step guide, what is a research methodology | steps & tips.

Reference management. Clean and simple.

Literature review

How to write a literature review in 6 steps

How do you write a good literature review? This step-by-step guide on how to write an excellent literature review covers all aspects of planning and writing literature reviews for academic papers and theses.

How to write a systematic literature review [9 steps]

How do you write a systematic literature review? What types of systematic literature reviews exist and where do you use them? Learn everything you need to know about a systematic literature review in this guide

What is a literature review? [with examples]

Not sure what a literature review is? This guide covers the definition, purpose, and format of a literature review.

Harvey Cushing/John Hay Whitney Medical Library

• Collections
• Research Help

YSN Doctoral Programs: Steps in Conducting a Literature Review

• Biomedical Databases
• Global (Public Health) Databases
• Soc. Sci., History, and Law Databases
• Grey Literature
• Trials Registers
• Data and Statistics
• Public Policy
• Google Tips
• Recommended Books
• Steps in Conducting a Literature Review

What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
• << Previous: Recommended Books
• Last Updated: Jan 4, 2024 10:52 AM
• URL: https://guides.library.yale.edu/YSNDoctoral

Get science-backed answers as you write with Paperpal's Research feature

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

Find academic papers related to your research topic faster. Try Research on Paperpal  

3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

Strengthen your literature review with factual insights. Try Research on Paperpal for free!    

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

Write and Cite as you go with Paperpal Research. Start now for free.   

Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

Paperpal is an AI writing assistant that help academics write better, faster with real-time suggestions for in-depth language and grammar correction. Trained on millions of research manuscripts enhanced by professional academic editors, Paperpal delivers human precision at machine speed.  

Try it for free or upgrade to  Paperpal Prime , which unlocks unlimited access to premium features like academic translation, paraphrasing, contextual synonyms, consistency checks and more. It’s like always having a professional academic editor by your side! Go beyond limitations and experience the future of academic writing.  Get Paperpal Prime now at just US$19 a month!

Related Reads:

• Empirical Research: A Comprehensive Guide for Academics 
• How to Write a Scientific Paper in 10 Steps 
• How Long Should a Chapter Be?
• How to Use Paperpal to Generate Emails & Cover Letters?

6 Tips for Post-Doc Researchers to Take Their Career to the Next Level

Self-plagiarism in research: what it is and how to avoid it, you may also like, how paperpal can boost comprehension and foster interdisciplinary..., what is the importance of a concept paper..., how to write the first draft of a..., mla works cited page: format, template & examples, how to ace grant writing for research funding..., powerful academic phrases to improve your essay writing , how to write a high-quality conference paper, how paperpal’s research feature helps you develop and..., how paperpal is enhancing academic productivity and accelerating..., how to write a successful book chapter for....

How to Write a Literature Review: Six Steps to Get You from Start to Finish

Writing-a-literature-review-six-steps-to-get-you-from-start-to-finish.

Tanya Golash-Boza, Associate Professor of Sociology, University of California

February 03, 2022

Writing a literature review is often the most daunting part of writing an article, book, thesis, or dissertation. “The literature” seems (and often is) massive. I have found it helpful to be as systematic as possible when completing this gargantuan task.

Sonja Foss and William Walters* describe an efficient and effective way of writing a literature review. Their system provides an excellent guide for getting through the massive amounts of literature for any purpose: in a dissertation, an M.A. thesis, or preparing a research article for publication  in any field of study. Below is a  summary of the steps they outline as well as a step-by-step method for writing a literature review.

How to Write a Literature Review

Step One: Decide on your areas of research:

Before you begin to search for articles or books, decide beforehand what areas you are going to research. Make sure that you only get articles and books in those areas, even if you come across fascinating books in other areas. A literature review I am currently working on, for example, explores barriers to higher education for undocumented students.

Step Two: Search for the literature:

Conduct a comprehensive bibliographic search of books and articles in your area. Read the abstracts online and download and/or print those articles that pertain to your area of research. Find books in the library that are relevant and check them out. Set a specific time frame for how long you will search. It should not take more than two or three dedicated sessions.

Step Three: Find relevant excerpts in your books and articles:

Skim the contents of each book and article and look specifically for these five things:

1. Claims, conclusions, and findings about the constructs you are investigating

2. Definitions of terms

3. Calls for follow-up studies relevant to your project

4. Gaps you notice in the literature

5. Disagreement about the constructs you are investigating

When you find any of these five things, type the relevant excerpt directly into a Word document. Don’t summarize, as summarizing takes longer than simply typing the excerpt. Make sure to note the name of the author and the page number following each excerpt. Do this for each article and book that you have in your stack of literature. When you are done, print out your excerpts.

Step Four: Code the literature:

Get out a pair of scissors and cut each excerpt out. Now, sort the pieces of paper into similar topics. Figure out what the main themes are. Place each excerpt into a themed pile. Make sure each note goes into a pile. If there are excerpts that you can’t figure out where they belong, separate those and go over them again at the end to see if you need new categories. When you finish, place each stack of notes into an envelope labeled with the name of the theme.

Step Five: Create Your Conceptual Schema:

Type, in large font, the name of each of your coded themes. Print this out, and cut the titles into individual slips of paper. Take the slips of paper to a table or large workspace and figure out the best way to organize them. Are there ideas that go together or that are in dialogue with each other? Are there ideas that contradict each other? Move around the slips of paper until you come up with a way of organizing the codes that makes sense. Write the conceptual schema down before you forget or someone cleans up your slips of paper.

Step Six: Begin to Write Your Literature Review:

Choose any section of your conceptual schema to begin with. You can begin anywhere, because you already know the order. Find the envelope with the excerpts in them and lay them on the table in front of you. Figure out a mini-conceptual schema based on that theme by grouping together those excerpts that say the same thing. Use that mini-conceptual schema to write up your literature review based on the excerpts that you have in front of you. Don’t forget to include the citations as you write, so as not to lose track of who said what. Repeat this for each section of your literature review.

Once you complete these six steps, you will have a complete draft of your literature review. The great thing about this process is that it breaks down into manageable steps something that seems enormous: writing a literature review.

I think that Foss and Walter’s system for writing the literature review is ideal for a dissertation, because a Ph.D. candidate has already read widely in his or her field through graduate seminars and comprehensive exams.

It may be more challenging for M.A. students, unless you are already familiar with the literature. It is always hard to figure out how much you need to read for deep meaning, and how much you just need to know what others have said. That balance will depend on how much you already know.

For people writing literature reviews for articles or books, this system also could work, especially when you are writing in a field with which you are already familiar. The mere fact of having a system can make the literature review seem much less daunting, so I recommend this system for anyone who feels overwhelmed by the prospect of writing a literature review.

*Destination Dissertation: A Traveler's Guide to a Done Dissertation

Image Credit/Source: Goldmund Lukic/Getty Images

Watch our Webinar to help you get published

Please enter your Email Address

Please enter valid email address

Please Enter your First Name

Please enter your Last Name

Please enter your Questions or Comments.

Please enter the Privacy

Please enter the Terms & Conditions

How research content supports academic integrity

Finding time to publish as a medical student: 6 tips for Success

Software to Improve Reliability of Research Image Data: Wiley, Lumina, and Researchers at Harvard Medical School Work Together on Solutions

Driving Research Outcomes: Wiley Partners with CiteAb

ISBN, ISSN, DOI: what they are and how to find them

Image Collections for Medical Practitioners with TDS Health

How do you Discover Content?

Writing for Publication for Nurses (Mandarin Edition)

Get Published - Your How to Webinar

Finding time to publish as a medical student: 6 tips for success

Related articles.

Learn how Wiley partners with plagiarism detection services to support academic integrity around the world

Medical student Nicole Foley shares her top tips for writing and getting your work published.

Wiley and Lumina are working together to support the efforts of researchers at Harvard Medical School to develop and test new machine learning tools and artificial intelligence (AI) software that can

Learn more about our relationship with a company that helps scientists identify the right products to use in their research

What is ISBN? ISSN? DOI? Learn about some of the unique identifiers for book and journal content.

Learn how medical practitioners can easily access and search visual assets from our article portfolio

Explore free-to-use services that can help you discover new content

Watch this webinar to help you learn how to get published.

How to Easily Access the Most Relevant Research: A Q&A With the Creator of Scitrus

Atypon launches Scitrus, a personalized web app that allows users to create a customized feed of the latest research.

Effectively and Efficiently Creating your Paper

FOR INDIVIDUALS

FOR INSTITUTIONS & BUSINESSES

WILEY NETWORK

ABOUT WILEY

Corporate Responsibility

Corporate Governance

Leadership Team

Cookie Preferences

Copyright @ 2000-2024  by John Wiley & Sons, Inc., or related companies. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.

Rights & Permissions

Privacy Policy

Terms of Use

Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

Make a Gift

• Library Homepage

Literature Review: The What, Why and How-to Guide: Literature Reviews?

• Literature Reviews?
• Strategies to Finding Sources
• Keeping up with Research!
• Evaluating Sources & Literature Reviews
• Organizing for Writing
• Writing Literature Review
• Other Academic Writings

What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
• << Previous: Overview
• Next: Strategies to Finding Sources >>
• Last Updated: Mar 5, 2024 11:44 AM
• URL: https://guides.library.ucsb.edu/litreview

Libraries | Research Guides

Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core Collection This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

• Next: Planning the Review >>
• Last Updated: May 2, 2024 10:39 AM
• URL: https://libguides.northwestern.edu/literaturereviews

University Libraries      University of Nevada, Reno

• Skill Guides
• Subject Guides

Systematic, Scoping, and Other Literature Reviews: Overview

• Project Planning

What Is a Systematic Review?

Regular literature reviews are simply summaries of the literature on a particular topic. A systematic review, however, is a comprehensive literature review conducted to answer a specific research question. Authors of a systematic review aim to find, code, appraise, and synthesize all of the previous research on their question in an unbiased and well-documented manner. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outline the minimum amount of information that needs to be reported at the conclusion of a systematic review project. 

Other types of what are known as "evidence syntheses," such as scoping, rapid, and integrative reviews, have varying methodologies. While systematic reviews originated with and continue to be a popular publication type in medicine and other health sciences fields, more and more researchers in other disciplines are choosing to conduct evidence syntheses. 

This guide will walk you through the major steps of a systematic review and point you to key resources including Covidence, a systematic review project management tool. For help with systematic reviews and other major literature review projects, please send us an email at  [email protected] .

Getting Help with Reviews

Organization such as the Institute of Medicine recommend that you consult a librarian when conducting a systematic review. Librarians at the University of Nevada, Reno can help you:

• Understand best practices for conducting systematic reviews and other evidence syntheses in your discipline
• Choose and formulate a research question
• Decide which review type (e.g., systematic, scoping, rapid, etc.) is the best fit for your project
• Determine what to include and where to register a systematic review protocol
• Select search terms and develop a search strategy
• Identify databases and platforms to search
• Find the full text of articles and other sources
• Become familiar with free citation management (e.g., EndNote, Zotero)
• Get access to you and help using Covidence, a systematic review project management tool

Doing a Systematic Review

• Plan - This is the project planning stage. You and your team will need to develop a good research question, determine the type of review you will conduct (systematic, scoping, rapid, etc.), and establish the inclusion and exclusion criteria (e.g., you're only going to look at studies that use a certain methodology). All of this information needs to be included in your protocol. You'll also need to ensure that the project is viable - has someone already done a systematic review on this topic? Do some searches and check the various protocol registries to find out. 
• Identify - Next, a comprehensive search of the literature is undertaken to ensure all studies that meet the predetermined criteria are identified. Each research question is different, so the number and types of databases you'll search - as well as other online publication venues - will vary. Some standards and guidelines specify that certain databases (e.g., MEDLINE, EMBASE) should be searched regardless. Your subject librarian can help you select appropriate databases to search and develop search strings for each of those databases.  
• Evaluate - In this step, retrieved articles are screened and sorted using the predetermined inclusion and exclusion criteria. The risk of bias for each included study is also assessed around this time. It's best if you import search results into a citation management tool (see below) to clean up the citations and remove any duplicates. You can then use a tool like Rayyan (see below) to screen the results. You should begin by screening titles and abstracts only, and then you'll examine the full text of any remaining articles. Each study should be reviewed by a minimum of two people on the project team. 
• Collect - Each included study is coded and the quantitative or qualitative data contained in these studies is then synthesized. You'll have to either find or develop a coding strategy or form that meets your needs. 
• Explain - The synthesized results are articulated and contextualized. What do the results mean? How have they answered your research question?
• Summarize - The final report provides a complete description of the methods and results in a clear, transparent fashion. 

Adapted from

Types of reviews, systematic review.

These types of studies employ a systematic method to analyze and synthesize the results of numerous studies. "Systematic" in this case means following a strict set of steps - as outlined by entities like PRISMA and the Institute of Medicine - so as to make the review more reproducible and less biased. Consistent, thorough documentation is also key. Reviews of this type are not meant to be conducted by an individual but rather a (small) team of researchers. Systematic reviews are widely used in the health sciences, often to find a generalized conclusion from multiple evidence-based studies. 

Meta-Analysis

A systematic method that uses statistics to analyze the data from numerous studies. The researchers combine the data from studies with similar data types and analyze them as a single, expanded dataset. Meta-analyses are a type of systematic review.

Scoping Review

A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps.

Rapid Review

Rapid reviews are systematic reviews conducted under a time constraint. Researchers make use of workarounds to complete the review quickly (e.g., only looking at English-language publications), which can lead to a less thorough and more biased review. 

Narrative Review

A traditional literature review that summarizes and synthesizes the findings of numerous original research articles. The purpose and scope of narrative literature reviews vary widely and do not follow a set protocol. Most literature reviews are narrative reviews. 

Umbrella Review

Umbrella reviews are, essentially, systematic reviews of systematic reviews. These compile evidence from multiple review studies into one usable document. 

Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal , vol. 26, no. 2, 2009, pp. 91-108. doi: 10.1111/j.1471-1842.2009.00848.x .

• Next: Project Planning >>

• Locations and Hours
• UCLA Library
• Research Guides
• Biomedical Library Guides

Systematic Reviews

• Types of Literature Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

• Planning Your Systematic Review
• Database Searching
• Creating the Search
• Search Filters and Hedges
• Grey Literature
• Managing and Appraising Results
• Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

• << Previous: Home
• Next: Planning Your Systematic Review >>
• Last Updated: Apr 17, 2024 2:02 PM
• URL: https://guides.library.ucla.edu/systematicreviews

• UWF Libraries

Literature Review: Conducting & Writing

• Sample Literature Reviews
• Steps for Conducting a Lit Review
• Finding "The Literature"
• Organizing/Writing
• APA Style This link opens in a new window
• Chicago: Notes Bibliography This link opens in a new window
• MLA Style This link opens in a new window

Sample Lit Reviews from Communication Arts

Have an exemplary literature review.

• Literature Review Sample 1
• Literature Review Sample 2
• Literature Review Sample 3

Have you written a stellar literature review you care to share for teaching purposes?

Are you an instructor who has received an exemplary literature review and have permission from the student to post?

Please contact Britt McGowan at [email protected] for inclusion in this guide. All disciplines welcome and encouraged.

• << Previous: MLA Style
• Next: Get Help! >>
• Last Updated: Mar 22, 2024 9:37 AM
• URL: https://libguides.uwf.edu/litreview

Loading metrics

Open Access

Peer-reviewed

Research Article

Clinical outcomes of chikungunya: A systematic literature review and meta-analysis

Roles Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft

* E-mail: [email protected]

Affiliation Asc Academics B.V., Groningen, Netherlands

Roles Conceptualization, Writing – original draft

Affiliations Valneva Austria GmbH, Vienna, Austria, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands

Roles Conceptualization, Data curation, Methodology, Project administration, Writing – review & editing

Affiliations Asc Academics B.V., Groningen, Netherlands, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands

Roles Investigation, Project administration

Roles Data curation, Investigation

Roles Conceptualization, Supervision

Affiliation Valneva Austria GmbH, Vienna, Austria

Roles Supervision

Affiliations Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands, Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia, Division of Pharmacology and Therapy, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia

Affiliations Asc Academics B.V., Groningen, Netherlands, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands

• Kris Rama, 
• Adrianne M. de Roo, 
• Timon Louwsma, 
• Hinko S. Hofstra, 
• Gabriel S. Gurgel do Amaral, 
• Gerard T. Vondeling, 
• Maarten J. Postma, 
• Roel D. Freriks

• Published: June 7, 2024
• https://doi.org/10.1371/journal.pntd.0012254
• Peer Review
• Reader Comments

This is an uncorrected proof.

Chikungunya is a viral disease caused by a mosquito-borne alphavirus. The acute phase of the disease includes symptoms such as fever and arthralgia and lasts 7–10 days. However, debilitating symptoms can persist for months or years. Despite the substantial impact of this disease, a comprehensive assessment of its clinical picture is currently lacking.

We conducted a systematic literature review on the clinical manifestations of chikungunya, their prevalence and duration, and related hospitalization. Embase and MEDLINE were searched with no time restrictions. Subsequently, meta-analyses were conducted to quantify pooled estimates on clinical outcomes, the symptomatic rate, the mortality rate, and the hospitalization rate. The pooling of effects was conducted using the inverse-variance weighting methods and generalized linear mixed effects models, with measures of heterogeneity reported.

