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Writing Research Papers

• Writing a Literature Review

When writing a research paper on a specific topic, you will often need to include an overview of any prior research that has been conducted on that topic.  For example, if your research paper is describing an experiment on fear conditioning, then you will probably need to provide an overview of prior research on fear conditioning.  That overview is typically known as a literature review.  

Please note that a full-length literature review article may be suitable for fulfilling the requirements for the Psychology B.S. Degree Research Paper .  For further details, please check with your faculty advisor.

Different Types of Literature Reviews

Literature reviews come in many forms.  They can be part of a research paper, for example as part of the Introduction section.  They can be one chapter of a doctoral dissertation.  Literature reviews can also “stand alone” as separate articles by themselves.  For instance, some journals such as Annual Review of Psychology , Psychological Bulletin , and others typically publish full-length review articles.  Similarly, in courses at UCSD, you may be asked to write a research paper that is itself a literature review (such as, with an instructor’s permission, in fulfillment of the B.S. Degree Research Paper requirement). Alternatively, you may be expected to include a literature review as part of a larger research paper (such as part of an Honors Thesis). 

Literature reviews can be written using a variety of different styles.  These may differ in the way prior research is reviewed as well as the way in which the literature review is organized.  Examples of stylistic variations in literature reviews include: 

• Summarization of prior work vs. critical evaluation. In some cases, prior research is simply described and summarized; in other cases, the writer compares, contrasts, and may even critique prior research (for example, discusses their strengths and weaknesses).
• Chronological vs. categorical and other types of organization. In some cases, the literature review begins with the oldest research and advances until it concludes with the latest research.  In other cases, research is discussed by category (such as in groupings of closely related studies) without regard for chronological order.  In yet other cases, research is discussed in terms of opposing views (such as when different research studies or researchers disagree with one another).

Overall, all literature reviews, whether they are written as a part of a larger work or as separate articles unto themselves, have a common feature: they do not present new research; rather, they provide an overview of prior research on a specific topic . 

How to Write a Literature Review

When writing a literature review, it can be helpful to rely on the following steps.  Please note that these procedures are not necessarily only for writing a literature review that becomes part of a larger article; they can also be used for writing a full-length article that is itself a literature review (although such reviews are typically more detailed and exhaustive; for more information please refer to the Further Resources section of this page).

Steps for Writing a Literature Review

1. Identify and define the topic that you will be reviewing.

The topic, which is commonly a research question (or problem) of some kind, needs to be identified and defined as clearly as possible.  You need to have an idea of what you will be reviewing in order to effectively search for references and to write a coherent summary of the research on it.  At this stage it can be helpful to write down a description of the research question, area, or topic that you will be reviewing, as well as to identify any keywords that you will be using to search for relevant research.

2. Conduct a literature search.

Use a range of keywords to search databases such as PsycINFO and any others that may contain relevant articles.  You should focus on peer-reviewed, scholarly articles.  Published books may also be helpful, but keep in mind that peer-reviewed articles are widely considered to be the “gold standard” of scientific research.  Read through titles and abstracts, select and obtain articles (that is, download, copy, or print them out), and save your searches as needed.  For more information about this step, please see the Using Databases and Finding Scholarly References section of this website.

3. Read through the research that you have found and take notes.

Absorb as much information as you can.  Read through the articles and books that you have found, and as you do, take notes.  The notes should include anything that will be helpful in advancing your own thinking about the topic and in helping you write the literature review (such as key points, ideas, or even page numbers that index key information).  Some references may turn out to be more helpful than others; you may notice patterns or striking contrasts between different sources ; and some sources may refer to yet other sources of potential interest.  This is often the most time-consuming part of the review process.  However, it is also where you get to learn about the topic in great detail.  For more details about taking notes, please see the “Reading Sources and Taking Notes” section of the Finding Scholarly References page of this website.

4. Organize your notes and thoughts; create an outline.

At this stage, you are close to writing the review itself.  However, it is often helpful to first reflect on all the reading that you have done.  What patterns stand out?  Do the different sources converge on a consensus?  Or not?  What unresolved questions still remain?  You should look over your notes (it may also be helpful to reorganize them), and as you do, to think about how you will present this research in your literature review.  Are you going to summarize or critically evaluate?  Are you going to use a chronological or other type of organizational structure?  It can also be helpful to create an outline of how your literature review will be structured.

5. Write the literature review itself and edit and revise as needed.

The final stage involves writing.  When writing, keep in mind that literature reviews are generally characterized by a summary style in which prior research is described sufficiently to explain critical findings but does not include a high level of detail (if readers want to learn about all the specific details of a study, then they can look up the references that you cite and read the original articles themselves).  However, the degree of emphasis that is given to individual studies may vary (more or less detail may be warranted depending on how critical or unique a given study was).   After you have written a first draft, you should read it carefully and then edit and revise as needed.  You may need to repeat this process more than once.  It may be helpful to have another person read through your draft(s) and provide feedback.

6. Incorporate the literature review into your research paper draft.

After the literature review is complete, you should incorporate it into your research paper (if you are writing the review as one component of a larger paper).  Depending on the stage at which your paper is at, this may involve merging your literature review into a partially complete Introduction section, writing the rest of the paper around the literature review, or other processes.

Further Tips for Writing a Literature Review

Full-length literature reviews

• Many full-length literature review articles use a three-part structure: Introduction (where the topic is identified and any trends or major problems in the literature are introduced), Body (where the studies that comprise the literature on that topic are discussed), and Discussion or Conclusion (where major patterns and points are discussed and the general state of what is known about the topic is summarized)

Literature reviews as part of a larger paper

• An “express method” of writing a literature review for a research paper is as follows: first, write a one paragraph description of each article that you read. Second, choose how you will order all the paragraphs and combine them in one document.  Third, add transitions between the paragraphs, as well as an introductory and concluding paragraph. 1
• A literature review that is part of a larger research paper typically does not have to be exhaustive. Rather, it should contain most or all of the significant studies about a research topic but not tangential or loosely related ones. 2   Generally, literature reviews should be sufficient for the reader to understand the major issues and key findings about a research topic.  You may however need to confer with your instructor or editor to determine how comprehensive you need to be.

Benefits of Literature Reviews

By summarizing prior research on a topic, literature reviews have multiple benefits.  These include:

• Literature reviews help readers understand what is known about a topic without having to find and read through multiple sources.
• Literature reviews help “set the stage” for later reading about new research on a given topic (such as if they are placed in the Introduction of a larger research paper). In other words, they provide helpful background and context.
• Literature reviews can also help the writer learn about a given topic while in the process of preparing the review itself. In the act of research and writing the literature review, the writer gains expertise on the topic .

Downloadable Resources

• How to Write APA Style Research Papers (a comprehensive guide) [ PDF ]
• Tips for Writing APA Style Research Papers (a brief summary) [ PDF ]
• Example APA Style Research Paper (for B.S. Degree – literature review) [ PDF ]

Further Resources

How-To Videos     

• Writing Research Paper Videos
• UCSD Library Psychology Research Guide: Literature Reviews

External Resources

• Developing and Writing a Literature Review from N Carolina A&T State University
• Example of a Short Literature Review from York College CUNY
• How to Write a Review of Literature from UW-Madison
• Writing a Literature Review from UC Santa Cruz  
• Pautasso, M. (2013). Ten Simple Rules for Writing a Literature Review. PLoS Computational Biology, 9 (7), e1003149. doi : 1371/journal.pcbi.1003149

1 Ashton, W. Writing a short literature review . [PDF]     

2 carver, l. (2014).  writing the research paper [workshop]. , prepared by s. c. pan for ucsd psychology.

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What is a Literature Review?

If this is your first time having to do a literature review, you might be wondering what a "literature review" actually is. Typically, this entails searching through various databases to find peer-reviewed research within a particular topic of interest and then analyzing what you find in order to situate your own research within the existing works.

Watch the following video to learn more:

Video Transcript

What is Peer Review?

Most of your literature review will involve searching for sources that have gone through the peer-reviewed process. These are typically academic articles that have been published in scholarly journals and have been vetted by other experts with knowledge of the topic at hand.

How Do I Find Psychology Literature?

The following database are a great place to start to find relevant, peer-reviewed literature within the broad research area of psychology:

• APA PsycInfo This link opens in a new window From the American Psychological Association (APA), PsycINFO contains nearly 2.3 million citations and abstracts of scholarly journal articles, book chapters, books, and dissertations in psychology and related disciplines. It is the largest resource devoted to peer-reviewed literature in behavioral science and mental health.
• DynaMed This link opens in a new window A clinical reference tool of more than 3000 topics designed for physicians and health care professionals for use primarily at the point-of-care. DynaMed is updated daily and monitors the content of over 500 medical journal and systemic evidence review databases.
• EMBASE This link opens in a new window EMBASE is a major biomedical and pharmaceutical database indexing over 3,500 international journals in the following fields of health sciences and biomedical research. It is considered as the European version of Medline.
• MEDLINE with Full Text This link opens in a new window A bibliographic database that contains more than 26 million references to journal articles in life sciences with a concentration on biomedicine. A distinctive feature of MEDLINE is that the records are indexed with NLM Medical Subject Headings (MeSH®).

• PubMed This link opens in a new window PubMed® comprises more than 30 million citations for biomedical literature from MEDLINE, life science journals, and online books.
• Web of Science This link opens in a new window Web of Science is a comprehensive research database. It contains records of journal articles, patents, and conference proceedings, It also provides a variety of search and analysis tools. Web of Science Core Collection is a painstakingly selected, actively curated database of the journals that researchers themselves have judged to be the most important and useful in their fields
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What is a Literature Review?

Description.

A literature review, also called a review article or review of literature, surveys the existing research on a topic. The term "literature" in this context refers to published research or scholarship in a particular discipline, rather than "fiction" (like American Literature) or an individual work of literature. In general, literature reviews are most common in the sciences and social sciences.

Literature reviews may be written as standalone works, or as part of a scholarly article or research paper. In either case, the purpose of the review is to summarize and synthesize the key scholarly work that has already been done on the topic at hand. The literature review may also include some analysis and interpretation. A literature review is  not  a summary of every piece of scholarly research on a topic.

Why are literature reviews useful?

Literature reviews can be very helpful for newer researchers or those unfamiliar with a field by synthesizing the existing research on a given topic, providing the reader with connections and relationships among previous scholarship. Reviews can also be useful to veteran researchers by identifying potentials gaps in the research or steering future research questions toward unexplored areas. If a literature review is part of a scholarly article, it should include an explanation of how the current article adds to the conversation. (From: https://researchguides.drake.edu/englit/criticism)

How is a literature review different from a research article?

Research articles: "are empirical articles that describe one or several related studies on a specific, quantitative, testable research question....they are typically organized into four text sections: Introduction, Methods, Results, Discussion." Source: https://psych.uw.edu/storage/writing_center/litrev.pdf)

Steps for Writing a Literature Review

1. Identify and define the topic that you will be reviewing.

The topic, which is commonly a research question (or problem) of some kind, needs to be identified and defined as clearly as possible.  You need to have an idea of what you will be reviewing in order to effectively search for references and to write a coherent summary of the research on it.  At this stage it can be helpful to write down a description of the research question, area, or topic that you will be reviewing, as well as to identify any keywords that you will be using to search for relevant research.

2. Conduct a Literature Search

Use a range of keywords to search databases such as PsycINFO and any others that may contain relevant articles.  You should focus on peer-reviewed, scholarly articles . In SuperSearch and most databases, you may find it helpful to select the Advanced Search mode and include "literature review" or "review of the literature" in addition to your other search terms.  Published books may also be helpful, but keep in mind that peer-reviewed articles are widely considered to be the “gold standard” of scientific research.  Read through titles and abstracts, select and obtain articles (that is, download, copy, or print them out), and save your searches as needed. Most of the databases you will need are linked to from the Cowles Library Psychology Research guide .

3. Read through the research that you have found and take notes.

Absorb as much information as you can.  Read through the articles and books that you have found, and as you do, take notes.  The notes should include anything that will be helpful in advancing your own thinking about the topic and in helping you write the literature review (such as key points, ideas, or even page numbers that index key information).  Some references may turn out to be more helpful than others; you may notice patterns or striking contrasts between different sources; and some sources may refer to yet other sources of potential interest.  This is often the most time-consuming part of the review process.  However, it is also where you get to learn about the topic in great detail. You may want to use a Citation Manager to help you keep track of the citations you have found. 