The systematic literature review identified 316 articles. Out of the 28 outcomes of interest, we were able to conduct 11 meta-analyses. The most prevalent symptoms during the acute phase included arthralgia in 90% of cases (95% CI: 83–94%), and fever in 88% of cases (95% CI: 85–90%). Upon employing broader inclusion criteria, the overall symptomatic rate was 75% (95% CI: 63–84%), the chronicity rate was 44% (95% CI: 31–57%), and the mortality rate was 0.3% (95% CI: 0.1–0.7%). The heterogeneity between subpopulations was more than 92% for most outcomes. We were not able to estimate all predefined outcomes, highlighting the existing data gap.

Chikungunya is an emerging public health concern. Consequently, a thorough understanding of the clinical burden of this disease is necessary. Our study highlighted the substantial clinical burden of chikungunya in the acute phase and a potentially long-lasting chronic phase. Understanding this enables health authorities and healthcare professionals to effectively recognize and address the associated symptoms and raise awareness in society.

Author summary

Chikungunya disease is an emerging public health concern. The disease is transmitted by mosquitoes and characterized by arthralgia and fever in the acute phase, lasting 7–10 days. Additionally, some individuals experience chronic symptoms such as arthralgia and tiredness that can last from months to years. Chikungunya is mainly present in the Americas and Asian countries, but the mosquitoes transmitting the disease are spreading to other regions due to climate change, amongst others. This increased disease threat highlights the importance of understanding chikungunya symptoms. However, there are currently no precise estimates on the prevalence of chikungunya symptoms. Therefore, we analysed the available literature on the clinical manifestations of chikungunya. We found that 75% of infected people develop symptoms, primarily characterized by arthralgia in 90% and fever in 88% of cases. Chronic symptoms affect 44% of symptomatic people, and 0.3% of patients with chikungunya die. Unfortunately, we were not able to estimate all predefined outcomes of interest because we did not find enough studies publishing on some of these, demonstrating that there is still much unknown around the clinical manifestations of chikungunya. However, the results can help healthcare workers early identifying chikungunya and raise awareness of this debilitating disease.

Citation: Rama K, de Roo AM, Louwsma T, Hofstra HS, S. Gurgel do Amaral G, Vondeling GT, et al. (2024) Clinical outcomes of chikungunya: A systematic literature review and meta-analysis. PLoS Negl Trop Dis 18(6): e0012254. https://doi.org/10.1371/journal.pntd.0012254

Editor: Richard A. Bowen, Colorado State University, UNITED STATES

Received: February 26, 2024; Accepted: May 28, 2024; Published: June 7, 2024

Copyright: © 2024 Rama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: This paper was funded by Valneva Austria GmbH. AMR and GTV are Valneva employees. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: KR, TL, HSH, and GSG are employees of Asc Academics. Asc Academics has received consultancy fees for this project from Valneva Austria GmbH. AMR and GTV are Valneva employees and own stock options of Valneva. MJP reports grants and honoraria from various pharmaceutical companies, including those developing, producing, and marketing vaccines. He holds stocks in Health-Ecore (Zeist, Netherlands) and PAG BV (Groningen, Netherlands), and advises ASC Academics (Groningen, Netherlands). These competing interest will not alter adherence to PLOS policies on sharing data and materials.

Introduction

Chikungunya is a viral disease caused by a mosquito-borne alphavirus, the chikungunya virus (CHIKV) [ 1 ]. The infection is characterized by an acute phase with symptoms including fever, arthralgia, and myalgia. While most infected individuals fully recover after the acute phase of the disease, between 30–40% of patients develop persistent symptoms, such as chronic arthritis, fatigue, stiffness, depression, and sleep and neurological disorders, which can last from months to several years [ 2 , 3 ]. Long-term effects lead to significant limitations in daily activities and reduce the patients’ overall quality of life [ 4 – 6 ]. Nevertheless, despite the negative impact of the disease on the quality of life, the awareness and societal understanding of chikungunya remain limited, even among the afflicted populations and healthcare workers [ 7 ]. Chikungunya has been identified as a public health threat based on several records of CHIKV outbreaks worldwide, with a risk of exacerbation in the future due to the global spread of CHIKV [ 8 ]. The distribution of the CHIKV vectors ( Aedes aegypti and Aedes albopictus ) is one of the main factors contributing to the disease’s dissemination. This expansion is attributed to globalization and climate change, allowing the Aedes mosquitos to survive in areas previously considered unsuitable [ 9 , 10 ]. Prevention against the disease consists predominantly of mosquito population control [ 11 ]. Recently, the FDA approved the first chikungunya vaccine, presenting a new tool to fight the disease and potentially alleviate the associated economic and health burdens [ 12 ]. Despite the increasing interest in CHIKV and the recent announcement of a vaccine, uncertainties persist regarding the clinical burden of chikungunya. Although multiple studies have explored one or more health outcomes associated with chikungunya [ 3 , 13 , 14 ], to the best of our knowledge, no extensive meta-analysis was performed to quantify pooled estimates on the clinical presentation of chikungunya. To address this gap, we conducted a comprehensive systematic literature review (SLR) on the clinical manifestations of chikungunya, and proceeded with a robust yet flexible meta-analysis. This approach allowed us to provide estimates on a broad spectrum of endpoints on the health outcomes of chikungunya. We paid particular attention to the symptomatic, mortality, and chronicity rates for a comprehensive understanding of the disease in both acute and chronic phases. Our study aims to contribute valuable insights into the overall clinical outcomes of chikungunya. This, in turn, can inform public health intervention strategies and enhance global surveillance by enabling earlier detection of outbreaks.

Literature search and study selection

The SLR adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) guidelines, with searches conducted on MEDLINE In-Process via PubMed.com, and Embase via Embase.com without time limits. Grey literature searches were performed for the years 2019–2023 to capture data that may not have yet been included in the databases. The search string included terms related to chikungunya and study design. Eligibility criteria were developed using a Population, Intervention, Comparator, Outcomes, Study (PICOS) framework. The inclusion criteria focused on the clinical manifestations of chikungunya, their prevalence and duration, and related hospitalization, and excluded in vitro/preclinical studies, reviews, and non-English articles. Specifics can be found in S1 Text .

Screening and data extraction

All retrieved articles were deduplicated and titles and abstracts were screened against the PICOS criteria using Rayyan. From the selected articles, full texts were examined for eligibility, followed by detailed data extraction organized by study design, patient characteristics, and outcomes of interest. The whole screening process was conducted by two independent reviewers (GG, HH), resolving conflicts through consensus. An exhaustive feasibility assessment ensured the inclusion of studies with explicit criteria and comparable reporting methods, reducing heterogeneity and potential outlier influence. The risk of bias was determined using a modified Downs and Black checklist [ 15 ] and NIH quality assessment tool for observational studies [ 16 ], see S2 Text . Discrepancies were resolved by consensus. No protocol for this systematic review and meta-analysis was registered.

Population and data analysis

The meta-analysis was performed using the meta package of the R statistical software to create a pooled estimate of the most important clinical outcomes of chikungunya. The outcomes of interest were the overall symptomatic, chronicity, and mortality rates, the underreporting factor, the duration of the acute and chronic phase, the hospitalization and outpatient rate (acute and chronic), the mortality rate per region, and the rate and duration of the following symptoms: arthralgia, arthritis, fatigue, fever, headache, joint swelling, myalgia, nausea, rash, and vomiting. The distinction between arthralgia and arthritis was made based on the definition used in the original study.

Both fixed-effects and random-effects models with logit transformation were estimated, where a random-effects model was chosen in case of high heterogeneity. Fixed-effects meta-analyses employed inverse-variance weighting, while random-effects accounted for between-study heterogeneity and are better suited to account for the larger variations in outcomes reported. Heterogeneity was assessed using Cochran’s Q , I 2 , H 2 statistics, and τ 2 estimation. Outlier analyses employed the leave-one-out method, Baujat plots, and statistical distance measures. All results were visually represented using forest plots, providing a clear and concise graphical representation of the individual study findings and the overall meta-analysis result.

Our study utilized subpopulations—subsets of the original populations defined by particular demographic and clinical features. These features correspond to the data reported in the studies we analyzed and the segmentation into subpopulations was based on the inclusion or exclusion criteria set forth in the original research papers. This approach allowed us to perform a more granular analysis. The clinical outcomes of interest were analyzed for a target population to ensure comparability among included studies, which excluded children under 15, individuals with comorbidities or concurrent infections, and pregnant women. Additionally, we excluded unconfirmed CHIKV cases and studies involving chronic patients reporting on the acute phase due to recall bias. Lastly, retrospective studies focusing on mortality were excluded as they exhibited evidence of selection bias. Meta-analyses were performed when an endpoint was reported at least five times for a given subpopulation.

A preliminary search indicated that data on chronicity, mortality, and symptomatic cases was predominantly reported for a more general population, including individuals under the age of 15 and chronic patients. Therefore, we decided to apply less strict criteria on the studies reporting these outcomes, allowing us to estimate these endpoints. Additionally, to detail the development of chronic symptoms, we estimated the chronic rate at various points from disease onset by dividing studies reporting on chronicity rates following a CHIKV infection into subgroups based on time intervals (three, six, and 12 months). The inclusion criteria for each subgroup were to fall within the time windows created by consecutive intervals (e.g., 90–180 days for three months). We excluded studies extending beyond 24 months to avoid a selection bias, as these already focused on patients with pre-existing chronic conditions.

For the mortality rates, we separated the groups that reported outcomes for high-risk populations from those dealing with the general population with lower risk. This stratification allowed us to account for potential confounding variables. Older age and comorbidities have been identified to increase the risk for mortality [ 2 , 17 ]. Therefore, we classify as high-risk of mortality the groups with a minimum age over 65 (or median above 70 when missing), and previous conditions that induced prior intensive care exceeding 24 hours.

To estimate the overall symptomatic rate, we included studies that explicitly reported symptomatic rates based on one or more of the symptoms commonly associated with the disease. Symptomatic patients were often an implicit inclusion criteria, or a precondition for laboratory testing, making most of the studies reporting on the symptomatic rate unusable. We excluded the studies that had a 100% symptomatic rate to prevent selection bias, as including those would lead to a skewed perspective due to symptoms being part of their inclusion criteria.

Literature search

The SLR was conducted on 4 July 2023 and yielded 16,308 hits. After removing 6,285 duplicates, 10,023 studies were screened by titles and abstracts. From these, a total of 316 articles were deemed suitable for inclusion. The process of the SLR is detailed in Fig 1 , which illustrates the PRISMA diagram of the included studies. The complete PRISMA checklist is provided in S3 Text . The quality assessment of included studies can be found in S1 Table .

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pntd.0012254.g001

Study characteristics

The categorization of study designs in the included articles was made with careful consideration, taking into account the diversity in how these studies defined their methodologies. The judgment used in categorizing these studies was guided by the definitions provided within the paper itself. When a study described its design in a way that matched more than one predefined category, the predominant one was chosen. This approach aimed to respect the original terminology used by the study authors while also creating a coherent framework for analysis.

Of the 316 articles included, 231 studies were observational, 11 were experimental, and for 74 studies this was not reported. Of the observational studies, 106 were cross-sectional, 35 were cohort, 29 were longitudinal, 25 were retrospective, 23 were prospective, and 13 were case-control or case-series studies. Of the experimental studies, there were 6 trials from phase I to III with double and single-blind designs. Goals ranged from assessing treatments like chloroquine and vaccines’ effectiveness to exploring seroprevalence and chronic CHIKV effects. Two trials investigated new mRNA treatment mechanisms. The focus was solely on CHIKV, not on coinfections.

The study location varied: Southern Asia was the most represented with 78 articles, followed by South America, with 67. There were 41 articles from The Caribbean region, 41 from Eastern Africa, 28 from South-Eastern Asia, 14 from Central America. Eight, six, five, four, and three articles were from Western Europe, Northern America, Southern Europe, Middle Africa, and Western Africa, respectively. Two or one articles were from Eastern Asia, Micronesia, Northern Europe, or Southern Africa. A total of 193 studies reported mean or median age. Data on co-infection with Zika and/or dengue were reported in 11 studies. An overview of the study characteristics, including details on the experimental studies, can be found in S2 Table .

The most commonly reported symptom was fever, reported in 57.9% of the studies (N = 183), followed by rash in 54.1% (N = 171), headache in 51.3% (N = 162), and arthralgia in 47.8% (N = 151). Most studies reported high rates (70% to 100%) of fever. Among the 151 studies reporting arthralgia rates, the symptom prevalence ranged from 1% to 100%, as studies presented heterogeneous settings, including, for example, recovered patients, patients in the acute phase, or chronic patients. Duration of symptoms was reported in 22 studies. Taking all symptoms into account, the mean duration of symptoms ranged from two days (fever) to 342 days (arthralgia). It is important to note that the studies presented heterogeneous groups of patients when reporting on the duration of symptoms, which could explain the wide range reported in literature. The hospitalization rate was reported by 53 studies. The hospitalization rate varied between 0%, reported by five different studies [ 18 – 22 ], and 93% in a study by Reller and colleagues [ 23 ].

The development of chronic disease after CHIKV infection was reported in 68 studies. Most studies defined chronic CHIKV infection as the presence of symptoms three months after the infection. Arthralgia was reported as a chronic symptom in 67 studies, joint swelling was reported in 11 studies, myalgia was reported in eight studies, stiffness, especially in the morning, was reported in six studies, and arthritis was reported in four studies. The percentage of patients developing chronic disease ranged from 16% in a study conducted during an outbreak in Chennai, India [ 24 ] to 100% in two other studies [ 25 , 26 ]. Fifty of the included studies reported data on mortality, of which 22 reported no deaths in the study population. The highest reported mortality rate was 36.67%, or 36,670 per 100,000 population, reported by Gupta and colleagues. This study population consisted of chikungunya patients who had been admitted to the intensive care [ 27 ].

Meta-analyses feasibility and results

From the 316 articles retrieved from the SLR, we extracted 756 distinct subpopulations. Each subpopulation corresponds to a group defined by a unique set of inclusion and exclusion criteria as per the definitions provided in each original study. Out of the 756 subpopulations, 335 were used for the analysis of the general population, while 52 where used for the target population. From the 28 selected clinical outcomes, we were able to conduct 11 meta-analyses for the target population, see Fig 2 . The number of studies and subpopulations available for each endpoint is shown in Table 1 . The forest plots from the individual meta-analyses can be found in S1 Fig , and the outlier analysis for each endpoint with the Baujat plot is presented in S2 Fig . No studies or subpopulations were excluded based on outlier analyses. Below, we present the 11 estimates from the meta-analyses on the target population, followed by the results of the analysis on mortality, chronicity, and overall symptomatic rates in the general population.

https://doi.org/10.1371/journal.pntd.0012254.g002

Presented are the number of studies and number of subpopulations reporting on the specific outcomes, the pooled estimates, confidence intervals and I 2 of the estimated endpoints. CI: confidence interval. I 2 : I-squared statistic of heterogeneity.

https://doi.org/10.1371/journal.pntd.0012254.t001

Chikungunya symptoms estimates in the target population.

The prevalence of arthralgia in symptomatic adults with confirmed chikungunya was estimated at 89.7%, while arthritis was less frequent at 17.6%. Fatigue was observed in 56% of patients, fever in 87.8%, and headache affected 49.5% of the population. Joint swelling was reported in 50% of patients, myalgia in 62.9%, nausea in 34.7%, rash in 44.3%, and vomiting in 17.1%. The hospitalization rate during the acute phase of chikungunya was reported by nine subpopulations and estimated at 17%. All results are presented in Table 1 , showing the pooled effect estimate for each symptom, reflecting the average rate of occurrence in the studied populations within specified confidence intervals. Each symptom analysis showed substantial heterogeneity between subpopulations, indicated by high I 2 statistics.

Chronicity, mortality, and overall symptomatic rate.

The meta-analysis for chronicity rate showed declining rates over time: 43.89% at three months, 34.39% at six months, and 31.87% at twelve months, see Fig 3 . Notably, persistent high heterogeneity was observed across subgroups ( I 2 between 96–97%). Mortality rates were estimated at 0.32% (320 per 100,000 population), for normal-risk populations and 15.34% (15,340 per 100,000 population) for high-risk populations, see Fig 4 . The latter displayed higher heterogeneity ( I 2 = 97%) compared to the normal risk ( I 2 = 87%). The meta-analysis estimates that 74.9% of the general population with CHIKV infection were symptomatic, with a 95% confidence interval from 63% to 84%, see Fig 5 . A total of eight studies with corresponding eight subgroups were included in this analysis. I 2 statistics showed a heterogeneity of 91%. Results of the outlier and influential cases analysis can be found in S2 Fig .

https://doi.org/10.1371/journal.pntd.0012254.g003

https://doi.org/10.1371/journal.pntd.0012254.g004

https://doi.org/10.1371/journal.pntd.0012254.g005

Chikungunya poses an emerging global health threat; however, uncertainties around the health burden of this infectious disease persist. This SLR and meta-analyses aim to consolidate existing research on the clinical manifestations of chikungunya. The objective of this study was to provide accurate estimates on the symptomatology of this disease, with a specific focus on the chronicity, mortality, and overall symptomatic rates. Overall, our findings emphasize the substantial disease burden associated with a CHIKV infection.