4. Organize your notes and thoughts; create an outline.

At this stage, you are close to writing the review itself.  However, it is often helpful to first reflect on all the reading that you have done.  What patterns stand out?  Do the different sources converge on a consensus?  Or not?  What unresolved questions still remain?  You should look over your notes (it may also be helpful to reorganize them), and as you do, to think about how you will present this research in your literature review.  Are you going to summarize or critically evaluate?  Are you going to use a chronological or other type of organizational structure?  It can also be helpful to create an outline of how your literature review will be structured.

5. Write the literature review itself and edit and revise as needed.

The final stage involves writing.  When writing, keep in mind that literature reviews are generally characterized by a  summary style  in which prior research is described sufficiently to explain critical findings but does not include a high level of detail (if readers want to learn about all the specific details of a study, then they can look up the references that you cite and read the original articles themselves).  However, the degree of emphasis that is given to individual studies may vary (more or less detail may be warranted depending on how critical or unique a given study was).   After you have written a first draft, you should read it carefully and then edit and revise as needed.  You may need to repeat this process more than once.  It may be helpful to have another person read through your draft(s) and provide feedback.

6. Incorporate the literature review into your research paper draft. (note: this step is only if you are using the literature review to write a research paper. Many times the literature review is an end unto itself).

After the literature review is complete, you should incorporate it into your research paper (if you are writing the review as one component of a larger paper).  Depending on the stage at which your paper is at, this may involve merging your literature review into a partially complete Introduction section, writing the rest of the paper around the literature review, or other processes.

These steps were taken from: https://psychology.ucsd.edu/undergraduate-program/undergraduate-resources/academic-writing-resources/writing-research-papers/writing-lit-review.html#6.-Incorporate-the-literature-r

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Annual Review of Psychology

Volume 70, 2019, review article, how to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses.

• Andy P. Siddaway 1 , Alex M. Wood 2 , and Larry V. Hedges 3
• View Affiliations Hide Affiliations Affiliations: 1 Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling FK9 4LA, United Kingdom; email: [email protected] 2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London WC2A 2AE, United Kingdom 3 Department of Statistics, Northwestern University, Evanston, Illinois 60208, USA; email: [email protected]
• Vol. 70:747-770 (Volume publication date January 2019) https://doi.org/10.1146/annurev-psych-010418-102803
• First published as a Review in Advance on August 08, 2018
• Copyright © 2019 by Annual Reviews. All rights reserved

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

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• Article Type: Review Article

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Writing a Literature Review

What is a literature review.

• Research Topic | Research Questions
• Outline (Example)
• What Types of Literature Should I Use in My Review?
• Project Planner: Literature Review
• Writing a Literature Review in Psychology
• Literature Review tips (video)

Table of Contents

• What is a literature review?
• How is a literature review different from a research article?
• The two purposes: describe/compare and evaluate
• Getting started Select a topic and gather articles
• Choose a current, well-studied, specific topic
• Search the research literature
• Read the articles
• Write the literature review
• Structure How to proceed: describe, compare, evaluate

Literature reviews survey research on a particular area or topic in psychology. Their main purpose is to knit together theories and results from multiple studies to give an overview of a field of research.

How is a Literature Review Different from a Research Article?

Research articles:

• are empirical articles that describe one or several related studies on a specific, quantitative, testable research question
• are typically organized into four text sections: Introduction, Methods, Results, Discussion

The Introduction of a research article includes a condensed literature review. Its purpose is to describe what is known about the area of study, with the goal of giving the context and rationale for the study itself. Published literature reviews are called review articles. Review articles emphasize interpretation. By surveying the key studies done in a certain research area, a review article interprets how each line of research supports or fails to support a theory. Unlike a research article, which is quite specific, a review article tells a more general story of an area of research by describing, comparing, and evaluating the key theories and main evidence in that area.

The Two Purposes of a Literature Review

Your review has two purposes:

(1) to describe and compare studies in a specific area of research and

(2) to evaluate those studies. Both purposes are vital: a thorough summary and comparison of the current research is necessary before you can build a strong evaluative argument about the theories tested.

Getting Started

(1) Select a research topic and identify relevant articles.

(2) Read the articles until you understand what about them is relevant to your review.

(3) Digest the articles: Understand the main points well enough to talk about them.

(4) Write the review, keeping in mind your two purposes: to describe and compare, and to evaluate.

SELECT A TOPIC AND COLLECT ARTICLES

Choose a current, well-studied, specific topic.

Pick a topic that interests you. If you're interested in a subject, you're likely to already know something about it. Your interest will help you to choose meaningful articles, making your paper more fun both to write and to read. The topic should be both current and well studied. Your goal is to describe and evaluate recent findings in a specific area of research, so pick a topic that you find in current research journals. Find an area that is well defined and well studied, meaning that several research groups are studying the topic and have approached it from different perspectives. If all the articles you find are from the same research group (i.e., the same authors), broaden your topic or use more general search terms.

You may need to narrow your topic. The subject of a short literature review must be specific enough, yet have sufficient literature on the subject, for you to cover it in depth. A broad topic will yield thousands of articles, which is impossible to survey meaningfully. If you are drowning in articles, or each article you find seems to be about a completely different aspect of the subject, narrow your topic. Choose one article that interests to you and focus on the specific question investigated. For example, a search for ‘teenage alcohol use’ will flood you with articles, but searching for ‘teenage alcohol use and criminal behavior’ will yield both fewer and more focused articles.

You may need to broaden your topic. You need enough articles on your topic for a thorough review of the research. If you’re unable to find much literature on your topic, or if you find articles you want that are not easy to find online, broaden your topic. What’s a more general way to ask your question of interest? For example, if you’re having a hard time finding articles on ‘discrimination against Asian-American women in STEM fields,’ broaden your topic (e.g., ‘academic discrimination against Asian-American women’ or ‘discrimination against women in STEM.’)

Consider several topics, and keep an open mind. Don't fall in love with a topic before you find how much research has been done in that area. By exploring different topics, you may discover something that is newly exciting to you!

Search the Research Literature

Do a preliminary search. Use online databases to search the research literature. If you don’t know how to search online databases, ask your instructor or reference librarian. Reference librarians are invaluable!

Search for helpful articles. Find one or more pivotal articles that can be a foundation for your paper. A pivotal article may be exceptionally well written, contain particularly valuable citations, or clarify relationships between different but related lines of research. Two sources of such articles in psychology are:

• Psychological Bulletin •
• Current Directions in Psychological Science (published by the American Psychological Society) has general, short articles written by scientists who have published a lot in their research area

How many articles? Although published review articles may cite more than 100 articles, literature reviews for courses are often shorter because they present only highlights of a research area and are not exhaustive. A short literature review may survey 7-12 research articles and be about 10-15 pages long. For course paper guidelines, ask your instructor.

Choose representative articles, not just the first ones you find. This consideration is more important than the length of your review.

Choose readable articles. Some research areas are harder to understand than others. Scan articles in the topic areas you are considering to decide on the readability of the research in those areas.

READ THE ARTICLES

To write an effective review, you’ll need a solid grasp of the relevant research. Begin by reading the article you find easiest. Read, re-read, and mentally digest it until you have a conversational understanding of the paper. You don’t know what you know until you can talk about it. And if you can’t talk about it, you won’t be able to write about it.

Read selectively. Don't start by reading the articles from beginning to end. First, read just the Abstract to get an overview of the study.

Scan the article to identify the answers to these “Why-What-What-What” questions:

• Why did they do the study? Why does it matter?
• What did they do?
• What did they find?
• What does it mean?

The previous four questions correspond to these parts of a research article:

• Introduction: the research question and hypotheses

Create a summary sheet of each article’s key points. This will help you to integrate each article into your paper.

TIP: Give Scholarcy a try.

Read for depth. After you understand an article’s main points, read each section in detail for to gain the necessary indepth understanding to compare the work of different researchers.

WRITE THE LITERATURE REVIEW

Your goal is to evaluate a body of literature; i.e., to “identify relations, contradictions, gaps, and inconsistencies” and “suggest next steps to solve the research problem” (APA Publication Manual 2010, p. 10). Begin writing when you have decided on your story and how to organize your research to support that story.

Organization

Organize the literature review to highlight the theme that you want to emphasize – the story that you want to tell. Literature reviews tend to be organized something like this:

Introduction:

• Introduce the research topic (what it is, why does it matter)
• Frame the story: narrow the research topic to the studies you will discuss
• Briefly outline how you have organized the review
• Headings. Use theme headings to organize your argument (see below)
• Describe the relevant parts of each study and explain why it is relevant to the subtopic at hand.
• Compare the studies if need be, to discuss their implications (i.e., your interpretation of what the studies show and whether there are important differences or similarities)
• Evaluate the importance of each study or group of studies, as well as the implications for the subtopic, and where research should go from here (on the level of the subtopic)

Conclusion: Final evaluation, summation and conclusion

Headings. Use headings to identify major sections that show the organization of the paper. (Headings also help you to identify organizational problems while you’re writing.) Avoid the standard headings of research articles (Introduction, Method, Results, Discussion). Use specific, conceptual headings. If you are reviewing whether facial expressions are universally understood, headings might include Studies in Western Cultures and Studies in Non-Western Cultures. Organize your argument into topics that fit under each heading (one or more per heading).

Describe. For each section or subtopic, briefly describe each article or line of research. Avoid sudden jumps betewen broader and narrower ideas. Keep your story in mind to help keep your thoughts connected.

Compare. For each section or topic, compare related studies, if this is relevant to your story. Comparisons may involve the research question, hypotheses, methods, data analysis, results, or conclusions. However, you don’t want to compare everything. That wouldn’t be a story! Which parts are relevant? What evidence supports your arguments? Identifying strengths and weaknesses of each study will help you make meaningful comparisons.

If you're having trouble synthesizing information, you probably don't understand the articles well. Reread sections you don’t understand. Discuss the studies with someone: you don’t know what you know until you can talk about it.

Evaluate. Descriptions/comparisons alone are not illuminating. For each section or topic, evaluate the studies you have reviewed based on your comparisons. Tell your reader what you conclude, and why. Evaluating research is the most subjective part of your paper. Even so, always support your claims with evidence. Evaluation requires much thought and takes on some risk, but without it, your paper is just a book report.

Final evaluation and summation. On a broader scale, relating to your main theme, tell your reader what you conclude and why. Reiterate your main claims and outline the evidence that supports them.

Conclusion. How does your evaluatio change or add to current knowledge in the field field? What future studies are implied by your analysis? How would such studies add to current knowledge of the topic?

The purpose of a literature review is to survey, describe, compare, and evaluate research articles on a particular topic. Choose a current topic that is neither too broad nor too narrow. Find the story that you want to tell. Spend a lot of time reading and thinking before you write. Think critically about the main hypotheses, findings, and arguments in a line of research. Identify areas of agreement among different articles as well as their differences and areas for future study. Expect to revise your review many times to refine your story. A well-written literature review gives the reader a comprehensive understanding of the main findings and remaining questions brought about by research on that topic.

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• > Guide to Publishing in Psychology Journals
• > Writing a Literature Review

Book contents

• Frontmatter
• PART ONE INTRODUCTION
• 1 Writing an Empirical Article
• 2 Writing a Literature Review
• PART TWO PARTS OF AN ARTICLE
• PART THREE DEALING WITH REFEREES
• PART FOUR CONCLUSION

2 - Writing a Literature Review

Published online by Cambridge University Press:  05 February 2012

Writing a literature review requires a somewhat different set of skills than writing an empirical research article. Indeed, some people who are very good at writing empirical research reports are not skilled at composing review papers. What are the characteristics that differentiate literature reviews that are likely to be published and make a difference from those that are difficult to publish and make a limited contribution?

I have been thinking about this topic quite a lot recently. As the current editor of Psychological Bulletin , the literature review journal of the American Psychological Association, I constantly deal with the issue of evaluating review papers. I had written a number of literature reviews myself prior to becoming editor; however, in the process of editing the journal I have had to consolidate what were vague, sometimes unverbalized cognitions regarding the properties of an excellent review into criteria for guiding editorial decisions.

Before writing this chapter, I started to outline my recommendations. As a last step before beginning to write, I read a similar paper written by Daryl Bem that was published in Psychological Bulletin in 1995. I was surprised at how similar Bem's and my ideas were; sometimes he even used the same words that I have used when talking about writing reviews to groups at conferences and to my students. Based on this similarity, one could conclude either that great minds think alike or that there is considerable interrater reliability between people who have been editors about what constitutes a high-quality review paper.

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• Writing a Literature Review
• By Nancy Eisenberg
• Edited by Robert J. Sternberg , Yale University, Connecticut
• Book: Guide to Publishing in Psychology Journals
• Online publication: 05 February 2012
• Chapter DOI: https://doi.org/10.1017/CBO9780511807862.003

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PSY 348/349: Research Methods in Psychology

• APA Style and Citation Managers
• Step 1: Background Information
• Step 2: Literature Review: Psychology-related databases
• Step 3: Literature Review: Other subject databases
• Step 4: Science Search Engines
• Step 5: Tests and Measurements
• Step 6: Statistics
• Step 7: Web sites
• Step 8: Google Scholar

Psychology-related

• APA PsycInfo® This link opens in a new window APA PsycInfo® is an electronic bibliographic database providing abstracts and citations to the scholarly literature in the psychological, social, behavioral, and health sciences. The database includes material of relevance to psychologists and professionals in related fields such as psychiatry, management, business, education, social science, neuroscience, law, medicine, and social work. Updated weekly, APA PsycInfo® provides access to journal articles, books, chapters, and dissertations.
• PTSDpubs (free site) This link opens in a new window PTSDpubs database, covering the Published International Literature On Traumatic Stress, is produced at the National Center for Post-Traumatic Stress Disorder and sponsored by the U.S. Department of Veterans Affairs. Its goal is to include citations to all literature on post-traumatic stress disorder (PTSD) and to also cover these related subjects: acute stress disorder; the assessment, description, prevention, or treatment of any psychiatric disorder; mental health services to a traumatized population; issues of professional ethics, scientific methodology, or public policy relating to traumatized populations.
• PsychiatryOnline This link opens in a new window PsychiatryOnline provides access to: DSM® Library titles including DSM-IV-TR®, DSM-IV-TR® Handbook of Differential Diagnosis, and DSM-IV-TR® Casebook and its Treatment Companion; journals including The American Journal of Psychiatry, Psychiatric Services,Journal of Neuropsychiatry and Clinical Neurosciences, Psychosomatics, and Academic Psychiatry; textbooks including The American Psychiatric Publishing Textbook of Psychiatry, Gabbard’s Treatments of Psychiatric Disorders, Textbook of Psychotherapeutic Treatments, The American Psychiatric Publishing Textbook of Substance Abuse Treatment, Essentials of Clinical Psychopharmacology, and Manual of Clinical Psychopharmacology; American Psychiatric Association Practice Guidelines for the treatment of psychiatric disorders (quick reference [subscribers only] and comprehensive[freely available] versions); self-assessment tools for study, board certification and recertification review, AMA PRA Category 1 CreditsTM, and lifelong learning; clinical & research news from Psychiatric News; and medication information handouts for patients.
• Psychology and Behavioral Sciences Collection This link opens in a new window The Psychology and Behavioral Sciences Collection is a comprehensive database offering 539 full-text titles (515 of which are peer-reviewed) and 541 indexed and abstracted journals (517 of which are peer-reviewed) dating as far back as 1965. The database covers topics such as emotional and behavioral characteristics, psychiatry & psychology, mental processes, anthropology, as well as observational and experimental methods.
• Gale OneFile: Psychology This link opens in a new window Gale OneFile: Psychology provides access to authoritative periodical content supporting research in all fields of psychology, including abnormal, biological, cognitive, comparative, developmental, personality, quantitative, social and all areas of applied psychology.

PsycINFO User Guide

• Quick Reference Guide to PsycINFO on OvidSP (PDF) A reference guide created by the APA.
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Psychology Research Guide

• Literature Review
• Web Resources
• Library Services

Literature Review Overview

A literature review involves both the literature searching and the writing. The purpose of the literature search is to:

• reveal existing knowledge
• identify areas of consensus and debate
• identify gaps in knowledge
• identify approaches to research design and methodology
• identify other researchers with similar interests
• clarify your future directions for research

List above from Conducting A Literature Search , Information Research Methods and Systems, Penn State University Libraries

A literature review provides an evaluative review and documentation of what has been published by scholars and researchers on a given topic. In reviewing the published literature, the aim is to explain what ideas and knowledge have been gained and shared to date (i.e., hypotheses tested, scientific methods used, results and conclusions), the weakness and strengths of these previous works, and to identify remaining research questions: A literature review provides the context for your research, making clear why your topic deserves further investigation.

Before You Search

• Select and understand your research topic and question.
• Identify the major concepts in your topic and question.
• Brainstorm potential keywords/terms that correspond to those concepts.
• Identify alternative keywords/terms (narrower, broader, or related) to use if your first set of keywords do not work.
• Determine (Boolean*) relationships between terms.
• Begin your search.
• Review your search results.
• Revise & refine your search based on the initial findings.

*Boolean logic provides three ways search terms/phrases can be combined, using the following three operators: AND, OR, and NOT.

Search Process

The type of information you want to find and the practices of your discipline(s) drive the types of sources you seek and where you search.

For most research you will use multiple source types such as: annotated bibliographies; articles from journals, magazines, and newspapers; books; blogs; conference papers; data sets; dissertations; organization, company, or government reports; reference materials; systematic reviews; archival materials; curriculum materials; and more. It can be helpful to develop a comprehensive approach to review different sources and where you will search for each. Below is an example approach.

Utilize Current Awareness Services  Identify and browse current issues of the most relevant journals for your topic; Setup email or RSS Alerts, e.g., Journal Table of Contents, Saved Searches

Consult Experts   Identify and search for the publications of or contact educators, scholars, librarians, employees etc. at schools, organizations, and agencies

• Annual Reviews and Bibliographies   e.g., Annual Review of Psychology
• Internet   e.g., Discussion Groups, Listservs, Blogs, social networking sites
• Grant Databases   e.g., Foundation Directory Online, Grants.gov
• Conference Proceedings   e.g., International Psychological Applications Conference and Trends (InPACT), The European Conference on Psychology & the Behavioral Sciences via IAFOR Research Archive
• Newspaper Indexes   e.g., Access World News, Ethnic NewsWatch, New York Times Historical
• Journal Indexes/Databases and EJournal Packages   e.g., PsycArticles, ScienceDirect
• Citation Indexes   e.g., PsycINFO, Psychiatry Online
• Specialized Data   e.g., American College Health Association-National College Health Assessment survey data, Substance Abuse and Mental Health Data Archive
• Book Catalogs – e.g., local library catalog or discovery search, WorldCat
• Library Web Scale Discovery Service  e.g., OneSearch
• Web Search Engines   e.g., Google, Yahoo
• Digital Collections   e.g., Archives & Special Collections Digital Collections, Archives of the History of American Psychology
• Associations/Community groups/Institutions/Organizations   e.g., American Psychological Association

Remember there is no one portal for all information!

Database Searching Videos, Guides, and Examples

• Comprehensive guide to the database
• Sample Searches
• Searchable Fields
• Education topic guide
• Child Development topic guide

ProQuest (platform for ERIC, PsycINFO, and Dissertations & Theses Global databases, among other databases) search videos:

• Basic Search
• Advanced Search
• Search Results
• Performing Basic Searches
• Performing Advanced Searches
• Search Tips

If you are new to research , check out the Searching for Information tutorials and videos for foundational information.

Finding Empirical Studies

In ERIC : Check the box next to “143: Reports - Research” under "Document type" from the Advanced Search page

In PsycINFO : Check the box next to “Empirical Study” under "Methodology" from the Advanced Search page

In OneSearch : There is not a specific way to limit to empirical studies in OneSearch, you can limit your search results to peer-reviewed journals and or dissertations, and then identify studies by reading the source abstract to determine if you’ve found an empirical study or not.

Summarize Studies in a Meaningful Way

The Writing and Public Speaking Center at UM provides not only tutoring but many other resources for writers and presenters. Three with key tips for writing a literature review are:

• Literature Reviews Defined
• Tracking, Organizing, and Using Sources
• Organizing and Integrating Sources

If you are new to research , check out the Presenting Research and Data tutorials and videos for foundational information. You may also want to consult the Purdue OWL Academic Writing resources or APA Style Workshop content.

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The literature review process. From Diana Ridley, The Literature Review: A Step-by-Step Guide for Students (2008), p. 81

For more information about writing a literature review as a senior thesis, see the Bates Psychology Department's Senior Thesis Proposal Guidelines page . Other resources include:

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

Bem, D. J. (1995). Writing a review article for Psychological Bulletin . Psychological Bulletin , 118(2), 172. doi:10.1037/0033-2909.118.2.172

University of Washington Psychology Writing Center.  Writing a Psychology Literature Review (PDF) .

PsycINFO is the premier research tool in psychology. One of its handiest features searching for articles by research methodology, including literature review. From the Advanced Search page, scroll down to the Methodology box in the lower right, and select Literature Review and Systematic Review. Then search the keywords related to your topic.

While many scholarly journals may publish literature reviews, some psychology journals are exclusively or mainly devoted to publishing review articles.  When researching a topic, a relevant literature review is an excellent entry point for understanding concepts and the current state of research.

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Writing a literature review.

Literature reviews analyze and evaluate previously published material on a topic. When they appear in journals, they are referred to as review articles. A systematic review is a kind of review that uses strict methods for identifying and synthesizing previous studies.

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Produced by the Buros Center for Testing at the University of Nebraska, this resource is essential for evaluating contemporary testing instruments. Designed for novices and professionals alike, it contains full-text reviews for test products in psychology, education, business and leadership. In addition, it provides a bibliography to English and Spanish-language tests.

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Finding Review Literature in Databases   |  Systematic Reviews   |  Books on Literature Reviews   |  Research Methodology

Finding Review Literature in Databases

• Annual Reviews Whole journals devoted to literature reviews! While the AnnRev suite does not have a social work title, it does include titles on sociology, psychology, law and social sciences, and organizational psychology that cover social work and social policy.
• Sociological Abstracts + Social Services Abstracts SocAbs isn't consistent in identifying literature reviews. So, add this line to your Advanced Search: AND (literature N/2 review) OR "systematic review" OR "meta-analysis" OR "scoping review" in Anywhere except full text - NOFT If that returns only a few results, modify the search line, changing the field tag from NOFT to Anywhere .
• APA PsycInfo The American Psychological Association's comprehensive indexing and abstracting service for the professional and scholarly literature in psychology and related fields. Coverage is worldwide. Sources are in English and over thirty languages.
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• SAGE Journals This major social sciences publisher's ejournal site offers a post-search filter for Article Type = REVIEW ARTICLE. That article type is very broad, retrieving book reviews and oddities as well as literature reviews and systematic reviews.
• Psychoanalytic Electronic Publishing (PEP) Archive The PEP Archive allows users to search for titles and to read abstracts and extracts of the entire back catalog of journals and classic books in psychoanalysis. (3-5 latest years may not be available)
• Dissertations and Theses Global (ProQuest) Fulltext for US doctoral dissertations and masters theses, 1997-present and sometimes earlier too, with many foreign universities' dissertations and theses too. Dissertations always have literature reviews, to place the dissertation research into its disciplinary context.

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• Campbell Collaboration - Library of Systematic Reviews Systematic reviews in areas such as education, criminal justice, social policy and social care. (The Campbell Collaboration was formally established at a meeting at the University of Pennsylvania on 24-25 February 2000.)
• Cochrane Interactive Learning “Developed by world-leading experts, this course provides over 15 hours of self-directed learning on conducting a complete systematic review process for both new and experienced review authors.” - from resource home page
• Cochrane Library Regularly updated collection of evidence-based medicine databases.
• Cochrane Collaboration Cochrane Reviews are systematic reviews of primary research in human health care and health policy. Since 2011, Cochrane has an official partnership with the WHO.
• RevMan (Cochrane ReviewManager Web) A web-based systematic-review production software. It is required for anyone doing a Cochrane systematic review and is now available for non-Cochrane systematic reviews “to support evidence synthesis development and evidence-based medical education. RevMan Web facilitates the creation of meta-analyses, forest plots, risk-of-bias tables, and other systematic review elements. It is also widely used in learning or training about systematic review production.” Users can access and work on systematic reviews together anywhere.
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Books on Literature Reviews

• "Reviewing the literature" (Project Planner). SAGE Research Methods A brief overview of the lit review process. Individual steps are linked to useful fulltext using SAGE Research Methods's Methods Map.
• "Literature reviews" / Lawrence A. Machi and Brenda T. McEvoy. Oxford Bibliographies : Education, 2016. An annotated bibliography identifying basic works and specialist works on researching and writing literature reviews, albeit with an education research focus.