Arthralgia, fever, and myalgia were the most prevalent symptoms, affecting 89.7%, 87.8%, and 62.9% of symptomatic adults, respectively. These symptoms are also described in previous literature as most common for chikungunya [ 17 , 28 ]. It’s important to note that these symptoms were often implicitly used when initially detecting suspected cases. Although we removed all explicit inclusion criteria, these estimates are likely affected by selection bias. The hospitalization rate of 17% underscores the challenges for healthcare systems during outbreaks. The disease burden related to these symptoms makes chikungunya a significant burden for local healthcare systems, highly influencing the quality of life of infected individuals [ 6 ].

The number of studies that provided data on mortality, chronicity, and overall symptomatic rate was limited for the target adult population. Thus, we decided to use less restrictive population criteria for these specific outcomes. Within this broader general population, we found a 0.32% (320 per 100,000 population) mortality rate in the low-risk group. This is slightly higher than the common reported case-fatality rate of 0.1% (100 per 100,000 population), although reports on mortality rated may vary [ 2 , 6 ]. To our knowledge, no previous meta-analysis on mortality rates has been performed. Therefore, we argue that 0.32% (320 per 100,000 population) is a realistic estimate for the general population. While this percentage is still relatively low compared to other arboviruses [ 29 ], mortality rates can be drastically higher in high-risk groups. Our meta-analysis revealed a mortality rate of 15.34% (15,340 per 100,000 population) in elderly and individuals with previous emergency department or intensive care admissions.

In defining the high-risk group for mortality, we included hospitalized patients who are typically older. As a result, the average age within this group was higher and advanced age is a recognized risk factor for increased mortality from CHIKV infection [ 30 ]. The task of separating the effects of comorbid conditions from the direct impact of CHIKV on mortality rates is complex. These factors often interact with each other, complicating the attribution of cause of death to CHIKV alone—particularly when our analysis could not conclusively establish the causes listed on death certificates. Furthermore, we recognize the possibility of publication bias in existing research on severe CHIKV cases. There may be an overrepresentation of studies focusing on severe outcomes and elevated mortality rates among individuals with underlying health complications or atypical presentations of CHIKV. Such a bias could lead to an overestimation of the mortality risk associated with the virus. Nonetheless, our SLR showed mortality rates up to 36.67% (36,670 per 100,000 population) in specific populations, demonstrating that despite its low rates in the general population, the impact of mortality should not be overlooked [ 27 ].

The chronic phase of chikungunya can be debilitating and long-lasting, leading to a significant health burden for individuals affected. Results from our meta-analysis showed a chronicity rate of 43.89% at three months, 34.39% at six months, and 31.87% at 12 months post-infection, indicating the lasting health burden. A meta-analysis conducted by Paixao and colleagues on the chronicity rate of chikungunya showed similar outcomes, with an overall no-recovery rate of 43% after three months [ 3 ]. One notable difference, possibly due to variations in methodologies, is that Paixao and colleagues reported slightly lower rates over time. Both studies indicate a stabilization over time, but more research is needed to comprehensively map the progression of the chronic phase. In conclusion, long-term chronic illness majorly impacts the quality of life of chikungunya patients [ 4 , 6 ], making these results alarming, especially in light of the potential growing spread of the disease [ 9 , 10 ].

The significant disease burden related to chikungunya was further underlined by an overall symptomatic rate of 74.9% in the general population. The symptomatic rate of chikungunya was estimated between 72% and 97% by the CDC Yellow Book, showing that our estimate could be on the low end [ 17 ]. A reason for this could be the various definitions of symptomatic manifestations across studies, which posed a challenge in deriving a precise estimate for this outcome. Additionally, estimates in the literature are mainly based on patients showing healthcare-seeking behaviour, leaving out asymptomatic patients. Therefore, these estimates are likely to be overestimated. Because we created our estimate based on the total general population, we expect them to provide a better reflection of reality.

Two studies identified in the SLR were designed to investigate treatment options for Chikungunya and therefore included control groups. However, we excluded control populations without confirmed CHIKV from our analysis because our focus was on populations with confirmed CHIKV. In instances where multiple treatment options were assessed among confirmed CHIKV populations, these groups were included in the analysis as we aimed to understand the symptomatology of the disease at presentation in its acute phase. It should be noted that the inclusion of these populations did not significantly influence the outcomes of our study since the primary interest was in the manifestation of symptoms rather than treatment efficacy.

Although we obtained estimates for 11 of the 28 predefined endpoints, estimation for several endpoints proved infeasible due to their infrequent reporting as identified in the SLR. We did not obtain estimates for the underreporting factor, the length of the acute and the chronic phase, the duration of the different symptoms, and the frequencies of hospitalization and outpatient care. Even considering the subpopulation analysis method used, we could not estimate more endpoints. The limited number of studies reflects the uncertainty and novelty associated with chikungunya and the need for more research in this field.

In cases where meta-analyses were feasible for the endpoints, we encountered challenges due to poor data quality or absent data. This is attributable to two main reasons: firstly, the reporting of several endpoints varied inconsistently across studies, preventing their combination in a meta-analysis; and secondly, some studies that reported the desired endpoint did not meet the inclusion criteria, resulting in sparse data that hindered meaningful analysis. As a result, significant knowledge gaps persist regarding various aspects of chikungunya. Further research is necessary to fill these gaps and enhance our understanding of this disease. Additionally, consistent and strict reporting criteria on the clinical picture of chikungunya are needed to help create more comprehensive estimates. Enhanced quality and quantity of data could facilitate the possibility to study potential differences in symptomatology for the different CHIKV subtypes. Furthermore, it could enable investigations into the pathogenicity of CHIKV over the years by comparing data from previous outbreaks.

A strength of our study is the use of subpopulation analyses. We discovered that extracting subpopulations from individual studies allows more endpoints to be estimated, offering comparable populations that limit heterogeneity. The use of subgroups could be useful for future research and mitigate some of the data discrepancies detected in the SLR.

The main limitation of our study is the significant presence of heterogeneity indicated by an average I 2 statistic of 92%. This reflects substantial differences in the inclusion criteria among the studies, a tendency inherent in the disease area of CHIKV as shown by other meta-analyses reporting similar, or even higher, levels of heterogeneity [ 3 ]. There are several reasons for this high heterogeneity. First, data collection on chikungunya is conducted mostly during the outbreaks which limits the possibility of establishing strict scientific protocols as researchers must adapt to the dynamic nature of the event. Secondly, a standardized methodology for reporting endpoints is lacking, making it challenging to compare studies in a meta-analysis. Thirdly, we noticed that including older individuals affected our results, by showing lower symptomatic rates but higher mortality and hospitalization rates. Future studies might exclude this demographic for more precise age-related outcomes. Additionally, other, less known, symptoms might have influenced the disease estimates. An example of this is depressive symptoms related to chikungunya. A study included in our analysis has potentially skewed our meta-analysis results with inflated estimates for fatigue, headache, and rash because they investigated depressive symptoms during the CHIKV infection [ 31 ]. This highlights how undisclosed factors that increase the population’s vulnerability to chikungunya symptoms can potentially impact the research. Another limitation is the potential for confounding factors contributing to symptom prevalence, which we were unable control for in our study. There’s an implicit assumption that the symptoms described have a causal association with Chikungunya; however, some symptoms such as myalgia and fatigue are commonly prevalent in the population and may not be causally related to CHIKV infection. The difficulty in establishing a direct causal relationship between these symptoms and CHIKV should be taken into consideration when interpreting the results. We acknowledge that this could affect the precision of the associations drawn in our analysis and suggest that future research should aim to discern the specific attributable risk of CHIKV for these symptoms. Lastly, outbreaks often occur in locations with limited surveillance systems, leading to lacking or less accurate data from these areas. The high heterogeneity shows the need for additional research in the fields, as well as standardized methodologies in studying chikungunya. Additionally, it emphasizes the importance of meta-analyses like these to come to accurate estimates.

Chikungunya is recognized as a global public health threat, and the disease is expected to spread further due to globalization and climate change. At the same time, vector control and surveillance systems remain limited. Consequently, a thorough understanding of the clinical burden of chikungunya is important to inform public health intervention strategies and improve global surveillance. Our study showed that chikungunya poses a significant health burden, with 74.9% of infected individuals experiencing symptomatic disease. Chronic symptoms are found in 43.4% of patients and can be debilitating and long-lasting. We were not able to create pooled estimates on all endpoints, highlighting the still existing data gap in literature here. Nevertheless, the outcomes determined add to the growing body of evidence underlining the debilitating consequences of chikungunya. With the growing threat of chikungunya, health authorities and healthcare professionals must be prepared to adequately diagnose patients affected by the disease and consider public health interventions to limit its burden. Our findings contribute to the comprehension of chikungunya’s clinical outcomes, essential for improving global surveillance and detecting potential outbreaks.

Supporting information

S1 text. literature search and study selection..

Containing the search strategy and PICOs of the studies included in the SLR.

https://doi.org/10.1371/journal.pntd.0012254.s001

S2 Text. Quality assessment tools.

Modified Downs & Black checklist and the NIH quality assessment tool.

https://doi.org/10.1371/journal.pntd.0012254.s002

S3 Text. PRISMA 2020 checklist.

https://doi.org/10.1371/journal.pntd.0012254.s003

S1 Table. Quality assessment of included studies.

https://doi.org/10.1371/journal.pntd.0012254.s004

S2 Table. Summary of study characteristics.

https://doi.org/10.1371/journal.pntd.0012254.s005

S1 Fig. Forest plots of the clinical outcomes of chikungunya.

https://doi.org/10.1371/journal.pntd.0012254.s006

S2 Fig. Influential case and outlier analysis with Baujat plots.

https://doi.org/10.1371/journal.pntd.0012254.s007

Acknowledgments

We would like to thank the internal teams of Asc Academics who helped during the data extraction phase of the SLR, as well as Roma Kwiatkiewicz from Asc Academics for providing medical writing support.

• View Article
• PubMed/NCBI
• Google Scholar
• 2. European Centre for Disease Prevention and Control [Internet]. Factsheet about chikungunya. [cited 2024 February 20]. Available from: https://www.ecdc.europa.eu/en/chikungunya/facts/factsheet .
• 8. Zavala-Colon M, Gonzalez-Sanchez JA. 2. In: Engohang-Ndong J, editor. History and Geographic Distribution of Chikungunya Virus. Rijeka: IntechOpen; 2022. p. 15–24. Available from: https://doi.org/10.5772/intechopen.98662 .
• 12. Food and Drug Administration [Internet]. FDA Approves First Vaccine to Prevent Disease Caused by Chikungunya Virus. [cited 2024 February 20]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-prevent-disease-caused-chikungunya-virus .
• 16. National Heart, Lung, and Blood Institute [Internet]. Study Quality Assessment Tools. [cited 2024 February 20]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools .
• 17. Centers for Disease Control and Prevention [Internet]. CDC Yellow Book 2024. [cited 2024 February 20]. Available from: https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/chikungunya .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Curr Dev Nutr

The Effects of Vinegar/Acetic Acid Intake on Appetite Measures and Energy Consumption: A Systematic Literature Review

Faten hasan.

University of Virginia

Kristen Hamilton

Siddhartha angadi, sibylle kranz.

Research suggests the active ingredient in vinegar, acetic acid, may reduce appetite, thereby reducing energy consumption. This systematic review aimed to assess the effect of vinegar or acetic acid on appetite and subsequent food intake in humans in the published literature.

All human subject studies, regardless of age or health status. A search using MedLine (Ovid), PubMed, CINAHL Plus, Web of Science, and Cochrane Library between January to April 2021 resulted in 12 papers. One of the publications by Darzi et al. combined the findings of two independent studies and was therefore treated as two separate studies in this review ( study 1 ” and “Darzi study 2 ). Outcomes included appetite, measured using an appetite rating scale or visual analog scale, satiation, measured as food intake of intervention meal, and satiety, measured as the amount of food intake following vinegar or acetic acid consumption.

Seven short-term studies were crossover randomized controlled trials (RCT) investigating the effect of a single vinegar exposure with satiety or appetite as the primary outcome. Six long-term studies were parallel-group RCTs with repeated vinegar exposure, ranging from 4 to 12 weeks. These studies compared energy intake before and after the vinegar/acetic acid intervention. The short-term interventions indicated that vinegar containing at least 24.6 mmol acetic acid when consumed alongside a meal containing solid foods, acutely suppressed appetite up to 120 minutes postprandially, and ad libitum food intake three- and 24-hours after vinegar consumption. However, results from the long-term studies found no effect on appetite suppression.

Conclusions

Overall, four of the six short-term studies reported that vinegar suppressed appetite, while none of the long-term studies were able to reproduce these results. Further research is needed to determine whether oral vinegar consumption may result in long-term appetite reduction, decrease energy intake, and potentially aid in weight loss.

Funding Sources

Not applicable.

• Research article
• Open access
• Published: 13 July 2022

Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis

• Jenna Jacob   ORCID: orcid.org/0000-0003-1006-1547 1 ,
• Milos Stankovic 2 ,
• Inga Spuerck 2 &
• Farhad Shokraneh 3  

BMC Psychology volume  10 , Article number:  171 ( 2022 ) Cite this article

15k Accesses

7 Citations

21 Altmetric

Metrics details

Goal setting and goal-focused work is widely used in young people’s mental health settings. However, little is known about how, why or for whom this is helpful. This study aims to explore the mechanisms of collaborative goal setting as part of therapeutic relationships: is it helpful for young people experiencing anxiety and/or depression, how and why/not, for whom, and under what circumstances?

Online database searches generated 10,907 records. Seven unique studies are included, combined with insight analysis from directed discussions with international advisors with lived experience of anxiety and/or depression and therapy (N = 8; mean age = 20.8), and mental health academics/clinicians (N = 6).

Findings are presented as a narrative synthesis and suggest that goal setting is helpful to young people experiencing anxiety and/or depression because it helps build good therapeutic relationships through open communication and building trust. Goal setting helps make things more manageable, enabling young people to feel supported and have ownership of their care. Individual preferences, or high levels of distress, trauma, low confidence, hopelessness, negative past experiences of goal setting, perfectionism, and rumination are considered limiting factors to goal setting. Additionally, contextual factors including country and long-term therapy are explored.

Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects.

Peer Review reports

Collaborative goal setting within therapeutic mental health settings refers to agreements made between young people and practitioners about specific therapy areas of focus: topics of personalised and meaningful outcome. Goals are concrete representations of intended endpoints, which fill the perceived gap between the current and desired end state [ 1 ]. Goals are usually formulated at the start of therapeutic interventions through a series of discussions. These differ from academic, physical rehabilitation, or general life goals, although there could be overlap. Progress towards these agreed goals may then be tracked over time, often through ratings on numerical scales, and there are tools available to support this. For example, the Goal Based Outcome tool (GBO; [ 2 ]) which comprises setting up to three goals and scoring progress between 0 and 10, is widely used to track progress against goal setting in youth mental health settings. Whilst goal tracking may lead to a shift in practitioners’ work to be goal focused [ 3 ], goals may also sit alongside usual clinical work, to track progress [ 4 ]. Goals set in therapy tend to be focused and specific, e.g., to deal with something in the immediacy, like a phobia [ 5 ], but it is important that these goals attain to more global goals [ 6 ], or are viewed as a “means to an end”.

Goals may take time to set, and can change and become more specific during the therapeutic process, for example, at the beginning of contact with a practitioner, a young person might have a general goal like “to feel less depressed”, but over time the young person, along with the practitioner, may learn more about the mechanisms behind the depression and may define more precise goals like “being able to stop negative thinking” or “being able to cope with flashbacks”. The types of phrases used by practitioners to help young people define goals may include: “what do you want to be different?”, “what will you get off your back?”, “where do you want to get to?”, and “how do you want things to change?” [ 4 , 6 ].

Goal setting and tracking in therapeutic settings is grounded in motivation theory [ 7 , 8 , 9 ] such that working towards goals is a continuous feedback loop which builds on self-efficacy, self-determination and motivation to continue to strive towards goals, acting as a self-regulation strategy [ 10 , 11 ]. Goal setting may be more feasible or acceptable to individuals with particular personality traits e.g., individuals who attribute successes and failures to external factors are less likely to find meaning in striving towards goals than those who attribute successes and failures to their own actions [ 12 ].

Further, young people have described recovery from depression as nested within relationships (e.g., [ 13 ]), portraying recovery as an intentional process, contingent on shared goals and joint action in relationships [ 14 ]. Good therapeutic relationships are considered a key element of effective therapy [ 15 , 16 , 17 , 18 ]. Also known as working relationships, or working/therapeutic alliance, this refers to the connection, bond or partnership between the young person and practitioner. Three key elements of therapeutic alliance have been identified in the literature: bond, tasks, and goals [ 19 ]. In a recent review of the effects of cognitive behavioural therapy (CBT) for young people experiencing anxiety and/or depression, three studies reported small-to-medium effect sizes for the correlational relationship between therapeutic alliance and symptom reduction [ 20 ]. This provides limited evidence linking goal collaboration to reduced anxiety/depression symptoms for young people, despite fair evidence supporting links between goal collaboration and positive adult anxiety and depression outcomes [ 21 ]. It is argued that goal agreement is a fundamental element missing from much work with young people, and it has been referred to as a “social contract” [ 22 ]. This emphasis on relationships is particularly important when working with young people with acute, or multifarious difficulties, where relationships are complex, difficult to develop and maintain (e.g., [ 23 ]).