Research Methodology

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Placebo effects in randomized trials of pharmacological and neurostimulation interventions for mental disorders: An umbrella review

• Nathan T. M. Huneke   ORCID: orcid.org/0000-0001-5981-6707 1 , 2 ,
• Jay Amin   ORCID: orcid.org/0000-0003-3792-0428 1 , 2 ,
• David S. Baldwin 1 , 2 , 3 ,
• Alessio Bellato 4 , 5 ,
• Valerie Brandt   ORCID: orcid.org/0000-0002-3208-2659 5 , 6 ,
• Samuel R. Chamberlain 1 , 2 ,
• Christoph U. Correll   ORCID: orcid.org/0000-0002-7254-5646 7 , 8 , 9 , 10 ,
• Luis Eudave 11 ,
• Matthew Garner 1 , 5 , 12 ,
• Corentin J. Gosling 5 , 13 , 14 ,
• Catherine M. Hill 1 , 15 ,
• Ruihua Hou 1 ,
• Oliver D. Howes   ORCID: orcid.org/0000-0002-2928-1972 16 , 17 , 18 ,
• Konstantinos Ioannidis 1 , 2 ,
• Ole Köhler-Forsberg 19 , 20 ,
• Lucia Marzulli 21 ,
• Claire Reed   ORCID: orcid.org/0000-0003-1385-4729 5 ,
• Julia M. A. Sinclair 1 ,
• Satneet Singh 2 ,
• Marco Solmi   ORCID: orcid.org/0000-0003-4877-7233 5 , 22 , 23 , 24 , 25   na1 &
• Samuele Cortese   ORCID: orcid.org/0000-0001-5877-8075 1 , 5 , 26 , 27 , 28   na1  

Molecular Psychiatry ( 2024 ) Cite this article

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There is a growing literature exploring the placebo response within specific mental disorders, but no overarching quantitative synthesis of this research has analyzed evidence across mental disorders. We carried out an umbrella review of meta-analyses of randomized controlled trials (RCTs) of biological treatments (pharmacotherapy or neurostimulation) for mental disorders. We explored whether placebo effect size differs across distinct disorders, and the correlates of increased placebo effects. Based on a pre-registered protocol, we searched Medline, PsycInfo, EMBASE, and Web of Knowledge up to 23.10.2022 for systematic reviews and/or meta-analyses reporting placebo effect sizes in psychopharmacological or neurostimulation RCTs. Twenty meta-analyses, summarising 1,691 RCTs involving 261,730 patients, were included. Placebo effect size varied, and was large in alcohol use disorder ( g  = 0.90, 95% CI [0.70, 1.09]), depression ( g  = 1.10, 95% CI [1.06, 1.15]), restless legs syndrome ( g  = 1.41, 95% CI [1.25, 1.56]), and generalized anxiety disorder ( d  = 1.85, 95% CI [1.61, 2.09]). Placebo effect size was small-to-medium in obsessive-compulsive disorder ( d  = 0.32, 95% CI [0.22, 0.41]), primary insomnia ( g  = 0.35, 95% CI [0.28, 0.42]), and schizophrenia spectrum disorders (standardized mean change = 0.33, 95% CI [0.22, 0.44]). Correlates of larger placebo response in multiple mental disorders included later publication year (opposite finding for ADHD), younger age, more trial sites, larger sample size, increased baseline severity, and larger active treatment effect size. Most (18 of 20) meta-analyses were judged ‘low’ quality as per AMSTAR-2. Placebo effect sizes varied substantially across mental disorders. Future research should explore the sources of this variation. We identified important gaps in the literature, with no eligible systematic reviews/meta-analyses of placebo response in stress-related disorders, eating disorders, behavioural addictions, or bipolar mania.

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Introduction.

A placebo is an ‘inactive’ substance or ‘sham’ technique that is used as a control for assessing the efficacy of an active treatment [ 1 ]. However, study participants in a placebo control group may experience considerable symptom improvements - a ‘placebo response’ [ 1 , 2 , 3 ]. Statistical artifacts or non-specific effects account for some of the placebo response. For example, many individuals seek treatment and are enrolled in clinical trials while their symptoms are at their worst. Their symptoms will gradually return to their usual severity (‘regression to the mean’), giving the appearance of a placebo response [ 4 ]. Further, it has been suggested that the placebo response is exacerbated due to unreliable ratings as well as baseline symptom severity inflation if raters are aware of severity criteria for entry to a trial [ 5 , 6 ]. Other potential sources of apparent placebo responses include sampling biases caused by the withdrawal of the least improved patients in the placebo arm, non-specific beneficial effects resulting from interactions with staff delivering the trial, environmental effects due to inpatient care during placebo-controlled trials, or other unaccounted for factors, such as dietary or exercise changes during the trial [ 7 , 8 , 9 ]. Nonetheless, there is evidence that placebo administration results in ‘true’ - or non-artefactual - placebo effects, that is, identifiable changes in biological systems [ 1 , 10 , 11 ]. For example, placebo administration is capable of causing immunosuppression [ 12 , 13 ], placebo effects in Parkinson’s disease are driven by striatal dopamine release [ 10 , 14 ], and placebo analgesia is mediated by endogenous opioid release [ 15 , 16 ]. Furthermore, there is evidence that placebo effects in depressive and anxiety disorders are correlated with altered activity in the ventral striatum, orbitofrontal cortex, rostral anterior cingulate cortex, and the default mode network [ 17 ]. The placebo effect size can be increased through the use of verbal suggestions and conditioning procedures, thus suggesting the underlying role of psychological mechanisms including learning and expectations [ 11 , 18 ].

Across age groups, treatment modalities, and diverse mental disorders, biological treatments (pharmacotherapy or neurostimulation) do reduce symptoms [ 19 , 20 , 21 , 22 ], but only a subgroup of patients experience a clinically significant symptom response or enter remission [ 23 , 24 , 25 ]. Furthermore, current medications may also have unfavourable side effects [ 23 , 26 , 27 , 28 , 29 , 30 , 31 ]. Given the high prevalence of mental disorders and their significant socioeconomic burden [ 32 , 33 , 34 ], there is a need to develop more effective and safer psychopharmacologic and neurostimulation treatments. However, in randomized-controlled trials (RCTs), the magnitude of the placebo response may be considerable, which can affect the interpretation of their results [ 35 , 36 , 37 ]. For example, in antipsychotic trials over the past 40 years, placebo response has increased while medication response has remained consistent [ 38 , 39 ]. Consequently, the trial’s ability to statistically differentiate between an active medication and a placebo is diminished [ 40 ]. Indeed, large placebo response rates have been implicated in hindering psychotropic drug development [ 41 , 42 ]. The increased placebo response can also affect larger data synthesis approaches, such as network meta-analysis, in which assumptions about placebo responses (e.g. stability over time) might affect the validity of results [ 43 ].

Improved understanding of participant, trial, and mental disorder-related factors that contribute to placebo response might allow better clinical trial design to separate active treatment from placebo effects. There is a growing body of research, including individual studies and systematic reviews/meta-analyses, examining the placebo response within specific mental disorders [ 35 ]. However, to date, no overarching synthesis of this literature, to detect any similarities or differences across mental disorders, has been published. We therefore carried out an umbrella review of meta-analyses to address this need. We aimed to assess the placebo effect size in RCTs for a range of mental disorders, whether the effect size differs across distinct mental disorders, and identify any correlates of increased placebo effect size or response rate.

The protocol for this systematic umbrella review was pre-registered on the open science framework ( https://osf.io/fxvn4/ ) and published [ 44 ]. Deviations from this protocol, and additions to it, were: eight authors were involved in record screening rather than two; we reported effect sizes pooled across age groups and analyses comparing placebo effect sizes between age groups; and we included a meta-analysis that incorporated trials of dietary supplements as well as medications in autism. For the rationale behind these decisions, see eMethods.

Eight authors (NH, AB, VB, LE, OKF, LM, CR, SS) carried out the systematic review and data extraction independently in pairs. Discrepancies were resolved through consensus or through arbitration by a third reviewer (NH or SCo). We searched, without date or language restrictions, up to 23.10.2022, Medline, PsycInfo, EMBASE + EMBASE Classic, and Web of Knowledge for systematic reviews with or without meta-analyses of RCTs of biological treatments (psychopharmacotherapy or neurostimulation) compared with a placebo or sham treatment in individuals with mental disorders diagnosed according to standardized criteria. The full search strategy is included in eMethods. We also sought systematic reviews of RCTs conducted in patients with sleep-wake disorders, since these disorders are included in the DSM-5 and their core symptoms overlap with those of mental disorders [ 45 ]. We retained systematic reviews with or without meta-analyses that reported within-group changes in symptoms in the placebo arm.

Next, to prevent duplication of data, a matrix containing all eligible systematic reviews/meta-analyses for each category of mental disorder was created. Where there were multiple eligible systematic reviews/meta-analyses for the same disorder and treatment, we preferentially included meta-analyses, and if multiple eligible meta-analyses remained, then we included the one containing the largest number of studies for the same disorder and treatment, in line with recent umbrella reviews [ 46 , 47 ].

Data were extracted by at least two among six reviewers (AB, VB, LE, OKF, CR, SS) independently in pairs via a piloted form. All extracted data were further checked by a third reviewer (NH). See eMethods for a list of extracted data.

Our primary outcome was the pre-post effect size of the placebo/sham related to the condition-specific primary symptom change for each mental disorder. Secondary outcomes included any other reported clinical outcomes in eligible reviews. We report effect sizes calculated within-group from baseline and post-treatment means by meta-analysis authors, including Cohen’s d and Hedges’ g for repeated measures, which account for both mean difference and correlation between paired observations; and standardized mean change, where the average change score is divided by standard deviation of the change scores. We interpreted the effect size in line with the suggestion by Cohen [ 48 ], i.e. small (~0.2), medium (~0.5), or large (~0.8).

In addition, we extracted data regarding potential correlates of increased placebo effect size or response rate (as defined and assessed by the authors of each meta-analysis) in each mental disorder identified through correlation analyses or meta-regression. Where available, results from multivariate analyses were preferred.

The methodological quality of included reviews was assessed by at least two among six reviewers (AB, VB, LE, OKF, NH, CR) independently and in pairs using the AMSTAR-2 tool, a critical appraisal tool that enables reproducible assessments of the conduct of systematic reviews [ 49 ]. The methodological quality of each included review was rated as high, moderate, low, or critically low.

Our initial search identified 6,108 records. After screening titles and abstracts, we obtained and assessed 115 full-text reports (see eResults for a list of articles excluded following full-text assessment, with reasons). Of these, 20 were deemed eligible, and all were systematic reviews with meta-analysis (Fig.  1 ). In total, the 20 included meta-analyses synthesized data from 1,691 RCTs (median 55) involving 261,730 patients (median 5,365). These meta-analyses were published between 2007 and 2022 and involved individuals with the following mental disorders: major depressive disorder (MDD; n  = 6) [ 50 , 51 , 52 , 53 , 54 , 55 ], anxiety disorders ( n  = 4) [ 55 , 56 , 57 , 58 ], schizophrenia spectrum disorders ( n  = 3) [ 38 , 59 , 60 ], alcohol use disorder (AUD; n  = 1) [ 61 ], attention-deficit/hyperactivity disorder (ADHD; n  = 1) [ 62 ], autism spectrum disorders ( n  = 1) [ 63 ], bipolar depression ( n  = 1) [ 64 ], intellectual disability ( n  = 1) [ 65 ], obsessive-compulsive disorder (OCD; n  = 1) [ 66 ], primary insomnia ( n  = 1) [ 67 ], and restless legs syndrome (RLS; n  = 1) [ 68 ].

Twenty meta-analyses were included.

The methodological quality of the included meta-analyses according to AMSTAR-2 ratings was high in two meta-analyses (ADHD and autism), low in four meta-analyses, and critically low in the remaining 14 meta-analyses (Table  1 ). The most common sources of bias that led to downgrading on the AMSTAR-2 were: no list of excluded full-text articles with reasons ( k  = 14), no explicit statement that the protocol was pre-registered ( k  = 14), and no assessment of the potential impact of risk of bias in individual studies on the results ( k  = 13). The full reasoning behind our AMSTAR-2 ratings is included in eResults.

Our first objective was to determine placebo effect sizes across mental conditions. Data regarding within-group placebo efficacy were reported in sixteen of the included meta-analyses [ 38 , 50 , 52 , 53 , 55 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 65 , 66 , 67 , 68 ]. Placebo effect sizes for the primary outcomes ranged from 0.23 to 1.85, with a median of 0.64 (Fig.  2 ). Median heterogeneity across meta-analyses was I 2  = 72%, suggesting a generally high percentage of heterogeneity due to true variation across studies.

Dots represent placebo group effect size while triangles represent active effect size. CI confidence interval, MDD major depressive disorder, GAD generalized anxiety disorder, SAD social anxiety disorder, OCD obsessive-compulsive disorder, g Hedges’ g, d Cohen’s d, SMC standardized mean change, NR not reported.

A detailed description of each meta-analysis included for this objective is included in eResults. Here, we report a summary of these results in order of the greatest number of RCT’s and meta-analyses included per disorder. In MDD, a large within-group placebo effect was observed ( g  = 1.10, 95% CI [1.06, 1.15]), although active medication had an even larger effect size ( g  = 1.49, 95% CI [1.44, 1.53]) [ 50 ]. Similarly, in children and adolescents with MDD, placebo effect size was large ( g  = 1.57, 95% CI [1.36, 1.78]), as was serotonergic medication effect size ( g  = 1.85, 95% CI [1.70, 2.00]) [ 55 ]. In treatment-resistant MDD, the within-group placebo effect size was smaller than in non-treatment-resistant MDD ( g  = 0.89, 95% CI [0.81, 0.98]) [ 52 ]. In neuromodulation trials for MDD, the effect size of sham was g  = 0.80 (95% CI [0.65, 0.95]) [ 53 ]. In this meta-analysis, the effect size was larger for non-treatment-resistant ( g  = 1.28, 95% CI [0.47, 2.97]) compared to treatment-resistant participants (g = 0.50 95% CI [0.03, 0.99]) [ 53 ]. In adults with anxiety disorders, placebo effect sizes varied across disorders, with a medium effect size in panic disorder ( d  = 0.57, 95% CI [0.50, 0.64]) [ 56 ] and large effect sizes in generalized anxiety disorder (GAD) ( d  = 1.85, 95% CI [1.61, 2.09]) and social anxiety disorder (SAD) ( d  = 0.94, 95% CI [0.77, 1.12]) [ 57 ]. Other meta-analyses in children and adolescents and older adults pooled RCTs across anxiety disorders, and found large placebo effect sizes ( g  = 1.03, 95% CI [0.84, 1.21] and d  = 1.06, 95% CI [0.71, 1.42], respectively) [ 55 , 58 ]. In ADHD, placebo effect size was medium-to-large for clinician-rated outcomes (SMC = 0.75, 95% CI [0.67, 0.83]) [ 62 ]. There was additionally a significant negative relationship between placebo effect size and drug-placebo difference (−0.56, p  < 0.01) for self-rated outcomes [ 62 ]. In schizophrenia spectrum disorders, placebo effect size was small-to-medium in antipsychotic RCTs (SMC = 0.33, 95% CI [0.22, 0.44]) [ 38 ] and medium in RCTs focusing specifically on negative symptoms ( d  = 0.64, 95% CI [0.46, 0.83]) [ 60 ]. Placebo effect size in RLS was large when measured via rating scales ( g  = 1.41, 95% CI [1.25, 1.56]), but small ( g  = 0.02 to 0.24) in RCTs using objective outcomes [ 68 ]. In autism, placebo effect sizes were small (SMC ranged 0.23 to 0.36) [ 63 ]. Similarly, placebo effect size was small in OCD ( d  = 0.32, 95% CI [0.22, 0.41]), although larger in children and adolescents ( d  = 0.45, 95% CI [0.35, 0.56]) compared with adults ( d  = 0.27, 95% CI [0.15, 0.38]) [ 66 ]. Placebo effect size was large in AUD ( g  = 0.90, 95% CI [0.70, 1.09]) [ 61 ], small in primary insomnia ( g ranged 0.25 to 0.43) [ 67 ], and medium in intellectual disability related to genetic causes ( g  = 0.47, 95% CI [0.18, 0.76]) [ 65 ].

Our second objective was to examine the correlates of increased placebo response. We included 14 meta-analyses that reported correlates of placebo effect size or response rate through correlation analysis or meta-regression [ 38 , 51 , 53 , 54 , 56 , 57 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 68 ]. The key correlates extracted from these studies are summarized in Table  2 .

Several variables were consistently identified across meta-analyses. Increased number of trial sites was a positive correlate of increased placebo response in MDD [ 51 , 54 ], schizophrenia spectrum disorders [ 59 ], and autism spectrum disorders [ 63 ]. Similarly, increased sample size was positively associated with placebo effect size in schizophrenia spectrum disorders [ 59 ], OCD [ 66 ], and panic disorder [ 56 ]. Later publication or study year was associated with greater placebo response in anxiety disorders [ 56 , 57 ], schizophrenia spectrum disorders [ 38 ], AUD [ 61 ], and OCD [ 66 ] but not in MDD [ 51 ], and with reduced placebo response in ADHD [ 62 ]. Younger age was associated with increased placebo responses in schizophrenia spectrum disorders [ 38 , 59 ] and OCD [ 66 ]. Increased baseline illness severity was associated with increased placebo response in schizophrenia spectrum disorders [ 38 ], ADHD [ 62 ], and AUD [ 61 ]. Increased trial or follow-up duration was positively associated with increased placebo response in MDD [ 51 ], but negatively associated with placebo response in schizophrenia spectrum disorders [ 38 , 60 ] and OCD [ 66 ]. Finally, the effect size of active treatment was positively associated with increased placebo response in neurostimulation trials for MDD [ 53 ], bipolar depression [ 64 ], autistic spectrum disorders [ 63 ], and ADHD [ 62 ].

There were also some variables associated with increased placebo response in single disorders only. Flexible dosing, rather than fixed dosing, was associated with increased placebo response in MDD [ 51 ]. Increased illness duration was associated with reduced placebo response in schizophrenia spectrum disorders [ 38 ]. In RCTs for negative symptoms of schizophrenia, a higher number of active treatment arms was associated with increased placebo response [ 60 ]. A number of treatment administrations was a positive correlate of increased placebo response in patients with AUD [ 61 ]. A low risk of bias in selective reporting was associated with increased placebo response in ADHD [ 62 ]. Finally, a low risk of bias in allocation concealment was associated with increased placebo response in autism [ 63 ].

To our knowledge, this is the first overarching synthesis of the literature exploring the placebo response in RCTs of biological treatments across a broad range of mental disorders. We found that placebo responses were present and detectable across mental disorders. Further, the placebo effect size across these disorders varied between small and large (see Fig.  3 ). Additionally, several variables appeared to be associated with increased placebo effect size or response rate across a number of disorders, while others were reported for individual disorders only.

CI confidence interval, MDD major depressive disorder, GAD generalized anxiety disorder, SAD social anxiety disorder, OCD obsessive-compulsive disorder, g Hedges’ g, d Cohen’s d, SMC standardized mean change.

Our umbrella review distinguishes itself from a recent publication on placebo mechanisms across medical conditions [ 69 ]. Only four systematic reviews of research in mental disorders were included in that recent review [ 69 ], none of which were eligible for inclusion in our umbrella review, as we focus specifically on RCTs in mental disorders. Thus, our current umbrella review synthesizes different literature and is complementary [ 69 ].

We found substantial variation in placebo effect sizes across mental disorders. In GAD, SAD, MDD, AUD, and RLS (for subjective outcomes), placebo effects were large (>0.9), while they were small (approximately 0.3) in OCD, primary insomnia, autism, RLS (for objective outcomes), and schizophrenia spectrum disorders. It is noteworthy that placebo effect size/response rate correlated with active treatment effect size/response rate in many disorders (MDD, bipolar depression, ADHD, and autism). Nonetheless, where reported, active treatment was always superior. This possibly suggests an underlying ‘treatment responsiveness’ of these disorders that can vary in size. Perhaps, the natural history of a disorder is an important factor in ‘responsiveness’, i.e., disorders in which there is greater natural fluctuation in severity will show larger placebo (and active treatment) effect sizes. Supporting this hypothesis, increased trial duration predicted a larger placebo effect size in MDD, a disorder in which the natural course includes improvement [ 31 , 51 , 70 ]. Conversely, in schizophrenia spectrum disorders where improvement (particularly of negative symptoms) is less likely [ 71 ], increased trial and illness duration predicted a smaller placebo effect size [ 38 , 60 ]. However, previous meta-analyses suggest that natural improvement, for example, measured via waiting list control, does not fully account for the placebo effect in depression and anxiety disorders [ 72 , 73 ]. Statistical artifact, therefore, does not seem to fully explain the variation in effect size.

Non-specific treatment mechanisms are likely an additional source of the observed placebo effect. For example, those with treatment-resistant illness might have reduced expectations regarding treatment. This assumption is supported by the subgroup analysis reported by Razza and colleagues showing sham neuromodulation efficacy reduced as the number of previous failed antidepressant trials increased [ 53 ]. Another factor to consider is the outcome measure chosen. For example, the placebo effect size in panic disorder was smaller when calculated with objective or self-report measures compared with clinician-rated measures [ 56 ]. A similar finding was reported in ADHD trials [ 62 ]. Why placebo effect sizes would differ with clinician-rated versus self-rated scales is unclear. This might result from ‘demand characteristics’ (i.e., cues that suggest to a patient how they ‘should’ respond), or unblinding of the rater, or a combination of the two [ 74 , 75 ].

Several correlates of increased placebo response were reported in included meta-analyses. These included a larger sample size, more study sites, a later publication year (but with an opposite finding for ADHD), younger age, and increased baseline illness severity. This might reflect changes in clinical trial methods over time, the potential for increased ‘noise’ in the data with larger samples or more study sites, and, more speculatively, variables associated with increased volatility in symptoms [ 39 , 51 , 76 ]. A more extensive discussion regarding the potential reasons these variables might correlate with, or predict, placebo response is included in the eDiscussion. Although some correlates of increased placebo response were identified, perhaps more pertinently, it is unknown whether these also predict the separation between active treatment and placebo in most mental disorders. Three included meta-analyses did show that as placebo response increases, the likelihood of drug-placebo separation decreases [ 38 , 62 , 64 ]. This suggests correlates of placebo effect size are also correlates of trial success or failure, but this hypothesis needs explicit testing. In addition, few of the meta-analyses we included explored whether correlates of placebo response differed from correlates of active treatment response. For example, in clinical trials for gambling disorder, response to active treatment was predicted by weeks spent in the trial and by baseline severity, while response to placebo was predicted by baseline depressive and anxiety symptoms [ 77 ]. Furthermore, there is evidence that industry sponsorship is a specific correlate of reduced drug-placebo separation in schizophrenia spectrum disorders [ 78 ]. The largest meta-analysis that we included (conducted by Scott et al. [ 50 ]) did not explore correlates of increased placebo response through meta-regression analysis; rather, it was designed specifically to assess the impact of the use of placebo run-in periods in antidepressant trials. The authors found that use of a placebo run-in was associated with reduced placebo response. However, this effect did not enhance sensitivity to detect medication efficacy versus control groups, as trials with placebo run-in periods were also associated with a reduced medication response. Similar effects of placebo run-in were seen in univariate (but not multivariable) models in ADHD, where placebo run-in reduced placebo effect size in youth, but did not affect drug vs placebo difference [ 62 ]. Further work should be undertaken to ascertain whether trial-level correlates (including the use of placebo run-in) differentially explain active treatment or placebo response and whether controlling for these can improve drug-placebo separation.

Our results should be considered in the light of several possible limitations. First, as in any umbrella review, we were limited by the quality of the meta-analyses we included. Our AMSTAR-2 ratings suggest that confidence in the conclusions of most included meta-analyses should be critically low or low. Indeed, several meta-analyses did not assess for publication bias or for bias in included RCTs. This is relevant, as the risk of bias in selective reporting was highlighted as potentially being associated with placebo effect size in ADHD [ 62 ], and might therefore be relevant in other mental disorders. Second, our results are potentially vulnerable to biases or unmeasured confounders present in the included meta-analyses. Third, we attempted to prevent overlap and duplication of information by including only the meta-analyses with the most information. This might, however, have resulted in some data not being included in our synthesis. Fourth, an exploration of the potential clinical relevance of the placebo effect sizes reported here was outside the scope of the current review but should be considered an important question for future research. Finally, the meta-analyses we included encompassed RCTs with different levels of blinding (double-blind, single-blind). Although the majority of trials were likely double-blind, it is possible that different levels of blinding could have influenced placebo effect sizes through effects on expectations. Future analyses of placebo effects and their correlates should either focus on double-blind trials or compare results across levels of blinding. Related to this, the included meta-analyses pooled phase 2 and phase 3 trials (the latter of which will usually follow positive phase 2 trials), which might result in different expectation biases. Therefore, placebo effects should be compared between phase 2 and phase 3 trials in the future.