Existing evidence suggests that there are certain elements of mental health support for young people that are effective, but there is a lack of identification and knowledge about mechanisms to refine and improve this support [ 24 ]. Specifically, there is a paucity of research exploring the mechanisms underpinning why goal setting may be helpful for some young people, and not others. There are likely to be confounding variables which interplay the effectiveness of goals, depression and/or anxiety, cognition, and motivation, yet there is little research that has explored this in clinical settings with young people.

The aim of this study is to summarise existing literature, supplemented by discussions with international advisors to contextualise and aid interpretation of the findings. The research question is:

“Is collaborative goal setting helpful or unhelpful to young people experiencing anxiety and/or depression, as an element of therapeutic relationships? a. Why/why not and how? b. For whom? c. Under what circumstances?”

A mixed methodological approach combined reviews of peer-reviewed, grey literature and additional sources (e.g., websites), with consultation with experts by experience. The risk of expert view biasing the findings was mitigated via the validating steps outlined below. The study was designed by the lead researcher, and other researchers in the team, in collaboration with the peer researchers.

Whilst it is acknowledged that there are important outcome areas such as quality of life and existential factors, aside from symptom reduction, the focus of this study was to specifically explore the research questions in relation to potential anxiety and depression symptom reduction. Anxiety and depression were focused on as the most common mental health difficulties worldwide. This focus on medicalised symptomology differs from quality of life, which is a multi-dimensional construct comprised of several domains, such as psychological, physical, and social wellbeing. Anxiety, depression, therapeutic relationships, and goal progress are routinely measured using self- and proxy-reported outcome measures, with numerical rating scales. It was anticipated that the research question would not be adequately explored through findings from outcome measures alone. Based on some initial scoping work, we determined that there would be more evidence on the effectiveness of goal setting and tracking via qualitative enquiry, including narratives. The exploration of the nuances identified in the research question was key to the study, and so it was important to give precedence to young people’s voices through existing research and youth advisors, combined with findings from any relevant supporting measures. Such explorations would not be possible through quantitative enquiry of outcome measure data.

Goal setting alongside usual clinical work and goals work (goal focused interventions) were differentiated from implicit goal-oriented practice, non-directive approaches and paternalistic approaches to support in this study. This meant that to be included in the literature synthesis, goals needed to be explicitly identified as an approach to progress tracking, and/or informing the work. This study also focused on individual settings, and whilst these relationships may include parents/carers in a triad, the primary focus was on the relationship built between the practitioner and the young person. This was due to the complexities and potential dilution of agreeing goals and developing therapeutic relationships in group work and with parents/carers in addition. Ethical approval was not required because this study did not involve collection nor analysis of primary data, and youth advisors were consulted on in the capacity of being part of the advisory group, rather than within the capacity of research participants [ 25 ].

Literature review

First, search terms and inclusion and exclusion criteria were agreed in collaboration with the academic/clinical and youth advisors (See Additional file 1 : Appendix 1 Inclusion and exclusion criteria and Search Strategies). The project was registered with PROSPERO (number: CRD42021259611).

Second, searches of ten online databases were conducted (PsycINFO (OVID), MEDLINE (OVID), EMBASE (OVID), Web of Science core collection, current contents connect, SciELOCitation Index, Cochrane Library of Systematic Reviews, CINAHL (EBSCO), ERIC (EBSCO), and child and adolescent studies (EBSCO)). The search strategy developed for each database comprised three concepts: anxiety and/or depression (condition), goals (intervention) and therapeutic alliance or general views on goal setting, e.g., perspective, view, narrative (intervention/outcome). Searches were restricted to the past 20 years (2000-present). Citation tracking of included papers was performed. Retrieved hits were exported to EndNote 20 [ 26 ], Rayyan [ 27 ] and Excel for title/abstract screening.

Third, two researchers (FS, JJ) independently screened titles and abstracts. Where one researcher (JJ) was an author in retrieved studies, screening was conducted by the other researcher (FS), to ensure unbiased screening. Fourth, two researchers (JJ, IS) explored resultant literature main texts, extracting and synthesising relevant information. Key literature identified by researchers and advisors was added. The quality of the studies was assessed using criteria for qualitative studies ([ 28 ]; See Additional file 1 : Appendix 2 Core Criteria for Quality Assessment of Qualitative Studies).

Grey literature search

Google and Google Scholar title search, Google Books, PsycEXTRA, PsyArXiv, and ProQuest Dissertations and Theses were used. Google's Site Search was used to search American Psychological Association, British Psychological Society, Australian Psychological Society, European Federation of Psychologists' Associations, International Association of Applied Psychology, Association for Psychological Science, International Union of Psychological Science, Canadian Psychological Association, and UN-affiliated websites (.int domains). To identify more relevant literature, ResearchRabbit.ai was used to track the citations to the included studies. As a result of Google title search, websites were identified and browsed. The searches were restricted to those: (1) written in English, (2) published from January 2000 to August 2021, (3) focused on goal setting with young people experiencing mental health difficulties. Two researchers (FS, JJ) independently screened titles and abstracts of the resultant sources for relevance.

Insight analysis

An advisory group was formed at the study’s outset, comprising: (1) young people with lived experience of anxiety and/or depression and therapy (N = 8; age range 15–26 years; mean age = 20.8; female (includes transgender) N = 5; and male (includes transgender) N = 3; located in Brazil, Pakistan, Spain, Turkey, and UK); and (2) academics and clinicians (N = 6; female N = 1, male N = 5; located in Norway and UK). Criteria for youth advisors to take part where that they were around the age of interest (14–24 years) and had lived experience of anxiety and/or depression and had previously -or currently-experienced receiving a mental health intervention. Youth advisors’ experience of anxiety and/or depression was balanced across advisors. Youth advisors were recruited via adverts circulated by a European network of peer advisors with international reach, and signed an agreement at the outset of the project, by way of consent to participate, which included specific duties and responsibilities of what would be expected of them, as well as hours and reimbursement details. For those under 18 years old, parent/carer consent and agreements were gained. One-to-one meetings between each youth advisor and the participation lead for the study were conducted before and after the study took place. A written agreement was made between the lead research organisation, and the participation organisation which facilitates the network of peer advisors.

Academic/clinical advisors were experienced and specialised in goals work and were recruited via existing networks. Criteria for academic/clinical advisors were that they had research and/or clinical experience in the field of mental health goal setting with young people (academic N = 6; clinical N = 4; categories not mutually exclusive). Written agreements were made between the lead research organisation, and each academic/clinical advisor.

Directed discussions were held at six advisory group meetings (two academic/clinical and four youth) facilitated by two researchers (JJ, MS) and conducted in English. All advisors spoke English, but time was given in the meetings to check understanding, as English was not a native language for many. The academic/clinical and youth advisors met separately, enabling the youth advisors to share openly with their peers. These discussions focused on the research question and drawing inferences about resultant findings, as well as appraising the evidence to identify key literature gaps. The summary of findings from the literature review was presented via PowerPoint to the advisors. The questions asked were broadly: is setting goals an important part of the relationship with the therapist and why/not; do these findings align with your experiences; is there anything you can think of that has not been considered; are there any elements of these findings that do not make sense in your experience; how do you interpret and understand these findings within the context of your own experience? Youth advisors were asked additional questions about the nature of language, for example, what do you think about the term “goal”? Is it the word you use, is it understandable, how does it translate to your national languages?. Field notes were taken, alongside notes in advisors’ own words on the JamBoard interactive workspace, allowing for anonymous contributions. Analysis comprised four stages. First, one researcher (MS) organised field notes and comments into a narrative summary. Second, one researcher (JJ) used the nuanced elements of the research question to organise the summary. Third, feedback was sought from advisors to evaluate and assess whether it was a true reflection of the discussions. Fourth, one researcher (JJ) refined and renamed the themes.

Online searches generated 10,907 records. Ten potentially eligible studies were identified. Upon screening full texts, seven unique studies met the selection criteria (See Fig.  1 and Table 1 ).

PRISMA flow chart of the study selection process. From: Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71)

Included studies comprised three narrative case studies [ 29 , 30 , 31 ] a randomised control trial [ 32 ]; a narrative review [ 33 ] a practitioners’ guidance document [ 34 ]; and a naturalistic study [ 35 ]. Critical appraisal of the evidence (Table 1 ) demonstrates that caution must be exercised when considering the findings. The main strength of the included studies is the voice of young people through verbatim quotes, and for some, strong consideration of the researchers’ impact. However, less strength is attributed to the dependability or generalisability of the findings, mainly due to the high proportion of small-and-homogenous samples. The advisors’ discussion summaries were organised into themes within the nuances of the research question: Why/why not and how? For whom? Under what circumstances?”, and presented as a narrative synthesis.

Why/why not and how (mechanisms)

A conduit for open communication.

Six studies described collaborative goal setting as a conduit for communication [ 29 , 30 , 31 , 33 , 34 , 35 ]. Specifically, agreement on goals leads to open communication, a shared understanding of difficulties and ways forward [ 29 , 31 , 35 ]. Formulating goals was described as key to helping young people to feeling understood, valued and that practitioners are listening to them [ 33 , 34 , 35 ]. Collaborative goal setting enables young people and practitioners to make genuine disclosures, not necessarily otherwise possible [ 30 ] and facilitates mutual support [ 31 ].

Both academic/clinical and youth advisors said that open communication and trust were key, broadly agreeing that goal setting could be helpful to support building trusting relationships. It was agreed that collaboratively agreeing goals may take time and should not happen immediately. Rather, practitioners should work flexibly, aiming to understand what is comfortable for young people experiencing anxiety and/or depression. Some youth advisors said that relationships need to be built first, with trust established prior to goal setting, particularly when goal setting feels complicated. It was agreed by youth and academic/clinical advisors that goal setting should be led by young people and guided by practitioners, sharing responsibility. Youth advisors considered open communication the most crucial factor in therapy, with a sense that much therapeutic work cannot take place without it.

Feel supported and involved

Young people value receiving support to split actions into smaller manageable steps, with encouragement from practitioners stimulating validation that their goals are achievable ([ 35 ], and youth advisors). Being given choice about goal content and how this translates into the options for care was identified as an important part of the process in the literature [ 35 ]. Evidence suggests that this leads to a sense of autonomy and control over what happens to young people and enables them to feel involved in the process and increases engagement [ 30 , 33 , 35 ]. This was not directly addressed by the academic/clinical advisors in their discussions.

Nature of difficulties

All seven studies, and youth and academic/clinical advisors, suggested that goal setting was a helpful element of therapeutic relationships for young people experiencing anxiety and/or depression, and more broadly with other undefined presenting difficulties. Both academic/clinical and youth advisors agreed that there was no need to separate specific attributes of anxiety or depression, due in part, to high proportions of comorbidity.

Age, and previous experiences

Three studies described difficulties for young people engaging in goal setting [ 32 , 33 , 34 ]. These were: age-appropriate quests for independence interfering with establishing collaborative relationships with adults [ 32 ]; significant and repeated traumas impacting development, relationships and challenges ordering thoughts, particularly within the context of long-term therapy [ 34 ]; low confidence or feelings of hopelessness; and poor previous experiences of goal setting [ 33 ]. Youth advisors agreed that previous life experiences were important, e.g., views of goal setting in therapeutic settings were impacted by how successful they had been in achieving past goals, regardless of goal type. Academic/clinical advisors agreed that personal factors such as previous experiences and factors surrounding—or leading to—difficulties, may lead to challenges setting goals in the first instance.

Levels of distress, personality traits and preferences

Youth and academic/clinical advisors suggested that specific unhelpful elements may depend on the young person, and sometimes levels of distress, rather than the nature of difficulties. Some youth advisors expressed preferences for practitioner-directed work, particularly in times of high distress, e.g.,: “If I’m going through something very bad, I can be very frustrated/sad so I can’t think clear” (youth advisor) . It was also agreed that goals may exacerbate anxiety, particularly at times of overwhelm, whilst for others this could be a helpful anxiety reduction approach, e.g., in exposure therapy. Youth advisors said that ensuring goals are achievable is key to building good therapeutic relationships, and the impact on anxiety/depression; the individual’s capacity to set goals should be considered, e.g., someone struggling with day-to-day tasks may find even small goals too challenging. Youth advisors considered perfectionism to be important, where some people may feel pressure to achieve goals. A sense of hopelessness, or procrastination, and rumination also, where delaying tasks may result in delaying work on goals. For some youth advisors, goal setting felt especially important, whilst for others it was not, rather a supportive relationship was identified as most important, and they could not see how that would be developed through goal setting. Academic/clinical advisors said that young people’s preferences to work on goals, or not, was in itself of key importance to the therapeutic relationship. There was no evidence from the included literature to support/oppose these points.

Language and power dynamics

Linked to preferences, youth advisors said that young people tend not to like the term “goal” because they attribute it to work and formal settings, whereas “therapeutic goals” are personal with deeper meaning. Academic/clinical advisors discussed using alternative language for goal setting and goal directed work, and the importance of being led by the young person. Posing questions such as “What do you want to change?” is suggested as an alternative in the literature ([ 33 ]; p.47). Youth advisors said that whilst some young people may feel able to say they do not want to set goals, others may not, due to the young person-practitioner power imbalance, which has implications for relationships, and therapeutic work. There was no further evidence from the included literature to support/oppose these points.

Under what circumstances (contextual factors)

Broadly helpful.

All seven studies suggested that goal setting was a helpful element of therapeutic relationships for young people within the research contexts. This included year-long narrative therapy with interpersonal therapy and CBT techniques in alliance with the family [ 29 ]; multimodal family therapy [ 31 ]; Gestalt therapy [ 30 ]; either CBT, short-term psychoanalytic psychotherapy or brief psychosocial intervention [ 32 ]; UK child and adolescent mental health services [ 33 , 34 ] and UK inpatient settings [ 35 ]. All studies were based in Western high-income countries. Academic/clinical and youth advisors agreed with this assessment.

Review points and referral routes

Reviewing progress towards goals too frequently could give the impression that practitioners are more interested in gauging their own success, rather than in the young person as a whole person, and rating could end up being done by rote, making goals increasingly meaningless [ 34 ] . Academic/clinical and youth advisors agreed with this, discussing the need to work with goals in a flexible manner. Additionally, young people may not recognise the symptoms identified, particularly when referred for treatment by another party (e.g., parents/carers), which is crucial to enable collaborative goal setting [ 32 ]. Challenges associated with thinking of goals in this way was addressed by the academic/clinical and youth advisors in wider discussions elsewhere (see therapy contexts).

Culture and therapy contexts

Youth and academic/clinical advisors located in Western high-income countries agreed that it may depend on types of interventions offered and practitioner’s preferred working style, but young people largely have agency to set goals. However, it was recognised by the youth and academic/clinical advisors that some young people in some countries do not have agency to set goals. There, decisions are made by families, in collaboration with practitioners, and so less consideration is given to young people’s perspectives. It was suggested that, in some countries, there is no concept of setting goals (e.g., a youth advisor discussed their experience in Pakistan), and ongoing stigma associated with mental health difficulties, which may lead to distrust, scepticism in, and a disconnect with practitioners. Youth advisors said that this may also be true in other countries not represented. A youth advisor suggested that young people in Brazil were relaxed towards goal setting and would not mind if goals were not achieved; directed therapy was considered more helpful.

Youth and academic/clinical advisors discussed goals in long-term therapy as potentially feeling restrictive, with challenges associated with thinking of what goals might be. Both long-and short-term goal setting within this context may feel meaningless, which if then pressed by the practitioner, has a negative impact on relationships. Academic/clinical advisors said that the feasibility of goal setting in the first instance is likely to be attributable to the factors young people who might be offered long-term therapy might have, rather than the work itself leading to these challenges. Youth and academic/clinical advisors also said that where there are multiple needs and risks, goals need to be simpler to feel manageable. Youth advisors said that sometimes there were concerns about the achievement of goals equating to treatment ending, which felt unsettling. There was no evidence from the included literature to support/oppose these points.

This study aimed to provide a synthesis of existing literature, identifying knowledge gaps. Whilst much may be drawn from related research, caution must be exercised when translating findings into other contexts [ 11 ], and whilst promising, generalising adult findings to youth must be exercised with an abundance of caution. Evidence suggests that adults and children think differently; as children grow, their cognitive processes develop, and their contexts and perspectives change, impacting on understandings of the self and the world around them. Further, models of recovery from depression are notably different between adults and young people [ 14 ]. As such, we have focused on evidence from the youth field in our discussion, and further highlight the paucity of research with young people in this area.

The included evidence originates from Western high-income and largely specialist settings; further research in majority world countries is urgently required. Many studies identified in initial searches only partially met inclusion criteria. This evidence paucity may suggest goal setting is not embedded in service standards or practice in most countries, or other limiting factors such as the general underfunding of youth mental health research. Some examples were derived from the insight analysis, highlighting the advisors’ value, who helped contextualise and interpret evidence, grounded in lived experience. However, whilst the research question pertained to the effectiveness of goal setting as part of therapeutic relationships, the findings were related to the feasibility, or acceptability of goal setting itself. Links between effective goal setting, good therapeutic relationships and positive outcomes are inferred based on evidence that partially supports the research question, and the discussions with the advisory group, but no evidence relating to anxiety or depression outcomes was found in this study. Future research should consider in depth explorations of mechanisms of goal setting within therapeutic relationships, for young people experiencing anxiety and/or depression.