In this umbrella review, we found placebo effect sizes varied substantially across mental disorders. The sources of this variation remain unknown and require further study. Some variables were correlates of increased placebo response across mental disorders, including larger sample size, higher number of study sites, later publication year (opposite for ADHD), younger age, and increased baseline illness severity. There was also evidence that clinician-rated outcomes were associated with larger placebo effect sizes than self-rated or objective outcomes. We additionally identified important gaps in the literature, with no eligible systematic reviews identified in stress-related disorders, eating disorders, behavioural addictions, or bipolar mania. In relation to these disorders, some analyses have been published but they have not been included in systematic reviews/meta-analyses (e.g. analyses of individual patient data pooled across RCTs in acute mania [ 79 ] or gambling disorder [ 77 , 80 ]) and therefore were not eligible for inclusion here. We also focused on placebo response in RCTs of pharmacotherapies and neurostimulation interventions for mental disorders. We did not include placebo effects in psychosocial interventions, but such an analysis would also be valuable. Future studies should address these gaps in the literature and furthermore should compare findings in placebo arms with active treatment arms, both regarding treatment effect size and its correlates. Gaining additional insights into the placebo response may improve our ability to separate active treatment effects from placebo effects, thus paving the way for potentially effective new treatments for mental disorders.

Data availability

The datasets generated during and/or analysed during the current study are available in the Open Science Framework repository, https://osf.io/fxvn4/ .

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Acknowledgements

Dr Nathan TM Huneke is an NIHR Academic Clinical Lecturer. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution License (CC BY) to any Author Accepted Manuscript version arising from this submission.

Author contributors

NTMH, JA, DSB, SRC, CUC, MG, CMH, RH, ODH, JMAS, MS, and SCo conceptualized the study. NTMH, AB, VB, LE, CJG, OKF, LM, CR, SS, and SCo contributed to data collection, data curation, or data analysis. NTMH, MS, and SCo wrote the first draft of the manuscript. All authors had access to the raw data. All authors reviewed and edited the manuscript and had final responsibility for the decision to submit it for publication.

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These authors contributed equally: Marco Solmi, Samuele Cortese.

Authors and Affiliations

Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK

Nathan T. M. Huneke, Jay Amin, David S. Baldwin, Samuel R. Chamberlain, Matthew Garner, Catherine M. Hill, Ruihua Hou, Konstantinos Ioannidis, Julia M. A. Sinclair & Samuele Cortese

Southern Health NHS Foundation Trust, Southampton, UK

Nathan T. M. Huneke, Jay Amin, David S. Baldwin, Samuel R. Chamberlain, Konstantinos Ioannidis & Satneet Singh

University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

David S. Baldwin

School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia

Alessio Bellato

Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

Alessio Bellato, Valerie Brandt, Matthew Garner, Corentin J. Gosling, Claire Reed, Marco Solmi & Samuele Cortese

Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany

Valerie Brandt

Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany

Christoph U. Correll

Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA

Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA

Faculty of Education and Psychology, University of Navarra, Pamplona, Spain

Luis Eudave

School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

Matthew Garner

Université Paris Nanterre, DysCo Lab, F-92000, Nanterre, France

Corentin J. Gosling

Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100, Boulogne-Billancourt, France

Department of Sleep Medicine, Southampton Children’s Hospital, Southampton, UK

Catherine M. Hill

Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Oliver D. Howes

H Lundbeck A/s, Iveco House, Watford, UK

Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK

Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Ole Köhler-Forsberg

Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark

Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, Bari, Italy

Lucia Marzulli

Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

Marco Solmi

Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada

Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada

School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Solent NHS Trust, Southampton, UK

Samuele Cortese

DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University “Aldo Moro”, Bari, Italy

Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA

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DSB is President of the British Association for Psychopharmacology, Editor of the Human Psychopharmacology journal (for which he receives an editor’s honorarium), and has received royalties from UpToDate. CMH has acted on an expert advisory board for Neurim Pharmaceuticals. ODH is a part-time employee and stockholder of Lundbeck A/s. He has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organized by Angellini, Autifony, Biogen, Boehringer-Ingelheim, Eli Lilly, Heptares, Global Medical Education, Invicro, Jansenn, Lundbeck, Neurocrine, Otsuka, Sunovion, Recordati, Roche and Viatris/Mylan. ODH has a patent for the use of dopaminergic imaging. All other authors declare no competing interests. MS has received honoraria/has been a consultant for Angelini, Lundbeck, and Otsuka. SCo has received honoraria from non-profit associations (BAP, ACAMH, CADDRA) for educational activities and an honorarium from Medice. KI has received honoraria from Elsevier for editorial work. SRC receives honoraria from Elsevier for associate editor roles at comprehensive psychiatry and NBR journals. CUC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic.

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PLACEBO EFFECTS IN RANDOMIZED TRIALS OF PHARMACOLOGICAL AND NEUROSTIMULATION INTERVENTIONS FOR MENTAL DISORDERS: AN UMBRELLA REVIEW SUPPLEMENTARY APPENDIX

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Huneke, N.T.M., Amin, J., Baldwin, D.S. et al. Placebo effects in randomized trials of pharmacological and neurostimulation interventions for mental disorders: An umbrella review. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02638-x

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• Published: 29 June 2024

The 5Cs of positive youth development: their impact on symptoms of depression, anxiety, stress, and emotional distress in Chilean adolescents

• Mauricio Marín-Gutiérrez 1 ,
• Alejandra Caqueo-Urízar 2 ,
• Jenifer Castillo-Francino 3 &
• Carolang Escobar-Soler 1  

BMC Psychology volume  12 , Article number:  372 ( 2024 ) Cite this article

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Effective approaches to addressing mental health challenges faced by adolescents require a deep understanding of the factors contributing to optimal development, well-being, and prosperity. From the perspective of Positive Youth Development (PYD), this study proposes to examine the relationship between the 5Cs of PYD (Competence, Confidence, Connection, Character, and Caring) and symptoms of depression, anxiety, stress, and emotional distress among Chilean adolescents. A quantitative, cross-sectional, non-experimental study was conducted with 425 adolescents (ages 12 to 19, M = 14.95, SD = 1.81) from three Chilean cities: Arica (23%), Alto Hospicio (32%), and Iquique (46%). Data analysis included the use of confirmatory factor analysis (CFA) and structural equation modeling (SEM). The results indicate that two of the 5Cs, Confidence and Connection, have a significant negative direct effect on the four evaluated criterion indicators. These findings contribute to the literature on positive youth development in Latin America and underscore the importance of fostering confidence and connection in interventions aimed at promoting the mental health of adolescents in Chile and in similar contexts.

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Introduction

Adolescence is a crucial period of human development marked by significant physical, psychological, and social changes [ 1 , 2 ]. Factors such as puberty, social pressure, and academic expectations converge to contribute to the complexity of the adolescent individual [ 3 ]. During this stage, it is common for teenagers to explore the boundaries of their world, often engaging in risky behaviors as they embark on the challenging task of consolidating their identity and constructing a life plan [ 4 , 5 ].

The accumulation of stressful events and challenges inherent in their normative development can significantly impact their health, making them more prone to facing various mental health issues [ 6 , 7 ]. Consequently, adolescents constitute a risk population for development of common mental disorders (CMDs), including depressive and anxiety disorders [ 8 , 9 , 10 ].

According to a recent meta-analysis [ 10 ], the overall prevalence of CMDs is estimated to range between 25% and 31% in adolescents. However, these figures must be considered alongside the significant increase in mental health issues during the COVID-19 pandemic lockdown period [ 11 ], where children and adolescents constituted the most affected vulnerable population by preventive measures [ 12 ].

These mental health issues are particularly concerning for society, not only due to their widespread prevalence in adolescents but also because of their long-term consequences and the burden they represent for public health [ 12 ]. Regarding their consequences, experiencing depression during adolescence can interfere with normal development, increasing the risk of facing a wide range of psychosocial problems in adulthood, including depressive and anxiety disorders, as well as alcohol and substance abuse or dependence, and a higher propensity for suicide [ 8 , 13 ]. Similarly, experiencing anxiety carries similar consequences in adulthood due to the high comorbidity between depressive and anxiety disorders [ 14 ].

In terms of their burden on health, the 2019 Global Burden of Disease Study [ 15 ] highlighted that the two most disabling mental disorders worldwide were depressive and anxiety disorders. For the adolescent population in Chile, depressive and anxiety disorders rank among the top three causes of Disability-Adjusted Life Years (DALYs) for ages 10 to 14 years and 15 to 19 years [ 16 ], thus emphasizing the urgent need to address adolescent mental health in the country. Additionally, Quijada et al. [ 17 ] have shown that social inequality exacerbates mental health issues, with Chilean adolescents from lower socio-economic backgrounds facing increased risks due to factors such as poverty and limited access to resources.

This underscores a broader public health crisis, highlighting the critical need to prioritize access to mental health services for adolescents. Despite general awareness, a significant proportion of adolescents with mental health issues continue to lack access to these services, and when they do seek care, not all receive appropriate treatment [ 18 ]. In Chile, Vicente et al. [ 19 ] found that only one-third of children and adolescents with a psychiatric diagnosis received any mental health care, indicating a substantial treatment gap of 66.6%, which further increases to 85% when considering only the formal health system. More recently, Salinas-Contreras et al. [ 20 ] reported that only 16.5% of adolescents had ever used a mental health service for depression, with 9.7% receiving psychological treatment and 2.7% pharmacological treatment.

Given the evident crisis and the inadequacy in the provision of mental health services, the management of adolescent mental health in Chile requires a systemic approach that goes beyond mere clinical response. According to Martínez et al. [ 21 ], it is crucial to develop a comprehensive intervention strategy that not only combines treatment and prevention but also proactively and adaptively addresses the diverse needs of adolescents. This strategy must be flexible and evidence-based, allowing for the optimization of effective practices, adjustment of those that have not yielded results, and exploration of new approaches.

The 5Cs of positive youth development (PYD) and their relationship with mental health

Effectively addressing the complexities and challenges in adolescent mental health requires a deep understanding not only of the risks factors but also of those protective factors that facilitate and promote healthy development [ 2 ]. In this context, the so-called Positive Youth Development (PYD) approach has gained relevance in social and health sciences by detailing the conditions and processes that contribute to optimal development, well-being, prosperity, and success among young people [ 22 , 23 ].

The 5Cs model of PYD proposed by Lerner [ 1 , 24 ], is as one of the most influential frameworks for understanding healthy adolescent development [ 25 , 26 ]. It begins with the concept that young people are individuals with “resources to be developed” rather than incomplete, risky, or problematic beings [ 27 ]. In other words, all young people can thrive and embark on paths of healthy development when their personal strengths align with the support and opportunities provided by their family, peer group, school, and community [ 27 , 28 , 29 , 30 ].

From this understanding, positive development is manifested by the emergence of five internal characteristics, referred to as the “5Cs”, which enable young people to transition healthily into adulthood: (1) Competence, involving a positive view of one’s actions in specific areas such as social, academic, cognitive, and vocational; (2) Confidence, reflecting an internal sense of positive self-esteem and general self-efficacy; (3) Connection, establishing positive bonds with key individuals and institutions for their development (family, peers, school, and community); (4) Character, involving respect for and adherence to sociocultural norms, as well as an ethical and moral sense of right and wrong; and (5) Caring/Compassion, understood as a sense of sympathy and empathy towards others [ 1 , 24 , 26 ]. When these 5Cs are present, young people are less likely to engage in risky behaviors, experience fewer mental health problems, and ultimately develop a “sixth C”, characterized by positive contributions to their immediate context and, ultimately, society [ 27 , 31 ].

Over the last decade, research has shown significant relationships between the 5Cs of PYD and constructs relevant to adolescent well-being and mental health. For instance, in a study involving over 7,000 North American adolescents, Geldhof et al. [ 32 ]. observed that both positive youth development (PYD) and the 5Cs correlated with relevant criterion measures, such as depressive symptoms and behavioral problems. Consistently, a study in Ireland found that PYD was related to decreased depressive symptoms and risky behaviors, while also being associated with greater contribution [ 33 ]. In Norway, researchers found that the 5Cs were positively correlated with life satisfaction and empowerment and negatively correlated with depressive and anxiety symptoms [ 22 ]. On the other hand, Kozina et al. [ 34 ]. conducted a study with Portuguese, Slovenian, and Spanish adolescents, finding significant associations between the 5Cs of PYD and anxiety. More recently, Novak et al. [ 35 ]. conducted a study with Croatian adolescents, reporting positive associations between the 5Cs and mental well-being, as well as negative associations with emotional/mental distress. The latter is understood as a measure of vulnerability to different mental disorders, including depression, anxiety, and stress [ 36 , 37 ].

In general, the results suggest that the 5Cs of positive youth development contribute to a lower risk of experiencing mental health problems among adolescents. However, it is important to note that most of these findings come from samples that can be considered WEIRD (an acronym for ‘Western, Educated, Industrialized, Rich, and Democratic’), meaning they are primarily composed of individuals from Western, highly educated, industrialized, wealthy, and democratic societies. This raises concerns about the generalizability of these results to more diverse populations [ 38 ].

While research on the Lerner model in non-Western contexts is on the rise [ 39 , 40 , 41 ], empirical evidence concerning the 5Cs of Positive Youth Development within Latin American settings remains scarce. Only recently have a few studies begun to explore Lerner’s proposition of the 5Cs. For example, Tirrell et al. [ 42 ] provided evidence of their relationship with spirituality and hope among Salvadorian youth, Domínguez Espinosa et al. [ 43 ] linked them to healthy lifestyle behaviors in Mexican adolescents, and Manrique-Millones et al. [ 44 ] associated them with depressive symptoms among university students in Peru. Furthermore, an expanded version of the model, the 7Cs, was examined by Manrique-Millones et al. [ 45 ], which found consistent correlations with risky behaviors such as alcohol and drug use, violence, and suicide attempts among youth in Colombia and Peru. Regarding the Chilean context, the study of 5Cs of PYD initiated with the linguistic adaptation of the PYD-Scale Short Form by Marín-Gutiérrez et al. [ 46 ], which provided initial evidence of validity, internal consistency, and significant links with self-esteem, anxiety, and depression; however, there are no further studies.

Despite these initial findings, none of the previous studies have investigated the specific behaviors of each of the Cs of PYD in relation to various specific and general indicators of emotional distress. Moreover, given the cultural diversity across Latin American countries, it is expected that young people will exhibit differences in their personal experiences, worldviews, resources, and opportunities [ 25 , 28 ]. Therefore, it remains pertinent to continue questioning whether the 5Cs model and the positive outcomes derived from its theoretical foundation also apply to Chilean adolescents.

In this regard, the present study aims to contribute to fill the existing gap in the scientific literature by understanding the mechanisms that promote mental health among adolescents. Specifically, it explores the relationship between the 5Cs of Positive Youth Development and four indicators of mental health problems: depression, anxiety, stress, and emotional distress, in a sample of Chilean adolescents. The central research question is: How are the 5Cs of Positive Youth Development related to various indicators of emotional distress in Chilean adolescents? To address this question, the following hypotheses are proposed:

H1: The 5Cs of PYD are negatively associated with depression.

H2: The 5Cs of PYD are negatively associated with anxiety.

H3: The 5Cs of PYD are negatively associated with stress.

H4: The 5Cs of PYD are negatively associated with emotional distress.

Study design

The study corresponds to a quantitative, non-experimental, cross-sectional research design with correlational-explanatory scope. The subjects of the study were adolescents enrolled in secondary education in the Arica and Parinacota and Tarapacá regions in Northern Chile. The sampling method was non-probabilistic and purposive, implying that participants were selected based on their accessibility.

Participants

The sample consisted of 425 adolescents, all of whom were students from subsidized private schools Footnote 1 in three cities in Northern Chile: 97 from Arica (23%), 134 from Alto Hospicio (32%), and 194 from Iquique (46%). The ages of the participants ranged from 12 to 19 years (M = 14.95; SD = 1.81). Regarding their gender, 172 identified as male (40.5%), 238 as female (56%), 6 as transgender male (1.4%), one as transgender female (0.2%), and 8 as non-binary (1.9%). In terms of family structure, 217 (51.3%) came from two-parent families, 184 (43.5%) from single-parent families, and 22 (5.2%) from other family arrangements (adolescents living with relatives other than their parents). Regarding ethnicity, 333 (78.7%) reported no ethnic affiliation, while 90 (21.3%) identified with an ethnic group, specifically 56 (13.2%) as Aymara, 14 (3.3%) as Mapuche, 10 (2.4%) as Diaguita, and 9 (2.1%) from other Indigenous groups. The nationalities of the participants were as follows: 376 (88.9%) Chilean, 17 (4.0%) Bolivian, 13 (3.1%) Peruvian, 7 (1.7%) Venezuelan, and 10 (2.4%) from other countries.

Variables and instruments

5cs of positive youth development.

The Positive Youth Development Scale - Short Form (PYD-SF) [ 47 ], adapted into Spanish for Chilean adolescents [ 46 ] was used to assess the 5Cs of Lerner’s positive youth development model [ 1 , 24 ]: Competence, Confidence, Connection, Character, and Caring/Compassion. The instrument uses a five-point Likert-type response format ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). It is worth noting that the adapted version of the PYD-SF consists of 33 items instead of the original 34-item scale, as item 5 (“I hardly ever do things I know I shouldn’t do”) was discarded due to the absence of significant factorial saturation with the hypothesized dimension [ 39 ]. However, to adhere to best measurement practices, its content was readapted (“I avoid doing things I know are wrong”) to keep its original structure of 34 items. The psychometric properties of the 34-item version of the PYD-SF for this sample were satisfactory and are reported in the results section.

Depression, anxiety, and stress

To assess indicators of emotional distress, the Depression, Anxiety, and Stress Scales (DASS-21) [ 36 ], adapted for use in Chilean adolescents [ 48 ], were used. The DASS-21 is an instrument that evaluates the presence of symptoms of depression, anxiety, and stress from a dimensional perspective of these psychological disorders. It features four response alternatives in Likert format, ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much, or most of the time). Each scale consists of seven items, and the total score is obtained by summing the items corresponding to that scale, with a score range from 0 to 21 points. Regarding its internal consistency, the coefficients obtained for the present sample are reported in the results section.

This research received approval from the Scientific Ethics Committee of the Universidad de Tarapacá (CEC-UTA). Contact was established with educational institutions, and technical meetings were held with school principals and teachers from the participating schools. After coordinating available dates for the study, the following was obtained: (a) authorization through informed consent from parents, guardians, and tutors; (b) informed assent from those students who chose to participate voluntarily. The purpose of the study, procedures, and participants’ rights were explained to guardians in parent meetings and to students before the questionnaires were administered. Data collection took place within the school premises, in sessions with an average duration of 30 min, using paper-and-pencil format, conducted collectively and assisted, always supervised by at least one of the researchers. Finally, questionnaire responses were transferred to electronic format using a spreadsheet to build the database for analysis.

Data analysis

Preliminary statistical analyses were conducted using the Jamovi 2.5 statistical package [ 49 ] to describe data central tendency, dispersion, and distribution shape, and to assess univariate normality using the Shapiro-Wilk test (W). The internal consistency reliability of the scales was examined by calculating Cronbach’s alpha (α) and McDonald’s omega (ω) coefficients, with values above 0.70 considered acceptable. Subsequently, a series of confirmatory factor analyses (CFA) and structural equation models (SEM) were conducted using Mplus software v.8.2 [ 50 ]. To evaluate model adequacy for the study sample, a model with five correlated factors and a refined version including observed variables from the PYD-SF [ 46 ] were estimated. For the DASS-21 indicators, two models were estimated: a three-correlated factors model previously reported in a study with Chilean secondary school students [ 48 ] and a bifactor model with a general factor named “emotional distress” and three specific factors [ 37 ]. Two structural equation models (SEM) were then performed to test study hypotheses, one for depression, anxiety, and stress, and the other for emotional distress (see Fig.  1 ), using the five dimensions of the PYD-SF as independent variables. Both CFA and SEM used the Weighted Least Squares Mean and Variance (WLSMV) estimation method [ 51 ]. Model fit was assessed using multiple indicators: a ratio of χ²/df < 5, RMSEA < 0.08, CFI and TLI > 0.90 indicated acceptable fit, while a ratio of χ²/df < 2, RMSEA < 0.06, CFI and TLI > 0.95 indicated excellent fit [ 52 , 53 ] Additionally, a SRMR < 0.08 was considered indicative of acceptable fit between the hypothesized model and the observed data [ 54 ].

Analyzed Structural Equation Models (SEM) of the 5Cs of Positive Youth Development on Criterion Variables. Note : Observed variables have been omitted to facilitate the schematic representation of structural equation models (SEM). M1 represents the hypothesized relationship of the 5Cs of PYD on depression (DEP), anxiety (ANX), and stress (STR). M2 represents the hypothesized relationship of the 5Cs of PYD on emotional distress (EMO)

Preliminary analysis

Table  1 presents descriptive statistics, univariate normality, and alpha and omega coefficients for each dimension of the PYD-SF and the DASS-21. The proportion of valid cases exceeded 96.9% for all variables under analysis. Shapiro-Wilk test results were significant, indicating that the variables did not follow a normal distribution. Additionally, alpha and omega coefficients were above 0.70, indicating good internal consistency across all evaluated dimensions.

Measurement models

Goodness-of-fit indices for the measurement models of the PYD-SF and DASS-21 are presented in Table  2 . Regarding the PYD-SF, the correlated five-factor model (5 F in Table  2 ) exhibited unsatisfactory fit (χ2/df = 3.887, RMSEA = 0.084 (90% CI = 0.080 – 0.088), CFI = 0.891, TLI = 0.882, and SRMR = 0.081). However, guided by the analyses of Marín-Gutiérrez et al. [ 46 ] and modification indices proposed by the statistical report, we proceeded to examine a refined version of the model. The re-specification of the correlated five-factor model of the PYD-SF (5 F* in Table  2 ) adequately fit the data (χ2/df = 3.049, RMSEA = 0.071 (90% CI = 0.067 – 0.075), CFI = 0.923, TLI = 0.916, and SRMR = 0.074), showing a significant improvement compared to its predecessor model (χ2Δ = 287.493, df = 3, p  < .001). Item factor loadings were significant for each factor ( p  < .001) and ranged from 0.438 to 0.916. Meanwhile, correlations between factors were significant ( p  < .001) and direct (competence × character = 0.578; competence × confidence = 0.783; competence × compassion = 0.195; competence × connection = 0.814; character × confidence = 0.481; character × compassion = 0.780; character × connection = 0.654; confidence × connection = 0.763; compassion × connection = 0.369). The lowest correlation was observed between the confidence and compassion factors ( r  = .093, p  = .049). Regarding the DASS-21, two measurement models were evaluated. Firstly, the theoretical model of three correlated factors (3 F in Table  2 ) was tested, which exhibited satisfactory fit (χ2/df = 3.066, RMSEA = 0.071 [90% CI = 0.064 – 0.077], CFI = 0.977, TLI = 0.974, and SRMR = 0.038). The factor loadings for this measurement model were significant ( p  < .001) and ranged between 0.487 and 0.923. The factors obtained significant ( p  < .001) and high-magnitude direct correlations (depression × anxiety = 0.856; depression × stress = 0.844; anxiety × stress = 0.943). Secondly, the fit of a bifactor model (BF in Table  2 ) was explored, characterized by a general factor of emotional distress and three specific factors. This latter model demonstrated an excellent fit to the data (χ2/df = 1.991, RMSEA = 0.049 [90% CI = 0.041 – 0.057], CFI = 0.990, TLI = 0.988, and SRMR = 0.027). The factor loadings of emotional distress were significant in all its items ( p  < .001) and ranged from 0.484 to 0.867. The factor saturation of the specific factors was lower (FL > 0.103 and < 0.724) and not significant in five of its elements: item 2, 7, and 9 for anxiety, and item 8 and 18 for stress.

Structural equation models (SEM)

The 5Cs of PYD and the indicators of mental health problems (depression, anxiety, stress, and emotional distress) are represented as latent variables in their respective structural models (see Fig.  1 ). Each latent variable is estimated from its respective indicators: (a) the 5Cs of PYD are estimated with 34 observed variables; (b) the specific dimensions of the DASS-21 with seven variables each; (c) the general factor of the DASS-21 with 21 variables. The overall fit of the SEMs is presented in Table  3 . Both models, M1 and M2, showed satisfactory fit to the data. M1, which represents the relationship between the 5Cs of PYD (competence, character, confidence, compassion, and connection) on the three specific dimensions of the DASS-21, exhibited good fit, with indicators such as CFI and TLI surpassing the threshold of 0.95, and an RMSEA within acceptable limits (χ2 = 2502.803, df = 1399, p  < .001, χ2/df = 1.788, CFI = 0.957, TLI = 0.954, RMSEA = 0.044 [90% CI: 0.041–0.047], SRMR = 0.061). This model explained a significant change in the variance of depression symptoms (43.1%, p  < .001), anxiety (36.5%, p  < .001), and stress (31.3%, p  < .001). Similarly, M2, which explores the relationship between the dimensions of 5 C of PYD and the general factor of the DASS-21, also showed a solid fit to the data (χ2 = 2469.694, df = 1398, p  < .001, χ2/df = 1.766, CFI = 0.958, TLI = 0.955, RMSEA = 0.044 [90% CI: 0.041–0.046], SRMR = 0.061), explaining 39.4% of the variance in emotional distress ( p  < .001).