For many young people, goal setting is a helpful tool for building good therapeutic relationships via open communication. These findings support previous research which partially address the research question: young people find goal setting to be helpful to therapeutic relationships through the development of a shared language and understanding [ 3 ]. It has been suggested that goals are a mechanism of change via a means for “common ground” to be established [ 3 ]. Finding common ground and a shared understanding are particularly pertinent in youth mental health settings, where there are multiple stakeholders involved [ 36 , 37 , 38 ], which can be a balancing act [ 39 ]. Establishing this mutuality of situations is considered the key facilitator of engagement when referred for therapy by others [ 40 ]. Further, ownership of goals located with young people is important [ 41 ], which in turn gives young people ownership of their care, which can be motivational [ 42 , 43 ]. Young people experiencing anxiety may find goal setting an effective strategy due to links with avoidance motivation; such that they have reported pursuing approach goals to avoid negative emotional consequences of not doing so [ 44 ]. The ability of young people to maintain focus on the pursuit of personal goals has also been demonstrated as a moderator of depression and suicide [ 45 ].

One included study explicitly discussed parents/carers within collaborative goals and therapeutic relationships, as a foundation for mutual support [ 31 ]. Stronger relationships between both young people, parents/carers and practitioners and/or involving both young people and parents/carers in decision-making have been demonstrated to predict more positive outcomes [ 39 , 46 ]. Young people are often referred by their parents/carers, which must be considered, particularly where literature highlights challenges of setting goals when young people do not agree with the referral or recognise the difficulties [ 22 , 32 ]. Prior research has demonstrated that young people from minoritized ethnic groups are more likely to be referred for mental health support via social care and the youth justice system compared to their White British counterparts, who are commonly referred via primary care in the UK [ 47 ]. Further, evidence suggests that increases in emotional autonomy result in a shift from dependence on adults in adolescence, to reliance upon peers for support [ 48 ] particularly amongst girls [ 49 ], which may align with the developmental interference with building relationships outside of goal setting found by Cirasola and colleagues [ 32 ]. It has been argued that for young people who have difficulties building and maintaining relationships, the therapeutic relationship is particularly important (e.g., [ 23 ]). It is also noteworthy that young people in some countries may not have agency to set goals, a significant limiting factor. There are cultural and service level factors which were not explored. In some cultures, advice is sought from family and religious leaders over mental health professionals (e.g., [ 50 ]). Organisational level factors have also been found to hinder and influence therapeutic processes [ 40 ]. Further research is needed into referral routes, and intersections between systems, practice, and young people’s preferences.

Several elements of goal setting were identified as unhelpful for young people experiencing anxiety and/or depression, supporting previous literature. These discussions centred on the feasibility/acceptability of goals, rather than goal setting being detrimental to therapeutic relationships per se. Nevertheless, it is suggested that these factors were primarily related to the person, and that “personal” factors may be driven by underlying difficulties. For example, low confidence, hopelessness, levels of distress, perfectionism, and rumination (e.g., [ 51 , 52 , 53 , 54 , 55 ], may all be elements of anxiety and/or depression. Academic/clinical and youth advisors agreed that goals may become clearer over time, particularly for young people experiencing depression and purposeless, and through collaboration, goals could be formulated. The importance of considering specific challenges of goal setting during long-term therapy was highlighted. Academic/clinical and youth advisors discussed challenges associated with identifying priority areas for work, and that goals continue to flex and change, with the potential for goals work to feel too restrictive. This is in support of previous research suggesting that it is important that goals are worked on flexibly [ 3 ] with space for them to change; specifically in relation to depression. Compared to those with low levels of depression, young people with high levels of depression are more able to disengage with unhelpful goals over time and to set new goals, which in turn may predict lower levels of depressive symptoms over a year later [ 56 ]. This sense of goals flexing, feeling unique and changeable has been mirrored in descriptions of therapeutic relationships themselves [ 23 ]. There was a clear steer from youth advisors that the relationship independent of goal setting was key to good outcomes, and that this was a priority; that without the trusting relationship, there is no facilitator for goal setting. This is an important contradiction to the literature, warranting further exploration. One suggestion is that the initial goals for long-term therapy should be on relationship building, but reviewed, so the therapeutic relationship itself does not remain the primary goal [ 34 ]. Another key finding is that goals take time to establish, and pressure to set goals may render them meaningless, which also supports previous research [ 51 ]. Young people often do not know what their goals are [ 57 ], which impacts trust building, relationships and thus, therapeutic work. In support of prior research which defines recovery as contingent on shared goals and joint action in relationships [ 14 ], links found between goals, trust building and therapeutic relationships in the present study align with research on trauma informed care, and emotional and relational safety (see, [ 58 ]). Further consideration should be given to this area, particularly clinical implications, and interactions with levels of distress.

Whilst support approaches that incorporate structured goal setting are often characterised by a greater emphasis on client-centredness, the links between personally meaningful outcomes and the specific behaviour change techniques required to progress towards goals are not clear. Further, the person-centred focus is hypothesised as a conduit to positive ratings of self-efficacy, quality of life and service satisfaction, but evidence is lacking [ 11 ]. Whilst previous literature from within the youth mental health field suggests that working on goals is motivating and increases self-efficacy [ 34 , 42 ], evidence is still limited. Goal setting may be useful to young people because, whilst not necessarily synonymous, it has been demonstrated as a facilitative element of shared decision-making [ 59 , 60 ]. This collaborative way of working through shared understanding and the development of good therapeutic relationships [ 61 ] may be especially helpful to young people experiencing depression as it enables them to exercise control over their own feelings and behaviour [ 43 ] at a time when they may be experiencing feelings of hopelessness and purposeless. Whilst educated links are made to shared decision-making, further research should explore whether there is an embedded link to goals and therapeutic relationships.

Strengths and limitations

The mixed-methodological approach was a particular strength, with literature findings bolstered by lived experience. However, whilst advisors were from diverse demographic groups, not all groups were represented.

Whilst every attempt was made to include as many goal setting search terms as possible, the language is broad and fluid, meaning certain terms may have been missed. Still, the high number of results returned from literature searches suggests the strategy may need refinement. Nevertheless, we chose to ensure a large return given the subject’s broad nature. At the screening stage, the focus on explicitly identified goal setting and goal work made the identification of included studies less ambiguous, but meant that studies focused on implicit goals work would not have been included, reducing the number of studies included in the final synthesis.

Prior assumptions and knowledge of this topic will have influenced the researchers’ interpretation of the findings, even subconsciously. This includes the decision to use the nuanced elements of the research question to organise the findings. The researchers were located in Belgium, Germany, and the UK at the time of the study, which risks the perpetuation of the status quo of Western high-income-originating dominated research. Further, the findings were contextualised and linked to prior theory primarily by a researcher outside the age range of interest (JJ). The impact of both issues was mitigated via advisors, particularly those within majority world countries and the age range of interest, and the peer researchers entrenched in the research team (MS, IS), who provided contextual depth and understanding to the findings.

Literature focused on goal setting as helpful for young people with anxiety and/or depression is overwhelmingly supportive, but this leaves research gaps regarding in which ways, for whom and under what circumstances goal setting might be unhelpful. Priority must be given to researching unhelpful mechanisms of goal setting, to avoid potential iatrogenic effects. Accessibility could be improved through exploration of the intersections between systems/contexts (e.g., country), therapeutic practice (e.g., practitioner’s training/preferences) and young people’s preferences. Further research is also needed to explore mechanisms by which goal setting may help to reduce anxiety and/or depression symptoms, as well as other important areas of outcome, such as quality of life, using e.g., mediation analysis.

Scaling up in countries with well-developed systems could mean embedding goals in guidelines for anxiety and/or depression; in service specifications, including monitoring and reporting change mechanisms; staff training in consistency; and some interagency forums to align goal processes. For majority world countries with less developed systems, largely relying on non-specialist services e.g., NGOs, goals may be paradoxically more important for maximising limited resources. Despite nothing suggesting goal setting could not practically be scaled-up globally, cultural considerations may be a limiting factor in some places.

Preferences to not work on goals may be driven by the limiting factors identified, such as hopelessness or high distress. Practitioners should work through this first, reviewing the option to work on goals over time, respecting young people’s preferences. Flexibility is important, and ownership of goals located with young people is essential, particularly to those experiencing depression, enabling them to exercise control over their feelings and behaviour when they may be feeling hopeless and/or purposeless. Finally, there may be a unique opportunity for goals to facilitate work with young people experiencing high distress levels or who have experienced trauma, due to links to emotional and relational safety and building trusting relationships.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available to protect the confidentiality of the small number of advisors, but may be available from the corresponding author’s organisation, on reasonable request.

Abbreviations

Cognitive behavioural therapy

Goal based outcomes tool

United Kingdom

Austin JT, Vancouver JB. Goal constructs in psychology: structure, process, and content. Psychol Bull. 1996;122(3):338–75.

Article   Google Scholar  

Law D. Goals and goal based outcomes (GBOs): some useful information. London: Internal CORC Publication; 2011.

Google Scholar  

Di Malta G, Oddli HW, Cooper M. From intention to action: a mixed methods study of clients’ experiences of goal-oriented practices. J Clin Psychol. 2019;75(20):1770–89.

Article   PubMed   Google Scholar  

Law D, Jacob J. Goals and goal based outcomes: some useful information. 3rd ed. London: CAMHS Press; 2015.

Grosse M, Grawe HK. Bern inventory of treatment goals: part 1. Development and first application of a taxonomy of treatment goal themes. Psychother Res. 2002;12:79–99.

Law D. The goal-based outcome (GBO) tool. Guidance notes. [Internet]. Goals in Therapy. 2019. Available from: https://goalsintherapycom.files.wordpress.com/2019/02/gbo-version-2.0-guide-final-1st-feb-2019.pdf .

Bandura A. Self-regulation of motivation and action through goal systems. In: Bandura A, editor. Cognitive perspectives on emotion and motivation. Dordrecht: Springer; 1988. p. 37–61.

Chapter   Google Scholar  

Manderlink G, Harackiewicz JM. Proximal versus distal goal setting and intrinsic motivation. J Personal Soc Psychol. 1984;47:918–28.

Maslow AH. A theory of human motivation. Psychol Rev. 1943;50:370–96.

Harkin B, Webb TL, Chang BP, Prestwich A, Conner M, Kellar I, Benn Y, Sheeran P. Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence. Psychol Bull. 2016;142(2):198–229.

Levack WM, Weatherall M, Hay-Smith EC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD009727.pub2 .

Article   PubMed   PubMed Central   Google Scholar  

Mellat N, Lavasani MG. The role of epistemological beliefs, motivational constructs and Information processing strategies in regulation of learning. Procedia Soc Behav Sci. 2011;30(1):1761–9.

Leavey JE. Youth experiences of living with mental health problems: emergence, loss, adaptation and recovery (ELAR). Can J Community Ment Health. 2009;24(2):109–26.

Simonds LM, Pons RA, Stone NJ, Warren F, John M. Adolescents with anxiety and depression: Is social recovery relevant? Clin Psychol Psychother. 2014;21(4):289–98.

Castonguay LG. Predicting the effect of cognitive therapy for depression: a study of unique and common factors. J Consult Clin Psychol. 1996;64:497–504.

Duncan BL. The heart and soul of change second edition: delivering what works in therapy. Washington: American Psychological Association; 2010.

Book   Google Scholar  

Messer SB. Let’s face facts: common factors are more potent than specific therapy ingredients. Clin Psychol Sci Pract. 2002;9:21–5.

Kazdin AE, Siegel TC, Bass D. Drawing on clinical practice to inform research on child and adolescent psychotherapy: survey of practitioners. Prof Psychol Res Pract. 1990;21(3):189–98.

Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychother Theory Res Pract. 1979;16(3):252–60.

Luong HK, Drummond SPA, Norton PJ. Elements of the therapeutic relationship in CBT for anxiety disorders: a systematic review. J Anxiety Disord. 2020;76:102322. https://doi.org/10.1016/j.janxdis.2020.102322 .

Shick Tryon G, Birch SE, Verkuilen J. Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy. 2018;55(4):372–83.

DiGiuseppe R, Linscott J, Jilton R. Developing the therapeutic alliance in child-adolescent psychotherapy. Appl Prev Psychol. 1996;5(2):85–100.

Hartley S, Redmond T, Berry K. Therapeutic relationships within child and adolescent mental health inpatient services: a qualitative exploration of the experiences of young people, family members and nursing staff Short. PsyArXiv. 2021. https://doi.org/10.31234/osf.io/w2nct .

Wolpert M, Pote I, Sebastian C. Identifying and integrating active ingredients for mental health. Lancet Psychiatry. 2021;8(9):741–3.

INVOLVE. Briefing note for researchers: Public involvement in NHS, public health and social care research [Internet]. 2012. Available from: https://www.invo.org.uk/wp-content/uploads/2012/04/INVOLVEBriefingNotesApr2012.pdf .

Gotschall T. EndNote 20 desktop version. J Med Libr Assoc JMLA. 2021;109(3):520.

PubMed   Google Scholar  

Ouzzani M, Hammady H, Fedorowicz ZEA. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1–10.

Hannes K. Chapter 4: Critical appraisal of qualitative research. In: Njbahkhahjlsl C, editor. Supplementary guidance for inclusion of qualitative research in cochrane systematic reviews of interventions version 1. London: Cochrane Collaboration Qualitative Methods Group; 2011. p. 4.

Bennett LR. Adolescent depression: meeting therapeutic challenges through an integrated narrative approach. J Child Adolesc Psychiatr Nurs. 2012;25(4):184–94.

Berdondini L, Elliott R, Shearer J. Collaboration in experiential therapy. J Clin Psychol. 2012;68(2):159–67.

Diamond GM, Diamond GS, Liddle HA. The therapist–parent alliance in family-based therapy for adolescents. J Clin Psychol. 2000;56(8):1037–50.

Cirasola A, Midgley N, Fonagy P, Martin P, MGoodyer I, Reynolds S, et al. The factor structure of the working alliance inventory short-form in youth psychotherapy: an empirical investigation. Psychother Res. 2021;31(4):535–47. https://doi.org/10.1080/10503307.2020.1765041 .

Feltham A, Martin K, Walker L. Using goals in therapy: the perspective of people with lived experience. In: Cooper M, Law D, editors. Working with goals in psychotherapy and counselling. Oxford: Oxford University Press; 2018. p. 73–85.

Law D, Wolpert M. Guide to using outcomes and feedback tools with children, young people and families. Formally known as the COOP document. London: CAMHS Press; 2014.

Martin K. A critical realist study of shared decision-making in young people’s mental health inpatient units. Bristol: Bristol University Press; 2019.

Hawks JM. Exploring the therapeutic alliance with adolescents and their caregivers: A qualitative approach. Diss Abstr Int Sect A Humanit Soc Sci. 2016;77(4-A(E)):No-Specified. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc13&NEWS=N&AN=2016-37856-098 .

Marks D. Fostering parental growth and enhancing the therapeutic alliance: key tasks for the child psychotherapist. J Child Psychother. 2020;46(1):20–34. https://doi.org/10.1080/0075417X.2020.1743736 .

Shpigel MS, Diamond GM. Good versus poor therapeutic alliances with non-accepting parents of same-sex oriented adolescents and young adults: a qualitative study. Psychother Res. 2014;24(3):376–91. https://doi.org/10.1080/10503307.2013.856043 .

Paul M. Decision-making about children’s health care. Adv Psychiatr Treat. 2004;10:301–11.

Stige SH, Eik I, Oddli HW, Moltu C. Negotiating system requirements to secure client engagement—therapist strategies in adolescent psychotherapy initiated by others. Front Psychol. 2021. https://doi.org/10.3389/fpsyg.2021.704136 .

Marshall SL, Oades LG, Crowe TP. Australian mental health consumers’ contributions to the evaluation and improvement of recovery oriented service provision. Isr J Psychiatry Relat Sci. 2010;47(3):198–205.

Cairns A, Kavanagh D, Dark F, McPhail SM. Setting measurable goals with young people: qualitative feedback from the goal attainment scale in youth mental health. Br J Occup Ther. 2015;78(4):253–9.

Grossoehme DH, Gerbetz L. Adolescent perceptions of meaningfulness of psychiatric hospitalization. Clin Child Psychol Psychiatry. 2004;9(4):589–96.

Dickson JM, Moberly NJ. Goal internalization and outcome expectancy in adolescent anxiety. J Abnorm Child Psychol. 2013;41(3):389–97.

Abrera AM. Depression and suicide risk among adolescents: exploring the moderating role of benevolence and goal-orientation. In: The 6 th ASEAN regional union psychological society (ARUPS) congress “driving mental revolution in the psychological century: enhancing psychological services for a better future. Bali; 2018. p. 56.

Edbrooke-Childs J, Jacob J, Argent R, Patalay P, Deighton JWM. The relationship between child-and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data. Clin Child Psychol Psychiatry. 2016;21(2):324–38.

Edbrooke-Childs J, Patalay P. Ethnic differences in referral routes to youth mental health services. J Am Acad Child Adolesc Psychiatry. 2019;58(3):368–75.

Steinberg L, Silverberg SB. The vicissitudes of autonomy in early adolescence. Child Dev. 1986;57:841–51.

Slavin LA, Rainer KL. Gender differences in emotional support and depressive symptoms among adolescents: a prospective analysis. Am J Community Psychol. 1990;18(3):407–21.

Ciftci A, Jones N, Corrigan PW. Mental health stigma in the muslim community. J Muslim Ment Health. 2013;7(1):17–32.