Table  4 displays the standardized effects of the 5Cs of PYD on the dependent latent variables of both structural models (M1 and M2). Examination of the observed effects revealed that confidence has a significant direct effect on depression (-0.498, p  < .001), anxiety (-0.342, p  < .001), stress (-0.263, p  < .001), and emotional distress (-0.406, p  < .001). Similarly, connection has a significant direct effect, although somewhat weaker, on depression (-0.241, p  < .05), anxiety (-0.309, p  < .05), stress (-0.316, p  < .05), and emotional distress (-0.292, p  < .01). In M1, caring also stands out for its direct and positive effect on stress symptoms (0.376, p  < .05).

The purpose of this study was to investigate the impact of the 5Cs of positive youth development (PYD) on depression, anxiety, stress, and emotional distress among Chilean adolescents. The results suggest that only two out of the 5Cs of PYD demonstrate significant associations with the four indicators of mental health problems examined.

The evaluation of the dimensionality of the Positive Youth Development-Short Form Scale (PYD-SF) followed the recommendation of Marín-Gutiérrez et al. [ 46 ], which involved the readaptation of the content of item 5 before subjecting it to confirmatory factor analysis (CFA). Following the CFA, examination of modification indices suggested a re-specification of the model, involving the addition of parameters such as the covariation of errors between three pairs of items: (a) items 3 and 19 (Confidence), referring to perceptions of physical and/or athletic self-efficacy; (b) items 14 and 31 (Connection), related to support provided by the school environment; and (c) items 17 and 34 (Connection), concerning positive peer relationships. These adjustments to the model were consistent with those previously reported by Tomé et al. [ 55 ] with Portuguese adolescents, and Marín-Gutiérrez et al. [ 46 ] with Chilean adolescents. Moreover, subsequent analysis of the internal consistency of the instrument proved to be satisfactory, yielding alpha and omega coefficients equal to or greater than 0.73. Taken together, these findings provide evidence regarding the utility of the PYD-SF in consistently evaluating the 5Cs model of positive development in samples of Chilean adolescents.

The factorial analysis of the DASS-21 satisfactorily replicated the theoretical three-factor structure (depression, anxiety, and stress), as also evidenced by Mella et al. [ 48 ] in a sample of high school students from Southern Chile. As an innovation to the study of the internal validity of the DASS-21 in Chilean adolescent population, a bifactor model with a general factor and three specific factors proposed by Valencia [ 37 ] in his study with university students from Peru was examined. In this regard, the general factor, termed Emotional Distress (EMO), is operationalized as a latent factor in which the scores of the 21 items of the instrument saturate. The fit of the bifactor model was excellent and suggests that the dimensions of the DASS-21 can be interpreted both as three specific dimensions (depression, anxiety, and stress) and as a global dimension of EMO. In this sense, EMO can be understood as a measure of vulnerability to different mental health problems characterized by negative affective states [ 35 , 37 ].

The structural models provided evidence that partially supports the hypotheses regarding the relationship between the 5Cs of PYD and the four indicators of mental health problems included in the study. Specifically, models M1 and M2 demonstrated that two of the 5Cs (confidence and connection) exert a direct negative effect on depression, anxiety, stress, and emotional distress. This implies that adolescents who report high levels of self-confidence and maintain positive and stable bonds with key individuals and institutions in their context are less likely to experience symptoms of emotional distress. The effect of confidence and connection on these indicators aligns with recent research conducted by Novak et al. [ 35 ], where they examined the discriminant validity of the 5Cs model in Croatia. In this study, the depression, anxiety, and stress scales of the DASS-21 were used as criterion variables, along with a latent variable reflected through the total scores of each scale. However, unlike this research, the present study did not demonstrate the expected protective effect of the remaining 5Cs: competence, character, and caring.

Unexpectedly, it was identified that caring has a positive direct effect on symptoms of stress in adolescents, suggesting that young people who demonstrate compassion towards others’ problems may experience tension, irritability, and fatigue as a direct consequence of their caregiving efforts. Although this study does not address the role of gender in the expression of compassion by adolescents, reflection on traditional gender roles offers a possible interpretation of these results. Historically, women have more frequently assumed caregiving roles, thus facing a significant emotional and physical burden. This raises the question of whether the internalization of such gender roles could be exacerbating stress experiences among adolescents actively engaged in caregiving tasks, perhaps due to pressure to adhere to social norms and the emotional demands associated with caregiving. However, such considerations will need to be explored in future research.

These results suggest variability in the contribution of each dimension of PYD to adolescents’ mental health, which could be explained by differences of various kinds. These include cultural aspects, such as expectations, values, and sociocultural norms associated with youth; socioeconomic factors, such as access to resources and opportunities that shape adolescents’ developmental trajectories and, consequently, their mental health; the school system and the educational project of educational institutions, which could affect how PYD dimensions are promoted and experienced; and environmental elements, such as geography, climate, and community relationship structures.

Supporting these explanations, recent international studies compiled in the Positive Youth Development Handbook by Dimitrova and Wiium [ 38 ], suggest that young people around the world differ in how the 5Cs are configured and expressed, and that these differences are shaped by the sociocultural context in which they are immersed. However, in the Latin American context, it is necessary to continue gathering more data to begin questioning whether theoretical models of positive youth development should be proposed that are more rooted in the cultural realities of adolescents or to continue searching for models that establish general regularities in this population.

In relation to the situation in Chile, where the 5Cs model of positive development has received little attention from researchers, the findings of this study provide support for the proposal by Lerner [ 1 , 24 ]. The identification of the specific role that each of the 5Cs plays in mental health problems suggests that psychosocial interventions aimed at reducing adolescents’ vulnerability to experiencing symptoms of depression, anxiety, stress, and emotional distress should prioritize strengthening both adolescents’ self-confidence and the positive connections they maintain with others. This underscores the need to adopt a comprehensive approach to addressing adolescents’ mental health [ 2 ].

Integrating the principles of the 5Cs into both school and community mental health programs would enable more effective outcomes in protecting mental health and enhancing adolescent development. This approach includes strategies that strengthen the dimensions of Confidence and Connection by: (1) establishing systems that recognize and celebrate adolescents’ achievements and efforts, not only in academics but also in extracurricular and personal activities; (2) conducting workshops on self-awareness and personal development to help students explore their identity, identify their strengths and areas for improvement, and foster a positive self-view; (3) offering parent workshops that educate about adolescent development, conflict management, and effective communication techniques to improve the quality of parent-child relationships; (4) organizing family activities such as cultural fairs and sports days to promote effective alliances between families and schools; and (5) implementing community service projects that engage students in initiatives benefiting the local community, fostering a sense of responsibility and belonging among youth.

Regarding the strengths of the study, it must be acknowledged that the research adds knowledge to the literature on positive youth development and mental health in adolescents, especially in the Chilean context, where research on the 5Cs has been limited. Additionally, it employs advanced statistical analyses, such as confirmatory factor analysis (CFA) and structural equation modeling (SEM), to evaluate the dimensionality and proposed relationships in the theoretical framework. In line with this, the findings provide contextualized guidance for the development of psychosocial interventions aimed at promoting the mental health of Chilean adolescents.

As for its limitations, it is important to note that its cross-sectional design makes it difficult to draw causal conclusions about the interrelationship between the 5Cs and the examined criterion indicators. Additionally, the use of a convenience sample to obtain these results invites interpreting the findings with some caution regarding their generalizability. Finally, obtaining data on mental health problems through self-reporting may introduce perception biases, as some participants, especially younger ones, may have difficulty accurately assessing their own experiences and behaviors.

Future research could significantly mitigate the limitations presented in this study by accumulating evidence through replicating the research with samples of adolescents from diverse geographical locations in Chile or Latin America. The adoption of longitudinal designs would allow capturing temporal dynamics and offering a deeper understanding of the causal relationships between the 5Cs and indicators of mental health problems. Additionally, to enhance the validity of the data, it is suggested to complement the information on symptoms provided by adolescents by incorporating measures of hetero-report obtained from parents and/or teachers. Moreover, it is desirable to extend the line of research to explore the role played by the 5Cs in relation to other mental health problems that were not considered in the present study, including behavioral problems, substance abuse and/or dependence, and eating disorders. Additionally, investigating the influence of the model on other positive outcomes, such as psychological well-being, prosocial behavior, and academic achievement, would allow for a more comprehensive understanding of the influence of the 5Cs on the mental health and overall development of adolescents.

Data availability

The data analyzed in this research cannot be shared publicly at this time. This decision is based on the fact that the data in question are a critical part of an ongoing doctoral project led by the corresponding author. Since the research is still in progress, releasing the data at this stage could compromise the integrity and outcomes of the doctoral project.

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The present article is part of the doctoral research project of the first author, who is funded by the National Agency for Research and Development (ANID) of Chile, through its Doctoral National Scholarship program (Year 2021, File No. 21210257). The research also received funding from ANID PIA CIE160007, the Center for Educational Justice (CJE).

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M.M-G. and A.C-U. conceptualized the study. M.M-G. was responsible for the methodology development, formal analysis, and data curation. M.M-G. and J.C-F. conducted the investigation process, including data collection. A.C-U. provided supervision and project administration. M.M-G. and A.C-U. acquired the funding. The original draft of the manuscript was written by M.M-G., and all authors participated in reviewing and editing it. All authors have reviewed and approved the final manuscript.

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Marín-Gutiérrez, M., Caqueo-Urízar, A., Castillo-Francino, J. et al. The 5Cs of positive youth development: their impact on symptoms of depression, anxiety, stress, and emotional distress in Chilean adolescents. BMC Psychol 12 , 372 (2024). https://doi.org/10.1186/s40359-024-01863-x

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Positive and negative impacts of gamification on the fitness industry.

1. Introduction

2. materials and methods, 2.1. search strategy, 2.2. inclusion and exclusion criteria, 2.3. descriptive analysis of articles, 3.1. positive effects of gamification, 3.2. negative effects of gamification, 3.3. challenges of gamification usage in the fitness, 3.4. recommendations for fitness gamification applications proposed by the literature.

• Understanding user motivations and social needs: Understanding users’ primary psychological motivators and social needs in designing gamified fitness apps [ 43 ].
• Data security: Improve user data security, as fitness apps typically capture user data. When third-party corporations or organizations track and store performance data, there is a danger that this data will be exploited or hacked somehow [ 14 ]. Therefore, there is a need to improve safety from data theft significantly.
• Usability improvements: Fixing technical issues and bugs to improve the usability of gamified fitness apps and make them more engaging [ 8 ].
• Gender inclusivity: Well-structured design of gamified apps in a way that appeals to both male and female users, especially in self-monitoring drivers [ 39 ].
• Personalization: Apps that deliver messages tailored to each individual to suggest realistic and individualized goals [ 44 ].
• User-centric analysis: Qualitative and quantitative analysis should identify how gamified interventions affect different user demographics in a user-centered design approach [ 45 ], especially the most vulnerable or at risk of negative effects [ 36 ], e.g., older adults, before implementation.
• Improved accessibility: Providing better access to clear and concise information and simplifying interaction with the app, especially for older adults, benefitting [ 45 ].

4. Discussion

5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Ozdamli, F.; Milrich, F. Positive and Negative Impacts of Gamification on the Fitness Industry. Eur. J. Investig. Health Psychol. Educ. 2023 , 13 , 1411-1422. https://doi.org/10.3390/ejihpe13080103

Ozdamli F, Milrich F. Positive and Negative Impacts of Gamification on the Fitness Industry. European Journal of Investigation in Health, Psychology and Education . 2023; 13(8):1411-1422. https://doi.org/10.3390/ejihpe13080103

Ozdamli, Fezile, and Fulbert Milrich. 2023. "Positive and Negative Impacts of Gamification on the Fitness Industry" European Journal of Investigation in Health, Psychology and Education 13, no. 8: 1411-1422. https://doi.org/10.3390/ejihpe13080103

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