Bromley C, Westwood S. Young people’s participation: views from young people on using goals. Child Fam Clin Psychol Rev. 2013;1:29–40.

Clarke SP, Oades LG, Crowe TP, Caputi P, Deane FP. The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness. J Ment Health. 2009;18(5):389–97.

Trent ES, Viana AG, Raines EM, Woodward EC, Zvolensky MJCA. Exposure to parental threatening behaviors and internalizing psychopathology in a trauma-exposed inpatient adolescent sample: the role of difficulties with goal-directed behaviors. J Nerv Ment Dis. 2019;207(11):969–76.

Moberly NJ, Watkins ER. Negative affect and ruminative self-focus during everyday goal pursuit. Cogn Emot. 2010;24(4):729–39.

Steen A, Berghuis H, Braam AW. Lack of meaning, purpose and direction in life in personality disorder: a comparative quantitative approach using Livesley’s general assessment of personality disorder. Personal Ment Health. 2019;13(3):144–54.

Wrosch C, Miller GE. Depressive symptoms can be useful: self-regulatory and emotional benefits of dysphoric mood in adolescence. J Pers Soc Psychol. 2009;96(6):1181–90.

Troupp C. Distinguishing patient-generated outcome measures in CAMHS from a bespoke sandwich. Child Fam Clin Psychol Rev. 2013;1(1):19–28.

Taylor J, Shostak L, Rogers A, Mitchell P. Rethinking mental health provision in the secure estate for children and young people: a framework for integrated care (SECURE STAIRS). Safer Communities. 2018;17(4):193–201.

Cheng H, Hayes D, Edbrooke-Childs J, Martin K, Chapman L, Wolpert M. What approaches for promoting shared decision making are used in child mental health? A scoping review. Helen MIR mHealth uHealth. 2017;7(6):77.

Langer DA, Jensen-Doss A. Shared decision-making in youth mental health care: using the evidence to plan treatments collaboratively. J Clin Child Adolesc Psychol. 2018;47(5):821–31.

Coulter A, Edwards A, Elwyn G, Thomson R. Implementing shared decision making in the UK. Z Evid Fortbild Qual Gesundhwes. 2011;105(4):300–4.

Download references

Acknowledgements

The authors would like to thank the advisors, for their invaluable contribution from start to finish, including useful comments an early draft: Duncan Law, Elmas Aybike Yılmaz, Hanne Oddli, Isabella Valério, Jacob People, Josh D., Julian Edbrooke-Childs, Katya Proctor, Laura Calomarde Juárez, Mick Cooper, Nick Morgan, Panos Vostanis, Syeda Zeenat R., and Theo Jackson. Thank you to Bernice Appiah, Shade Davies and Shadia Robertson for helpful discussions about the findings, and assistance with evidence synthesis, and to Inês Pote from the Wellcome Active Ingredients team, and Jasmine Harju-Seppanen, for useful comments on a previous draft. The authors also wish to thank Zoe Thomas for incredibly useful advice and guidance regarding literature searches.

This work was funded by a Wellcome Trust Mental Health Priority Area “Active Ingredients” 2021 commission awarded to JJ at the Anna Freud Centre. It was a requirement of the funding team that the research design comprised a literature review, and that the involved and worked collaboratively with young people with lived experience of anxiety and/or depression throughout the course of the project. Members of the funding team provided feedback on an early draft of this manuscript.

Author information

Authors and affiliations.

Child Outcomes Research Consortium, Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK

Jenna Jacob

Euro Youth Mental Health, The Block, 35 Churchgate, Hitchin, SG5 1DN, UK

Milos Stankovic & Inga Spuerck

Systematic Review Consultants, 9 Sandfield Road, Nottingham, NG7 1QR, UK

Farhad Shokraneh

You can also search for this author in PubMed   Google Scholar

Contributions

JJ conceptualised the study, prepared the first draft protocol and search strategy, refining this with the study authors and advisors. JJ undertook the library database searches for published literature, partially screened the titles and abstracts of literature, screened all full texts, led communication with study authors and advisors, led four advisory group meetings, maintained the databases which were used to extract and manage study data, prepared, and revised the manuscript. MS contributed to the first draft protocol and search strategy, led communication with youth advisors, led two advisory group meetings, created the narrative summaries, and contributed to the manuscript. IS contributed to the first draft protocol and search strategy, supported communication with youth advisors, screened full texts for further relevant literature, and contributed to the manuscript. FS conducted the grey literature searches, screened all potential title and abstracts from all searches (published and unpublished literature), maintained the databases which were used to extract and manage study data, and contributed to the manuscript. All study advisors were invited to comment on the protocol and initial search terms, and were invited to comment on earlier drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jenna Jacob .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval for this research was not required because it does not involve collection nor analysis of primary data, and youth advisors were consulted on in the capacity of being part of the advisory group, to discuss their interpretation of the findings, rather than within the capacity of research participants.

Consent for publication

Not applicable.

Competing interests

JJ works on the Child Outcomes Research Consortium (CORC) project at the Anna Freud National Centre for Children and Families, which encourages the use of outcome measures in youth mental health settings amongst its members. No other authors report any competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1. appendix 1..

Inclusion and exclusion criteria and Search Strategies. Appendix 2 Core Criteria for Quality Assessment of Qualitative Studies.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Jacob, J., Stankovic, M., Spuerck, I. et al. Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis. BMC Psychol 10 , 171 (2022). https://doi.org/10.1186/s40359-022-00879-5

Download citation

Received : 16 March 2022

Accepted : 30 June 2022

Published : 13 July 2022

DOI : https://doi.org/10.1186/s40359-022-00879-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Youth mental health
• Goal setting
• Therapeutic alliance
• Outcome measurement
• Active ingredients
• Goal based outcomes

BMC Psychology

ISSN: 2050-7283

• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Gender and Media Representations: A Review of the Literature on Gender Stereotypes, Objectification and Sexualization

Affiliation.

• 1 Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy.
• PMID: 37239498
• PMCID: PMC10218532
• DOI: 10.3390/ijerph20105770

Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between media representations and gender stereotypes, objectification and sexualization, focusing on their presence in the cultural context. Results show how stereotyping, objectifying and sexualizing representations appear to be still very common across a number of contexts. Exposure to stereotyping representations appears to strengthen beliefs in gender stereotypes and endorsement of gender role norms, as well as fostering sexism, harassment and violence in men and stifling career-related ambitions in women. Exposure to objectifying and sexualizing representations appears to be associated with the internalization of cultural ideals of appearance, endorsement of sexist attitudes and tolerance of abuse and body shame. In turn, factors associated with exposure to these representations have been linked to detrimental effects on physical and psychological well-being, such as eating disorder symptomatology, increased body surveillance and poorer body image quality of life. However, specificities in the pathways from exposure to detrimental effects on well-being are involved for certain populations that warrant further research.

Keywords: gender; media; objectification; representation; sexualization; stereotypes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Similar articles

• Empowering or oppressing? Development and exploration of the Enjoyment of Sexualization Scale. Liss M, Erchull MJ, Ramsey LR. Liss M, et al. Pers Soc Psychol Bull. 2011 Jan;37(1):55-68. doi: 10.1177/0146167210386119. Epub 2010 Oct 14. Pers Soc Psychol Bull. 2011. PMID: 20947776
• Self-subjugation among women: exposure to sexist ideology, self-objectification, and the protective function of the need to avoid closure. Calogero RM, Jost JT. Calogero RM, et al. J Pers Soc Psychol. 2011 Feb;100(2):211-28. doi: 10.1037/a0021864. J Pers Soc Psychol. 2011. PMID: 21186932
• Gender Stereotypes and Discrimination: How Sexism Impacts Development. Brown CS, Stone EA. Brown CS, et al. Adv Child Dev Behav. 2016;50:105-33. doi: 10.1016/bs.acdb.2015.11.001. Epub 2016 Jan 27. Adv Child Dev Behav. 2016. PMID: 26956071 Review.
• The Role of Social Presence in Relationships Among Gender Stereotypes, Sexism, and In-Game Sexual Harassment Among Young Korean Gamers. Oh HJ, Choi MY. Oh HJ, et al. Cyberpsychol Behav Soc Netw. 2023 Jun;26(6):432-439. doi: 10.1089/cyber.2022.0265. Epub 2023 May 24. Cyberpsychol Behav Soc Netw. 2023. PMID: 37222760
• Gender Stereotypes. Ellemers N. Ellemers N. Annu Rev Psychol. 2018 Jan 4;69:275-298. doi: 10.1146/annurev-psych-122216-011719. Epub 2017 Sep 27. Annu Rev Psychol. 2018. PMID: 28961059 Review.
• Martin C.L., Ruble D.N. Patterns of Gender Development. Annu. Rev. Psychol. 2010;61:353–381. doi: 10.1146/annurev.psych.093008.100511. - DOI - PMC - PubMed
• Giles J.W., Heyman G. Young Children’s Beliefs About the Relationship Between Gender and Aggressive Behavior. Child Dev. 2005;76:107–121. doi: 10.1111/j.1467-8624.2005.00833.x. - DOI - PubMed
• Signorella M.L., Bigler R.S., Liben L.S. Developmental Differences in Children’s Gender Schemata about Others: A Meta-analytic Review. Dev. Rev. 1993;13:147–183. doi: 10.1006/drev.1993.1007. - DOI
• Stoller R.J. Sex and Gender. Science House; Sydney, Australia: 1968.
• Eagly A.H., Wood W. Social Role Theory. In: Van Lange P., Kruglanski A., Higgins E., editors. Handbook of Theories of Social Psychology. SAGE Publications Ltd.; Thousand Oaks, CA, USA: 2012. pp. 458–476. - DOI

Publication types

• Search in MeSH

Grants and funding

Linkout - more resources, full text sources.

• Europe PubMed Central
• PubMed Central

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Obstructive sleep apnea and acute lower respiratory tract infections: a narrative literature review.

1. Introduction

2. literature search strategy, 3. obstructive sleep apnea and community-acquired pneumonia, 4. obstructive sleep apnea and influenza pneumonia, 5. obstructive sleep apnea and covid-19 pneumonia, 6. obstructive sleep apnea and lower respiratory tract infections: pathophysiology, 6.1. altered immunity, 6.2. risk of aspiration, 6.3. the role of obesity and other comorbidities, 7. obstructive sleep apnea and lower respiratory tract infections: treatment, 7.1. settings of care and empiric antibiotics, 7.2. specific risks guiding empiric antibiotic therapy, 7.3. antibiotic pharmacokinetics, side effects, and resistance, 8. discussion, 9. conclusions, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

• Benjafield, A.V.; Ayas, N.T.; Eastwood, P.R.; Heinzer, R.; Ip, M.S.M.; Morrell, M.J.; Nunez, C.M.; Patel, S.R.; Penzel, T.; Pépin, J.L.; et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir. Med. 2019 , 7 , 687–698. [ Google Scholar ] [ CrossRef ]
• Heinzer, R.; Vat, S.; Marques-Vidal, P.; Marti-Soler, H.; Andries, D.; Tobback, N.; Mooser, V.; Preisig, M.; Malhotra, A.; Waeber, G.; et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. Lancet Respir. Med. 2015 , 3 , 310–318. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dempsey, J.A.; Veasey, S.C.; Morgan, B.J.; O’Donnell, C.P. Pathophysiology of sleep apnea. Physiol. Rev. 2010 , 90 , 47–112. [ Google Scholar ] [ CrossRef ]
• Eckert, D.J.; Malhotra, A. Pathophysiology of adult obstructive sleep apnea. Proc. Am. Thorac. Soc. 2008 , 5 , 144–153. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Randerath, W.; Bassetti, C.L.; Bonsignore, M.R.; Farre, R.; Ferini-Strambi, L.; Grote, L.; Hedner, J.; Kohler, M.; Martinez-Garcia, M.A.; Mihaicuta, S.; et al. Challenges and perspectives in obstructive sleep apnoea: Report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society. Eur. Respir. J. 2018 , 52 , 1702616. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bonsignore, M.R.; Baiamonte, P.; Mazzuca, E.; Castrogiovanni, A.; Marrone, O. Obstructive sleep apnea and comorbidities: A dangerous liaison. Multidiscip. Respir. Med. 2019 , 14 , 8. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kim, J.Y.; Ko, I.; Kim, D.K. Association of Obstructive Sleep Apnea with the Risk of Affective Disorders. JAMA Otolaryngol. Head. Neck Surg. 2019 , 145 , 1020–1026. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Feldman, C.; Shaddock, E. Epidemiology of lower respiratory tract infections in adults. Expert. Rev. Respir. Med. 2019 , 13 , 63–77. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• International Respiratory Coalition (IRC). Lower Respiratory Tract Infections. Available online: https://international-respiratory-coalition.org/diseases/lower-respiratory-tract-infections/ (accessed on 10 April 2024).
• The Top 10 Causes of Death. Available online: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (accessed on 10 April 2024).
• Docherty, A.B.; Harrison, E.M.; Green, C.A.; Hardwick, H.E.; Pius, R.; Norman, L.; Holden, K.A.; Read, J.M.; Dondelinger, F.; Carson, G.; et al. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ 2020 , 369 , m1985. [ Google Scholar ] [ CrossRef ]
• Mizgerd, J.P. Acute lower respiratory tract infection. N. Engl. J. Med. 2008 , 358 , 716–727. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ludwig, K.; Huppertz, T.; Radsak, M.; Gouveris, H. Cellular Immune Dysfunction in Obstructive Sleep Apnea. Front. Surg. 2022 , 9 , 890377. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Faverio, P.; Zanini, U.; Monzani, A.; Parati, G.; Luppi, F.; Lombardi, C.; Perger, E. Sleep-Disordered Breathing and Chronic Respiratory Infections: A Narrative Review in Adult and Pediatric Population. Int. J. Mol. Sci. 2023 , 24 , 5504. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Keto, J.; Feuth, T.; Linna, M.; Saaresranta, T. Lower respiratory tract infections among newly diagnosed sleep apnea patients. BMC Pulm. Med. 2023 , 23 , 332. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Grant, L.R.; Meche, A.; McGrath, L.; Miles, A.; Alfred, T.; Yan, Q.; Chilson, E. Risk of Pneumococcal Disease in US Adults by Age and Risk Profile. Open Forum Infect. Dis. 2023 , 10 , ofad192. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lutsey, P.L.; Zineldin, I.; Misialek, J.R.; Full, K.M.; Lakshminarayan, K.; Ishigami, J.; Cowan, L.T.; Matsushita, K.; Demmer, R.T. OSA and Subsequent Risk of Hospitalization with Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study. Chest 2023 , 163 , 942–952. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chiner, E.; Llombart, M.; Valls, J.; Pastor, E.; Sancho-Chust, J.N.; Andreu, A.L.; Sánchez-de-la-Torre, M.; Barbé, F. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia. PLoS ONE 2016 , 11 , e0152749. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Su, V.Y.; Liu, C.J.; Wang, H.K.; Wu, L.A.; Chang, S.C.; Perng, D.W.; Su, W.J.; Chen, Y.M.; Lin, E.Y.; Chen, T.J.; et al. Sleep apnea and risk of pneumonia: A nationwide population-based study. CMAJ 2014 , 186 , 415–421. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lindenauer, P.K.; Stefan, M.S.; Johnson, K.G.; Priya, A.; Pekow, P.S.; Rothberg, M.B. Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia. Chest 2014 , 145 , 1032–1038. [ Google Scholar ] [ CrossRef ]
• Beumer, M.C.; Koch, R.M.; van Beuningen, D.; OudeLashof, A.M.; van de Veerdonk, F.L.; Kolwijck, E.; van der Hoeven, J.G.; Bergmans, D.C.; Hoedemaekers, C.W.E. Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality. J. Crit. Care 2019 , 50 , 59–65. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Boattini, M.; Charrier, L.; Almeida, A.; Christaki, E.; Moreira Marques, T.; Tosatto, V.; Bianco, G.; Iannaccone, M.; Tsiolakkis, G.; Karagiannis, C.; et al. Burden of primary influenza and respiratory syncytial virus pneumonia in hospitalised adults: Insights from a 2-year multi-centre cohort study (2017–2018). Intern. Med. J. 2023 , 53 , 404–408. [ Google Scholar ] [ CrossRef ]
• Mok, E.M.; Greenough, G.; Pollack, C.C. Untreated obstructive sleep apnea is associated with increased hospitalization from influenza infection. J. Clin. Sleep Med. 2020 , 16 , 2003–2007. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tsai, M.S.; Chen, H.C.; Li, H.Y.; Tsai, Y.T.; Yang, Y.H.; Liu, C.Y.; Lee, Y.C.; Hsu, C.M.; Lee, L.A. Sleep Apnea and Risk of Influenza-Associated Severe Acute Respiratory Infection: Real-World Evidence. Nat. Sci. Sleep 2022 , 14 , 901–909. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chen, T.Y.; Chang, R.; Chiu, L.T.; Hung, Y.M.; Wei, J.C. Obstructive sleep apnea and influenza infection: A nationwide population-based cohort study. Sleep Med. 2021 , 81 , 202–209. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mashaqi, S.; Lee-Iannotti, J.; Rangan, P.; Celaya, M.P.; Gozal, D.; Quan, S.F.; Parthasarathy, S. Obstructive sleep apnea and COVID-19 clinical outcomes during hospitalization: A cohort study. J. Clin. Sleep Med. 2021 , 17 , 2197–2204. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Maas, M.B.; Kim, M.; Malkani, R.G.; Abbott, S.M.; Zee, P.C. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure. Sleep Breath 2021 , 25 , 1155–1157. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Strausz, S.; Kiiskinen, T.; Broberg, M.; Ruotsalainen, S.; Koskela, J.; Bachour, A.; Palotie, A.; Palotie, T.; Ripatti, S.; Ollila, H.M. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir. Res. 2021 , 8 , e000845. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rögnvaldsson, K.G.; Eyþórsson, E.S.; Emilsson, Ö.I.; Eysteinsdóttir, B.; Pálsson, R.; Gottfreðsson, M.; Guðmundsson, G.; Steingrímsson, V. Obstructive sleep apnea is an independent risk factor for severe COVID-19: A population-based study. Sleep 2022 , 45 , zsab272. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Cade, B.E.; Dashti, H.S.; Hassan, S.M.; Redline, S.; Karlson, E.W. Sleep Apnea and COVID-19 Mortality and Hospitalization. Am. J. Respir. Crit. Care Med. 2020 , 202 , 1462–1464. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pena Orbea, C.; Wang, L.; Shah, V.; Jehi, L.; Milinovich, A.; Foldvary-Schaefer, N.; Chung, M.K.; Mashaqi, S.; Aboussouan, L.; Seidel, K.; et al. Association of Sleep-Related Hypoxia with Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System. JAMA Netw. Open 2021 , 4 , e2134241. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Oh, T.K.; Song, I.A. Impact of coronavirus disease-2019 on chronic respiratory disease in South Korea: An NHIS COVID-19 database cohort study. BMC Pulm. Med. 2021 , 21 , 12. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gottlieb, M.; Sansom, S.; Frankenberger, C.; Ward, E.; Hota, B. Clinical Course and Factors Associated with Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois. Acad. Emerg. Med. 2020 , 27 , 963–973. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kendzerska, T.; Povitz, M.; Gershon, A.S.; Ryan, C.M.; Talarico, R.; Franco Avecilla, D.A.; Robillard, R.; Ayas, N.T.; Pendharkar, S.R. Association of clinically significant obstructive sleep apnoea with risks of contracting COVID-19 and serious COVID-19 complications: A retrospective population-based study of health administrative data. Thorax 2023 , 78 , 933–941. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Peker, Y.; Celik, Y.; Arbatli, S.; Isik, S.R.; Balcan, B.; Karataş, F.; Uzel, F.I.; Tabak, L.; Çetin, B.; Baygül, A.; et al. Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019: A Multicenter, Prospective, Observational Clinical Trial. Ann. Am. Thorac. Soc. 2021 , 18 , 1548–1559. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Girardin, J.L.; Seixas, A.; Ramos Cejudo, J.; Osorio, R.S.; Avirappattu, G.; Reid, M.; Parthasarathy, S. Contribution of pulmonary diseases to COVID-19 mortality in a diverse urban community of New York. Chron. Respir. Dis. 2021 , 18 , 1479973120986806. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gimeno-Miguel, A.; Bliek-Bueno, K.; Poblador-Plou, B.; Carmona-Pírez, J.; Poncel-Falcó, A.; González-Rubio, F.; Ioakeim-Skoufa, I.; Pico-Soler, V.; Aza-Pascual-Salcedo, M.; Prados-Torres, A.; et al. Chronic diseases associated with increased likelihood of hospitalization and mortality in 68,913 COVID-19 confirmed cases in Spain: A population-based cohort study. PLoS ONE 2021 , 16 , e0259822. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Cariou, B.; Hadjadj, S.; Wargny, M.; Pichelin, M.; Al-Salameh, A.; Allix, I.; Amadou, C.; Arnault, G.; Baudoux, F.; Bauduceau, B.; et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: The CORONADO study. Diabetologia 2020 , 63 , 1500–1515. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ioannou, G.N.; Locke, E.; Green, P.; Berry, K.; O’Hare, A.M.; Shah, J.A.; Crothers, K.; Eastment, M.C.; Dominitz, J.A.; Fan, V.S. Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection. JAMA Netw. Open 2020 , 3 , e2022310. [ Google Scholar ] [ CrossRef ]
• Izquierdo, J.L.; Ancochea, J.; Soriano, J.B. Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients with COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing. J. Med. Internet Res. 2020 , 22 , e21801. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lohia, P.; Sreeram, K.; Nguyen, P.; Choudhary, A.; Khicher, S.; Yarandi, H.; Kapur, S.; Badr, M.S. Preexisting respiratory diseases and clinical outcomes in COVID-19: A multihospital cohort study on predominantly African American population. Respir. Res. 2021 , 22 , 37. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Prasad, B.; Mechineni, A.; Talugula, S.; Gardner, J.; Rubinstein, I.; Gordon, H.S. Impact of Obstructive Sleep Apnea on Health Outcomes in Veterans Hospitalized with COVID-19 Infection. Ann. Am. Thorac. Soc. 2024; online ahead of print . [ Google Scholar ] [ CrossRef ]
• Bailly, S.; Galerneau, L.M.; Ruckly, S.; Seiller, A.; Terzi, N.; Schwebel, C.; Dupuis, C.; Tamisier, R.; Mourvillier, B.; Pepin, J.L.; et al. Impact of obstructive sleep apnea on the obesity paradox in critically ill patients. J. Crit. Care 2020 , 56 , 120–124. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bolona, E.; Hahn, P.Y.; Afessa, B. Intensive care unit and hospital mortality in patients with obstructive sleep apnea. J. Crit. Care 2015 , 30 , 178–180. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kim, H.; Webster, R.G.; Webby, R.J. Influenza Virus: Dealing with a Drifting and Shifting Pathogen. Viral Immunol. 2018 , 31 , 174–183. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tyrrell, C.S.; Allen, J.L.Y.; Gkrania-Klotsas, E. Influenza: Epidemiology and hospital management. Medicine 2021 , 49 , 797–804. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Veerapandian, R.; Snyder, J.D.; Samarasinghe, A.E. Influenza in Asthmatics: For Better or for Worse? Front. Immunol. 2018 , 9 , 1843. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rennard, S.; Decramer, M.; Calverley, P.M.; Pride, N.B.; Soriano, J.B.; Vermeire, P.A.; Vestbo, J. Impact of COPD in North America and Europe in 2000: Subjects’ perspective of Confronting COPD International Survey. Eur. Respir. J. 2002 , 20 , 799–805. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Williamson, E.J.; Walker, A.J.; Bhaskaran, K.; Bacon, S.; Bates, C.; Morton, C.E.; Curtis, H.J.; Mehrkar, A.; Evans, D.; Inglesby, P.; et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020 , 584 , 430–436. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Denson, J.L.; Gillet, A.S.; Zu, Y.; Brown, M.; Pham, T.; Yoshida, Y.; Mauvais-Jarvis, F.; Douglas, I.S.; Moore, M.; Tea, K.; et al. Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19. JAMA Netw. Open 2021 , 4 , e2140568. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Miller, M.A.; Cappuccio, F.P. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Med. Rev. 2021 , 55 , 101382. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bellou, V.; Tzoulaki, I.; van Smeden, M.; Moons, K.G.M.; Evangelou, E.; Belbasis, L. Prognostic factors for adverse outcomes in patients with COVID-19: A field-wide systematic review and meta-analysis. Eur. Respir. J. 2022 , 59 , 2002964. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Vardavas, C.I.; Mathioudakis, A.G.; Nikitara, K.; Stamatelopoulos, K.; Georgiopoulos, G.; Phalkey, R.; Leonardi-Bee, J.; Fernandez, E.; Carnicer-Pont, D.; Vestbo, J.; et al. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: A systematic review and meta-analysis of cohort studies in Europe. Eur. Respir. Rev. 2022 , 31 , 220098. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hariyanto, T.I.; Kurniawan, A. Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review and meta-analysis. Sleep Med. 2021 , 82 , 47–53. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hu, M.; Han, X.; Ren, J.; Wang, Y.; Yang, H. Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19: A quantitative meta-analysis based on adjusted effect estimates. Sleep Med. Rev. 2022 , 63 , 101624. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mandel, L.H.; Colleen, G.; Abedian, S.; Ammar, N.; Charles Bailey, L.; Bennett, T.D.; Daniel Brannock, M.; Brosnahan, S.B.; Chen, Y.; Chute, C.G.; et al. Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: An electronic health record-based analysis from the RECOVER initiative. Sleep 2023 , 46 , zsad126. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Labarca, G.; Henríquez-Beltrán, M.; Lamperti, L.; Nova-Lamperti, E.; Sanhueza, S.; Cabrera, C.; Quiroga, R.; Antilef, B.; Ormazábal, V.; Zúñiga, F.; et al. Impact of Obstructive Sleep Apnea (OSA) in COVID-19 Survivors, Symptoms Changes Between 4-Months and 1 Year After the COVID-19 Infection. Front. Med. 2022 , 9 , 884218. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chervin, R.D. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000 , 118 , 372–379. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• O’Mahoney, L.L.; Routen, A.; Gillies, C.; Ekezie, W.; Welford, A.; Zhang, A.; Karamchandani, U.; Simms-Williams, N.; Cassambai, S.; Ardavani, A.; et al. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. eClinicalMedicine 2023 , 55 , 101762. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wulf Hanson, S.; Abbafati, C.; Aerts, J.G.; Al-Aly, Z.; Ashbaugh, C.; Ballouz, T.; Blyuss, O.; Bobkova, P.; Bonsel, G.; Borzakova, S.; et al. Estimated Global Proportions of Individuals with Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA 2022 , 328 , 1604–1615. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Yaffe, K.; Laffan, A.M.; Harrison, S.L.; Redline, S.; Spira, A.P.; Ensrud, K.E.; Ancoli-Israel, S.; Stone, K.L. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 2011 , 306 , 613–619. [ Google Scholar ] [ CrossRef ]
• Huang, L.; Yao, Q.; Gu, X.; Wang, Q.; Ren, L.; Wang, Y.; Hu, P.; Guo, L.; Liu, M.; Xu, J.; et al. 1-year outcomes in hospital survivors with COVID-19: A longitudinal cohort study. Lancet 2021 , 398 , 747–758. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wheaton, A.G.; Perry, G.S.; Chapman, D.P.; Croft, J.B. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005–2008. Sleep 2012 , 35 , 461–467. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Rezaeitalab, F.; Moharrari, F.; Saberi, S.; Asadpour, H.; Rezaeetalab, F. The correlation of anxiety and depression with obstructive sleep apnea syndrome. J. Res. Med. Sci. 2014 , 19 , 205–210. [ Google Scholar ] [ PubMed ]
• Menzler, K.; Mayr, P.; Knake, S.; Cassel, W.; Viniol, C.; Reitz, L.; Tsalouchidou, P.E.; Janzen, A.; Anschuetz, K.; Mross, P.; et al. Undiagnosed obstructive sleep apnea syndrome as a treatable cause of new-onset sleepiness in some post-COVID patients. Eur. J. Neurol. 2024 , 31 , e16159. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Punjabi, N.M.; Caffo, B.S.; Goodwin, J.L.; Gottlieb, D.J.; Newman, A.B.; O’Connor, G.T.; Rapoport, D.M.; Redline, S.; Resnick, H.E.; Robbins, J.A.; et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med. 2009 , 6 , e1000132. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kheirandish-Gozal, L.; Gozal, D. Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int. J. Mol. Sci. 2019 , 20 , 459. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dewan, N.A.; Nieto, F.J.; Somers, V.K. Intermittent hypoxemia and OSA: Implications for comorbidities. Chest 2015 , 147 , 266–274. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kimoff, R.J. Sleep fragmentation in obstructive sleep apnea. Sleep 1996 , 19 , S61–S66. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jun, J.; Savransky, V.; Nanayakkara, A.; Bevans, S.; Li, J.; Smith, P.L.; Polotsky, V.Y. Intermittent hypoxia has organ-specific effects on oxidative stress. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2008 , 295 , R1274–R1281. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Imani, M.M.; Sadeghi, M.; Khazaie, H.; Emami, M.; Sadeghi Bahmani, D.; Brand, S. Evaluation of Serum and Plasma Interleukin-6 Levels in Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression. Front. Immunol. 2020 , 11 , 1343. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Van der Touw, T.; Andronicos, N.M.; Smart, N. Is C-reactive protein elevated in obstructive sleep apnea? A systematic review and meta-analysis. Biomarkers 2019 , 24 , 429–435. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Freund, A.; Orjalo, A.V.; Desprez, P.Y.; Campisi, J. Inflammatory networks during cellular senescence: Causes and consequences. Trends Mol. Med. 2010 , 16 , 238–246. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Santoro, A.; Bientinesi, E.; Monti, D. Immunosenescence and inflammaging in the aging process: Age-related diseases or longevity? Ageing Res. Rev. 2021 , 71 , 101422. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Shukla, S.D.; Walters, E.H.; Simpson, J.L.; Keely, S.; Wark, P.A.B.; O’Toole, R.F.; Hansbro, P.M. Hypoxia-inducible factor and bacterial infections in chronic obstructive pulmonary disease. Respirology 2020 , 25 , 53–63. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Prabhakar, N.R.; Peng, Y.J.; Nanduri, J. Hypoxia-inducible factors and obstructive sleep apnea. J. Clin. Investig. 2020 , 130 , 5042–5051. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Besedovsky, L.; Lange, T.; Born, J. Sleep and immune function. Pflugers Arch. 2012 , 463 , 121–137. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ibarra-Coronado, E.G.; Pantaleón-Martínez, A.M.; Velazquéz-Moctezuma, J.; Prospéro-García, O.; Méndez-Díaz, M.; Pérez-Tapia, M.; Pavón, L.; Morales-Montor, J. The Bidirectional Relationship between Sleep and Immunity against Infections. J. Immunol. Res. 2015 , 2015 , 678164. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dopp, J.M.; Wiegert, N.A.; Moran, J.J.; Muller, D.; Weber, S.; Hayney, M.S. Humoral immune responses to influenza vaccination in patients with obstructive sleep apnea. Pharmacotherapy 2007 , 27 , 1483–1489. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tufik, S.; Andersen, M.L.; Rosa, D.S.; Tufik, S.B.; Pires, G.N. Effects of Obstructive Sleep Apnea on SARS-CoV-2 Antibody Response After Vaccination Against COVID-19 in Older Adults. Nat. Sci. Sleep 2022 , 14 , 1203–1211. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Quach, H.Q.; Warner, N.D.; Ovsyannikova, I.G.; Covassin, N.; Poland, G.A.; Somers, V.K.; Kennedy, R.B. Excessive daytime sleepiness is associated with impaired antibody response to influenza vaccination in older male adults. Front. Cell Infect. Microbiol. 2023 , 13 , 1229035. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dimitrov, S.; Lange, T.; Tieken, S.; Fehm, H.L.; Born, J. Sleep associated regulation of T helper 1/T helper 2 cytokine balance in humans. Brain Behav. Immun. 2004 , 18 , 341–348. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Patel, S.R.; Malhotra, A.; Gao, X.; Hu, F.B.; Neuman, M.I.; Fawzi, W.W. A prospective study of sleep duration and pneumonia risk in women. Sleep 2012 , 35 , 97–101. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Resta, O.; Foschino Barbaro, M.P.; Bonfitto, P.; Talamo, S.; Mastrosimone, V.; Stefano, A.; Giliberti, T. Hypercapnia in obstructive sleep apnoea syndrome. Neth. J. Med. 2000 , 56 , 215–222. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Budhiraja, R.; Siddiqi, T.A.; Quan, S.F. Sleep disorders in chronic obstructive pulmonary disease: Etiology, impact, and management. J. Clin. Sleep Med. 2015 , 11 , 259–270. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Macavei, V.M.; Spurling, K.J.; Loft, J.; Makker, H.K. Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J. Clin. Sleep Med. 2013 , 9 , 879–884. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gates, K.L.; Howell, H.A.; Nair, A.; Vohwinkel, C.U.; Welch, L.C.; Beitel, G.J.; Hauser, A.R.; Sznajder, J.I.; Sporn, P.H. Hypercapnia impairs lung neutrophil function and increases mortality in murine pseudomonas pneumonia. Am. J. Respir. Cell Mol. Biol. 2013 , 49 , 821–828. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhu, Q.; Hua, L.; Chen, L.; Mu, T.; Dong, D.; Xu, J.; Shen, C. Causal association between obstructive sleep apnea and gastroesophageal reflux disease: A bidirectional two-sample Mendelian randomization study. Front. Genet. 2023 , 14 , 1111144. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wu, Z.H.; Yang, X.P.; Niu, X.; Xiao, X.Y.; Chen, X. The relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease: A meta-analysis. Sleep Breath 2019 , 23 , 389–397. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Emilsson, Ö.I.; Bengtsson, A.; Franklin, K.A.; Torén, K.; Benediktsdóttir, B.; Farkhooy, A.; Weyler, J.; Dom, S.; De Backer, W.; Gislason, T.; et al. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: A longitudinal, general population study. Eur. Respir. J. 2013 , 41 , 1347–1354. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• You, C.R.; Oh, J.H.; Seo, M.; Lee, H.Y.; Joo, H.; Jung, S.H.; Lee, S.H.; Choi, M.G. Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population. J. Neurogastroenterol. Motil. 2014 , 20 , 197–204. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hsu, W.T.; Lai, C.C.; Wang, Y.H.; Tseng, P.H.; Wang, K.; Wang, C.Y.; Chen, L. Risk of pneumonia in patients with gastroesophageal reflux disease: A population-based cohort study. PLoS ONE 2017 , 12 , e0183808. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fohl, A.L.; Regal, R.E. Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all? World J. Gastrointest. Pharmacol. Ther. 2011 , 2 , 17–26. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Nguyen, A.T.; Jobin, V.; Payne, R.; Beauregard, J.; Naor, N.; Kimoff, R.J. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep 2005 , 28 , 585–593. [ Google Scholar ] [ CrossRef ]
• Ghannouchi, I.; Speyer, R.; Doma, K.; Cordier, R.; Verin, E. Swallowing function and chronic respiratory diseases: Systematic review. Respir. Med. 2016 , 117 , 54–64. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pizzorni, N.; Radovanovic, D.; Pecis, M.; Lorusso, R.; Annoni, F.; Bartorelli, A.; Rizzi, M.; Schindler, A.; Santus, P. Dysphagia symptoms in obstructive sleep apnea: Prevalence and clinical correlates. Respir. Res. 2021 , 22 , 117. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Teramoto, S.; Sudo, E.; Matsuse, T.; Ohga, E.; Ishii, T.; Ouchi, Y.; Fukuchi, Y. Impaired swallowing reflex in patients with obstructive sleep apnea syndrome. Chest 1999 , 116 , 17–21. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Javaheri, S.; Barbe, F.; Campos-Rodriguez, F.; Dempsey, J.A.; Khayat, R.; Javaheri, S.; Malhotra, A.; Martinez-Garcia, M.A.; Mehra, R.; Pack, A.I.; et al. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J. Am. Coll. Cardiol. 2017 , 69 , 841–858. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gleeson, K.; Eggli, D.F.; Maxwell, S.L. Quantitative aspiration during sleep in normal subjects. Chest 1997 , 111 , 1266–1272. [ Google Scholar ] [ CrossRef ]
• Beal, M.; Chesson, A.; Garcia, T.; Caldito, G.; Stucker, F.; Nathan, C.O. A pilot study of quantitative aspiration in patients with symptoms of obstructive sleep apnea: Comparison to a historic control group. Laryngoscope 2004 , 114 , 965–968. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sato, K.; Chitose, S.I.; Sato, K.; Sato, F.; Ono, T.; Umeno, H. Recurrent aspiration pneumonia precipitated by obstructive sleep apnea. Auris Nasus Larynx 2021 , 48 , 659–665. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Peppard, P.E.; Young, T.; Barnet, J.H.; Palta, M.; Hagen, E.W.; Hla, K.M. Increased prevalence of sleep-disordered breathing in adults. Am. J. Epidemiol. 2013 , 177 , 1006–1014. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jehan, S.; Zizi, F.; Pandi-Perumal, S.R.; Wall, S.; Auguste, E.; Myers, A.K.; Jean-Louis, G.; McFarlane, S.I. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med. Disord. 2017 , 1 , 00019. [ Google Scholar ] [ PubMed ]
• Anderson, M.R.; Shashaty, M.G.S. Impact of Obesity in Critical Illness. Chest 2021 , 160 , 2135–2145. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhao, Y.; Li, Z.; Yang, T.; Wang, M.; Xi, X. Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS ONE 2018 , 13 , e0198669. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kahlon, S.; Eurich, D.T.; Padwal, R.S.; Malhotra, A.; Minhas-Sandhu, J.K.; Marrie, T.J.; Majumdar, S.R. Obesity and outcomes in patients hospitalized with pneumonia. Clin. Microbiol. Infect. 2013 , 19 , 709–716. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Botros, N.; Concato, J.; Mohsenin, V.; Selim, B.; Doctor, K.; Yaggi, H.K. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am. J. Med. 2009 , 122 , 1122–1127. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Peppard, P.E.; Young, T.; Palta, M.; Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. N. Engl. J. Med. 2000 , 342 , 1378–1384. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Marin, J.M.; Carrizo, S.J.; Vicente, E.; Agusti, A.G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet 2005 , 365 , 1046–1053. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gottlieb, D.J.; Yenokyan, G.; Newman, A.B.; O’Connor, G.T.; Punjabi, N.M.; Quan, S.F.; Redline, S.; Resnick, H.E.; Tong, E.K.; Diener-West, M.; et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: The sleep heart health study. Circulation 2010 , 122 , 352–360. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Teodorescu, M.; Broytman, O.; Curran-Everett, D.; Sorkness, R.L.; Crisafi, G.; Bleecker, E.R.; Erzurum, S.; Gaston, B.M.; Wenzel, S.E.; Jarjour, N.N. Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II. J. Allergy Clin. Immunol. Pract. 2015 , 3 , 566–575.e561. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kimmel, P.L.; Miller, G.; Mendelson, W.B. Sleep apnea syndrome in chronic renal disease. Am. J. Med. 1989 , 86 , 308–314. [ Google Scholar ] [ CrossRef ]
• Torres, A.; Peetermans, W.E.; Viegi, G.; Blasi, F. Risk factors for community-acquired pneumonia in adults in Europe: A literature review. Thorax 2013 , 68 , 1057–1065. [ Google Scholar ] [ CrossRef ]
• Naqvi, S.B.; Collins, A.J. Infectious complications in chronic kidney disease. Adv. Chronic Kidney Dis. 2006 , 13 , 199–204. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Viasus, D.; Garcia-Vidal, C.; Manresa, F.; Dorca, J.; Gudiol, F.; Carratalà, J. Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia. J. Infect. 2013 , 66 , 27–33. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Johnsen, R.H.; Heerfordt, C.K.; Boel, J.B.; Dessau, R.B.; Ostergaard, C.; Sivapalan, P.; Eklöf, J.; Jensen, J.S. Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease. BMJ Open Respir. Res. 2023 , 10 , e001726. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Metlay, J.P.; Waterer, G.W.; Long, A.C.; Anzueto, A.; Brozek, J.; Crothers, K.; Cooley, L.A.; Dean, N.C.; Fine, M.J.; Flanders, S.A.; et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am. J. Respir. Crit. Care Med. 2019 , 200 , e45–e67. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kim, M.A.; Park, J.S.; Lee, C.W.; Choi, W.I. Pneumonia severity index in viral community acquired pneumonia in adults. PLoS ONE 2019 , 14 , e0210102. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Restrepo, M.I.; Babu, B.L.; Reyes, L.F.; Chalmers, J.D.; Soni, N.J.; Sibila, O.; Faverio, P.; Cilloniz, C.; Rodriguez-Cintron, W.; Aliberti, S. Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: A multinational point prevalence study of hospitalised patients. Eur. Respir. J. 2018 , 52 , 1701190. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Srivali, N.; Chongnarungsin, D.; Ungprasert, P.; Edmonds, L.C. Two cases of Legionnaires’ disease associated with continuous positive airway pressure therapy. Sleep Med. 2013 , 14 , 1038. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Schnirman, R.; Nur, N.; Bonitati, A.; Carino, G. A case of legionella pneumonia caused by home use of continuous positive airway pressure. SAGE Open Med. Case Rep. 2017 , 5 , 2050313x17744981. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Brady, M.F.; Awosika, A.O.; Sundareshan, V. Legionnaires’ Disease. In StatPearls ; StatPearls Publishing LLC.: Treasure Island, FL, USA, 2024. [ Google Scholar ]
• Kato, H.; Hagihara, M.; Asai, N.; Shibata, Y.; Koizumi, Y.; Yamagishi, Y.; Mikamo, H. Meta-analysis of fluoroquinolones versus macrolides for treatment of legionella pneumonia. J. Infect. Chemother. 2021 , 27 , 424–433. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Cesar, L.; Gonzalez, C.; Calia, F.M. Bacteriologic flora of aspiration-induced pulmonary infections. Arch. Intern. Med. 1975 , 135 , 711–714. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Influenza Antiviral Medications: Summary for Clinicians|CDC. Available online: https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#highrisk (accessed on 4 May 2024).
• People with Certain Medical Conditions|CDC. Available online: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html (accessed on 4 May 2024).
• Zhang, X.B.; Chen, X.Y.; Chiu, K.Y.; He, X.Z.; Wang, J.M.; Zeng, H.Q.; Zeng, Y. Intermittent Hypoxia Inhibits Hepatic CYP1a2 Expression and Delays Aminophylline Metabolism. Evid. Based Complement. Alternat Med. 2022 , 2022 , 2782702. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fradette, C.; Du Souich, P. Effect of hypoxia on cytochrome P450 activity and expression. Curr. Drug Metab. 2004 , 5 , 257–271. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fohner, A.E.; Sparreboom, A.; Altman, R.B.; Klein, T.E. PharmGKB summary: Macrolide antibiotic pathway, pharmacokinetics/pharmacodynamics. Pharmacogenet. Genom. 2017 , 27 , 164–167. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mesarwi, O.A.; Loomba, R.; Malhotra, A. Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease. Am. J. Respir. Crit. Care Med. 2019 , 199 , 830–841. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Elbarbry, F. Vancomycin Dosing and Monitoring: Critical Evaluation of the Current Practice. Eur. J. Drug Metab. Pharmacokinet. 2018 , 43 , 259–268. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Munar, M.Y.; Singh, H. Drug dosing adjustments in patients with chronic kidney disease. Am. Fam. Physician 2007 , 75 , 1487–1496. [ Google Scholar ] [ PubMed ]
• Gorelik, E.; Masarwa, R.; Perlman, A.; Rotshild, V.; Abbasi, M.; Muszkat, M.; Matok, I. Fluoroquinolones and Cardiovascular Risk: A Systematic Review, Meta-analysis and Network Meta-analysis. Drug Saf. 2019 , 42 , 529–538. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Guo, D.; Cai, Y.; Chai, D.; Liang, B.; Bai, N.; Wang, R. The cardiotoxicity of macrolides: A systematic review. Pharmazie 2010 , 65 , 631–640. [ Google Scholar ] [ PubMed ]
• Filippone, E.J.; Kraft, W.K.; Farber, J.L. The Nephrotoxicity of Vancomycin. Clin. Pharmacol. Ther. 2017 , 102 , 459–469. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Frieri, M.; Kumar, K.; Boutin, A. Antibiotic resistance. J. Infect. Public Health 2017 , 10 , 369–378. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• McIsaac, D.I.; Gershon, A.; Wijeysundera, D.; Bryson, G.L.; Badner, N.; van Walraven, C. Identifying Obstructive Sleep Apnea in Administrative Data: A Study of Diagnostic Accuracy. Anesthesiology 2015 , 123 , 253–263. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Steinhauer, K.; Goroncy-Bermes, P. Investigation of the hygienic safety of continuous positive airways pressure devices after reprocessing. J. Hosp. Infect. 2005 , 61 , 168–175. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ortolano, G.A.; Schaffer, J.; McAlister, M.B.; Stanchfield, I.; Hill, E.; Vandenburgh, L.; Lewis, M.; John, S.; Canonica, F.P.; Cervia, J.S. Filters reduce the risk of bacterial transmission from contaminated heated humidifiers used with CPAP for obstructive sleep apnea. J. Clin. Sleep Med. 2007 , 3 , 700–705. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sanner, B.M.; Fluerenbrock, N.; Kleiber-Imbeck, A.; Mueller, J.B.; Zidek, W. Effect of continuous positive airway pressure therapy on infectious complications in patients with obstructive sleep apnea syndrome. Respiration 2001 , 68 , 483–487. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jao, L.Y.; Su, W.L.; Chang, H.C.; Lan, C.C.; Wu, Y.K.; Yang, M.C. Pneumocystis jirovecii pneumonia presenting as a solitary pulmonary granuloma due to unclean continuous positive airway pressure equipment: A case report. J. Clin. Sleep Med. 2022 , 18 , 1717–1721. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Caiano Gil, J.; Calisto, R.; Amado, J.; Barreto, V. Eikenella corrodens and Porphyromonas asaccharolytica pleural empyema in a diabetic patient with obstructive sleep apnea syndrome on noninvasive ventilation. Rev. Port. Pneumol. 2013 , 19 , 76–79. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Patel, S.R. Providing Cleaning Recommendations for Positive Airway Pressure Devices. Ann. Am. Thorac. Soc. 2024 , 21 , 27–29. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mercieca, L.; Pullicino, R.; Camilleri, K.; Abela, R.; Mangion, S.A.; Cassar, J.; Zammit, M.; Gatt, C.; Deguara, C.; Barbara, C.; et al. Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea? Sleep Sci. 2017 , 10 , 28–34. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gavidia, R.; Shieu, M.M.; Dunietz, G.L.; Braley, T.J. Respiratory infection risk in positive airway pressure therapy users: A retrospective cohort study. J. Clin. Sleep Med. 2023 , 19 , 1769–1773. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mutti, C.; Azzi, N.; Soglia, M.; Pollara, I.; Alessandrini, F.; Parrino, L. Obstructive sleep apnea, cpap and COVID-19: A brief review. Acta Biomed. 2020 , 91 , e2020196. [ Google Scholar ] [ CrossRef ]
• Feng, Z.; Glasser, J.W.; Hill, A.N. On the benefits of flattening the curve: A perspective. Math. Biosci. 2020 , 326 , 108389. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Klompas, M.; Baker, M.A.; Rhee, C. Airborne Transmission of SARS-CoV-2: Theoretical Considerations and Available Evidence. JAMA 2020 , 324 , 441–442. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Drummond, M. Sleep labs, lung function tests and COVID-19 pandemic—Only emergencies allowed! Pulmonology 2020 , 26 , 244–245. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Barker, J.; Oyefeso, O.; Koeckerling, D.; Mudalige, N.L.; Pan, D. COVID-19: Community CPAP and NIV should be stopped unless medically necessary to support life. Thorax 2020 , 75 , 367. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sampol, J.; Sáez, M.; Martí, S.; Pallero, M.; Barrecheguren, M.; Ferrer, J.; Sampol, G. Impact of home CPAP-treated obstructive sleep apnea on COVID-19 outcomes in hospitalized patients. J. Clin. Sleep Med. 2022 , 18 , 1857–1864. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pépin, J.L.; Bailly, S.; Borel, J.C.; Logerot, S.; Sapène, M.; Martinot, J.B.; Lévy, P.; Tamisier, R. Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring. Digit. Health 2021 , 7 , 20552076211002957. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pneumococcal Vaccination: Who and When to Vaccinate|CDC. Available online: https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html#adults-19-64 (accessed on 10 April 2024).
• Influenza Vaccination: A Summary for Clinicians|CDC. Available online: https://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm#vaccinated (accessed on 10 April 2024).
• People at Higher Risk of Flu Complications|CDC. Available online: https://www.cdc.gov/flu/highrisk/index.htm (accessed on 10 April 2024).
• Kaku, Y.; Okumura, K.; Padilla-Blanco, M.; Kosugi, Y.; Uriu, K.; Hinay, A.A., Jr.; Chen, L.; Plianchaisuk, A.; Kobiyama, K.; Ishii, K.J.; et al. Virological characteristics of the SARS-CoV-2 JN.1 variant. Lancet Infect. Dis. 2024 , 24 , e82. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Song, X.D.; Yang, G.J.; Jiang, X.L.; Wang, X.J.; Zhang, Y.W.; Wu, J.; Wang, M.M.; Chen, R.R.; He, X.J.; Dong, G.; et al. Seroprevalence of SARS-CoV-2 neutralising antibodies and cross-reactivity to JN.1 one year after the BA.5/BF.7 wave in China. Lancet Reg. Health West. Pac. 2024 , 44 , 101040. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jeworowski, L.M.; Mühlemann, B.; Walper, F.; Schmidt, M.L.; Jansen, J.; Krumbholz, A.; Simon-Lorière, E.; Jones, T.C.; Corman, V.M.; Drosten, C. Humoral immune escape by current SARS-CoV-2 variants BA.2.86 and JN.1, December 2023. Euro Surveill. 2024 , 29 , 2300740. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Troeger, C.; Blacker, B.; Khalil, I.A.; Rao, P.C.; Cao, J.; Zimsen, S.R.M.; Albertson, S.B.; Deshpande, A.; Farag, T.; Abebe, Z.; et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect. Dis. 2018 , 18 , 1191–1210. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ford, N.D.; Patel, S.A.; Narayan, K.M. Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges. Annu. Rev. Public Health 2017 , 38 , 145–164. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Roche, J.; Rae, D.E.; Redman, K.N.; Knutson, K.L.; von Schantz, M.; Gómez-Olivé, F.X.; Scheuermaier, K. Sleep disorders in low- and middle-income countries: A call for action. J. Clin. Sleep Med. 2021 , 17 , 2341–2342. [ Google Scholar ] [ CrossRef ] [ PubMed ]

Share and Cite

Nemet, M.; Vukoja, M. Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review. Antibiotics 2024 , 13 , 532. https://doi.org/10.3390/antibiotics13060532

Nemet M, Vukoja M. Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review. Antibiotics . 2024; 13(6):532. https://doi.org/10.3390/antibiotics13060532

Nemet, Marko, and Marija Vukoja. 2024. "Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review" Antibiotics 13, no. 6: 532. https://doi.org/10.3390/antibiotics13060532

Article Metrics

Article access statistics, supplementary material.

ZIP-Document (ZIP, 196 KiB)

Further Information

Mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals