peer review research practice

Peer review templates, expert examples and free training courses

Joanna Wilkinson

Learning how to write a constructive peer review is an essential step in helping to safeguard the quality and integrity of published literature. Read on for resources that will get you on the right track, including peer review templates, example reports and the Web of Science™ Academy: our free, online course that teaches you the core competencies of peer review through practical experience ( try it today ).

How to write a peer review

Understanding the principles, forms and functions of peer review will enable you to write solid, actionable review reports. It will form the basis for a comprehensive and well-structured review, and help you comment on the quality, rigor and significance of the research paper. It will also help you identify potential breaches of normal ethical practice.

This may sound daunting but it doesn’t need to be. There are plenty of peer review templates, resources and experts out there to help you, including:

Peer review training courses and in-person workshops

• Peer review templates ( found in our Web of Science Academy )
• Expert examples of peer review reports
• Co-reviewing (sharing the task of peer reviewing with a senior researcher)

Other peer review resources, blogs, and guidelines

We’ll go through each one of these in turn below, but first: a quick word on why learning peer review is so important.

Why learn to peer review?

Peer reviewers and editors are gatekeepers of the research literature used to document and communicate human discovery. Reviewers, therefore, need a sound understanding of their role and obligations to ensure the integrity of this process. This also helps them maintain quality research, and to help protect the public from flawed and misleading research findings.

Learning to peer review is also an important step in improving your own professional development.

You’ll become a better writer and a more successful published author in learning to review. It gives you a critical vantage point and you’ll begin to understand what editors are looking for. It will also help you keep abreast of new research and best-practice methods in your field.

We strongly encourage you to learn the core concepts of peer review by joining a course or workshop. You can attend in-person workshops to learn from and network with experienced reviewers and editors. As an example, Sense about Science offers peer review workshops every year. To learn more about what might be in store at one of these, researcher Laura Chatland shares her experience at one of the workshops in London.

There are also plenty of free, online courses available, including courses in the Web of Science Academy such as ‘Reviewing in the Sciences’, ‘Reviewing in the Humanities’ and ‘An introduction to peer review’

The Web of Science Academy also supports co-reviewing with a mentor to teach peer review through practical experience. You learn by writing reviews of preprints, published papers, or even ‘real’ unpublished manuscripts with guidance from your mentor. You can work with one of our community mentors or your own PhD supervisor or postdoc advisor, or even a senior colleague in your department.

Go to the Web of Science Academy

Peer review templates

Peer review templates are helpful to use as you work your way through a manuscript. As part of our free Web of Science Academy courses, you’ll gain exclusive access to comprehensive guidelines and a peer review report. It offers points to consider for all aspects of the manuscript, including the abstract, methods and results sections. It also teaches you how to structure your review and will get you thinking about the overall strengths and impact of the paper at hand.

• Web of Science Academy template (requires joining one of the free courses)
• PLoS’s review template
• Wiley’s peer review guide (not a template as such, but a thorough guide with questions to consider in the first and second reading of the manuscript)

Beyond following a template, it’s worth asking your editor or checking the journal’s peer review management system. That way, you’ll learn whether you need to follow a formal or specific peer review structure for that particular journal. If no such formal approach exists, try asking the editor for examples of other reviews performed for the journal. This will give you a solid understanding of what they expect from you.

Peer review examples

Understand what a constructive peer review looks like by learning from the experts.

Here’s a sample of pre and post-publication peer reviews displayed on Web of Science publication records to help guide you through your first few reviews. Some of these are transparent peer reviews , which means the entire process is open and visible — from initial review and response through to revision and final publication decision. You may wish to scroll to the bottom of these pages so you can first read the initial reviews, and make your way up the page to read the editor and author’s responses.

• Pre-publication peer review: Patterns and mechanisms in instances of endosymbiont-induced parthenogenesis
• Pre-publication peer review: Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing
• Transparent peer review: Towards a standard model of musical improvisation
• Transparent peer review: Complex mosaic of sexual dichromatism and monochromatism in Pacific robins results from both gains and losses of elaborate coloration
• Post-publication peer review: Brain state monitoring for the future prediction of migraine attacks
• Web of Science Academy peer review: Students’ Perception on Training in Writing Research Article for Publication

F1000 has also put together a nice list of expert reviewer comments pertaining to the various aspects of a review report.

Co-reviewing

Co-reviewing (sharing peer review assignments with senior researchers) is one of the best ways to learn peer review. It gives researchers a hands-on, practical understanding of the process.

In an article in The Scientist , the team at Future of Research argues that co-reviewing can be a valuable learning experience for peer review, as long as it’s done properly and with transparency. The reason there’s a need to call out how co-reviewing works is because it does have its downsides. The practice can leave early-career researchers unaware of the core concepts of peer review. This can make it hard to later join an editor’s reviewer pool if they haven’t received adequate recognition for their share of the review work. (If you are asked to write a peer review on behalf of a senior colleague or researcher, get recognition for your efforts by asking your senior colleague to verify the collaborative co-review on your Web of Science researcher profiles).

The Web of Science Academy course ‘Co-reviewing with a mentor’ is uniquely practical in this sense. You will gain experience in peer review by practicing on real papers and working with a mentor to get feedback on how their peer review can be improved. Students submit their peer review report as their course assignment and after internal evaluation receive a course certificate, an Academy graduate badge on their Web of Science researcher profile and is put in front of top editors in their field through the Reviewer Locator at Clarivate.

Here are some external peer review resources found around the web:

• Peer Review Resources from Sense about Science
• Peer Review: The Nuts and Bolts by Sense about Science
• How to review journal manuscripts by R. M. Rosenfeld for Otolaryngology – Head and Neck Surgery
• Ethical guidelines for peer review from COPE
• An Instructional Guide for Peer Reviewers of Biomedical Manuscripts by Callaham, Schriger & Cooper for Annals of Emergency Medicine (requires Flash or Adobe)
• EQUATOR Network’s reporting guidelines for health researchers

And finally, we’ve written a number of blogs about handy peer review tips. Check out some of our top picks:

• How to Write a Peer Review: 12 things you need to know
• Want To Peer Review? Top 10 Tips To Get Noticed By Editors
• Review a manuscript like a pro: 6 tips from a Web of Science Academy supervisor
• How to write a structured reviewer report: 5 tips from an early-career researcher

Want to learn more? Become a master of peer review and connect with top journal editors. The Web of Science Academy – your free online hub of courses designed by expert reviewers, editors and Nobel Prize winners. Find out more today.

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Peer Review – Best Practices

“Peer review is broken. But let’s do it as effectively and as conscientiously as possible” — Rosy Hosking, CommLab

“ A thoughtful, well-presented evaluation of a manuscript, with tangible suggestions for improvement and a recommendation that is supported by the comments, is the most valuable contribution that you can make as a reviewer, and such a review is greatly appreciated by both the authors of the manuscript and the editors of the journal. ” — ACS Reviewer Lab

Criteria for success

A successful peer review:

• Contains a brief summary of the entire manuscript. Show the editors and authors what you think the main claims of the paper are, and your assessment of its impact on the field. What did the authors try to show and what did they try to claim?
• Clearly directs the editor on the path forward. Should this paper be accepted, rejected, or revised?
• Identifies any major (internal inconsistencies, missing data, etc.) concerns, and clearly locates them within the document. Why do you think that the direction specified is correct? What were the issues you identified that led you to that decision?
• Lists (if appropriate — i.e. if you are suggesting revision or acceptance) minor concerns to help the authors make the paper watertight (typographical errors, grammatical errors, missing references, unclear explanations of methodology, etc.).
• Explain how the arguments can be better defended through analysis, experiments, etc.
• Is reasonable within the original manuscript scope ; does not suggest modifications that would require excessive time or expense, or that could instead be addressed by adjusting the manuscript’s claims .

Structure Diagram

A typical peer review is 1-2 pages long. You can divide your content roughly as follows:

Identify your purpose

The purpose of your pre-publication peer review is two-fold:

• Scientific integrity (which can be handled with editorial office assistance)
• Quality of data collection methods and data analysis
• Veracity of conclusions presented in the manuscript
• Determine match between the proposed submission and the journal scope (subject matter and potential impact). For example, a paper that holds significance only for a particular subfield of chemical engineering is not appropriate for a broad multidisciplinary journal. Determining match is usually done in partnership with the editor, who can answer questions of journal scope.

Analyze your audience

The audience for your peer review work is unusual compared to most other kinds of communication you will undertake as a scientist. Your primary audience is the journal editor, who will use your feedback to make a decision to accept or reject the manuscript. Your secondary audience is the author, who will use your suggestions to make improvements to the manuscript. Typically, you will be known to the journal editors, but anonymous to the authors of the manuscript. For this reason, it is important that you balance your review between these two parties.

The editors are most interested in hearing your critical feedback on the science that is presented, and whether there are any claims that need to be adjusted. The editors need to know:

• Your areas of expertise within the manuscript
• The paper’s significance to your particular field

To help you, most journals willhave guidelines for reviewers to follow, which can be found on the journal’s website (e.g., Cell Guidelines ).

The authors are interested in:

• Understanding what aspects of their logic are not easily understood
• Other layers of experimentation or discussion that would be necessary to support claims
• Any additional information they would need to convince you in their arguments

Format Your Document in a Standard Way

Peer review feedback is most easily digested and understood by both editors and authors when it arrives in a clear, logical format. Most commonly the format is (1) Summary, (2) Decision, (3) Major Concerns, and (4) Minor Concerns (see also Structure Diagram above).

There is also often a multiple choice form to “rate” the paper on a number of criteria. This numerical scoring guide may be used by editors to weigh the manuscript against other submissions; think of it mostly as a checklist of topics to cover in your review.

The summary grounds the remainder of your review. You need to demonstrate that you have read and understood the manuscript, which helps the authors understand what other readers are understanding to be the manuscript’s main claims. This is also an opportunity to demonstrate your own expertise and critical thinking, which makes a positive impression on the editors who often may be important people in your field.

It is helpful to use the following guidelines:

• Start with a one-sentence description of the paper’s main point, followed by several sentences summarizing specific important findings that lead to the paper’s logical conclusion.
• Then, highlight the significance of the important findings that were shown in the paper.
• Conclude with the reviewer’s overall opinion of what the manuscript does and does not do well.

Your decision must be clearly stated to aid the interpretation of the rest of your comments (see Criteria for Success). Do this either as part of the concluding sentence in the summary paragraph, or as a separate sentence after the summary. In general, you try to categorize within the following framework:

• Accept with no revisions
• Accept with minor revisions
• Accept with major revisions

Some journals will have specific rules or different wording, so make sure you understand what your options are.

Most reviews also contain the option to provide confidential comments to the editor, which can be used to provide the editor with more detail on the decision. In extreme cases, this can also be where concerns about plagiarism, data manipulation, or other ethical issues can be raised.

The Decision area is also where you can state which aspects of complex manuscripts you feel you have the expertise to comment on.

Major Concerns (where relevant)

Depending on the journal that you are reviewing for, there might be criteria for significance, novelty, industrial relevance, or other field-specific criteria that need to be accounted for in your major concerns. Major concerns, if they are serious, typically lead to decisions that are either “reject” or “accept with major revisions.”

Major concerns include…

• issues with the arguments presented in the paper that are not internally consistent,
• or present arguments that go against significant understanding in the field, without the necessary data to back it up .
• a lack of key experimental or computational data that are vital to justify the claims made in the paper.
• Examples: a study that reports the identity of an unexpected peak in a GC-MS spectrum without accounting for common interferences, or claims pertaining to human health when all the data presented is in a model organism or in vitro .

One of the most important aspects of providing a review with major concerns is your ability to cite resolutions. For example…

• If you think that someone’s argument is going against the laws of thermodynamics, what data would they need to show you to convince you otherwise?
• What types of new statistical analysis would you need to see to believe the claims being made about the clinical trials presented in this work?
• Are there additional control experiments that are needed to show that this catalyst is actually promoting the reaction along the pathway suggested?

Minor Concerns (optional)

Minor concerns are primarily issues that are raised that would improve the clarity of the message, but don’t impact the logic of the argument. Most commonly these are…

• Grammatical errors within the manuscript
• Typographical errors
• Missing references
• Insufficient background or methods information (e.g., an introduction section with only five references)
• Insufficient or possibly extraneous detail
• Unclear or poorly worded explanations (e.g., a paragraph in the discussion section that seems to contradict other parts of the paper)
• Possible options for improving the readability of any graphics (e.g., incorrect labels on a figure)

While minor concerns are not always present in the case of reviews with many major concerns, they are almost always included in the case of manuscripts where the decision is an accept or accept with minor revisions.

Offer revisions that are reasonable and in scope

Think about the feasibility of the experiments you suggest to address your concerns. Are you suggesting 3 years’ more work that could form the basis for a whole other publication? If you are suggesting vast amounts of animal work or sequencing, then are the experiments going to be prohibitively expensive? If the paper would stand without this next layer of experimentation, then think seriously about the real value of these additional experiments. One of the major issues with scientific publishing is the length of time taken to get to the finish line. Don’t muddy the water for fellow authors unnecessarily!

As an alternative to more experiments, does the author need to adjust their claims to fit the extent of their evidence rather than the other way round? If they did that, would this still be a good paper for the journal you are reviewing for?

Structure your comments in a way that makes sense to the audience

Formatting choices:

• Separate each of your concerns clearly with line breaks (or numbering) and organize them in the order they appear in the manuscript.
• Quote directly from the text and bold or italicize relevant phrases to illustrate your points
• Include page and line/paragraph numbers for easy reference.

Style/Concision:

• Keep your comments as brief as possible by simply stating the issue and your suggestion for fixing it in a few sentences or less.

Offer feedback that is constructive and professional

Be unbiased and professional.

Although the identities of the authors are sometimes kept anonymous during the review process (this is rare in chemical and biological research), research communities are typically small and you may try to “guess” who the author is based on the methodology used or the writing style. Regardless, it is important to remain unbiased and professional in your review. Do not assume anything about the paper based on your perception of, for example, the author’s status or the impact their results may have on your own research. If you feel that this might be an issue for you, you must inform the editor that there is a conflict of interest and you should not review this manuscript.

Be polite and diplomatic .

Receiving critical feedback, even when constructive, can be difficult and possibly emotional for the authors. Since you are not anonymous to the editors, being unnecessarily harsh in your feedback will reflect badly on you in the end. Use similar language to what you would use when discussing research at a conference, or when talking with your advisor in a meeting. Manuscript peer review is a good way to practice these “soft” skills which are important yet often neglected in the science community.

Additional resources about effective peer reviewing

• American Chemical Society Reviewer Lab
• Nature.com offers a peer review training course for purchase:
• https://masterclasses.nature.com/courses/205
• http://senseaboutscience.org/activities/peer-review-the-nuts-and-bolts/
• http://asapbio.org/six-essential-reads-on-peer-review

This article was written by Mike Orella (MIT Chem E Comm Lab); edited by Mica Smith (MIT Chem E Comm Lab) and Rosy Hosking (Broad Comm Lab)

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The Peer Review Imperative

Threats to peer review, public trust in science and medicine, peer review matters: research quality and the public trust.

Michael M. Todd, M.D., served as Handling Editor for this article.

This article has a related Infographic on p. 17A.

Accepted for publication October 13, 2020.

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Evan D. Kharasch , Michael J. Avram , J. David Clark , Andrew J. Davidson , Timothy T. Houle , Jerrold H. Levy , Martin J. London , Daniel I. Sessler , Laszlo Vutskits; Peer Review Matters: Research Quality and the Public Trust. Anesthesiology 2021; 134:1–6 doi: https://doi.org/10.1097/ALN.0000000000003608

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“Peer review grounds the public trust in the scientific and medical research enterprise…”

Image: Adobe Stock.

In an era of evidence-based medicine, peer review is an engine and protector of that evidence. Such evidence, vetted by and surviving the peer review process, serves to inform clinical decision-making, providing practitioners with the information to make diagnostic and therapeutic decisions. Unfortunately, there is recent and growing pressure to prioritize the speed of research dissemination, often at the expense of careful peer review. It is timely to remind readers and the public of the value brought by peer review, its benefits to patients, how much the public trust in science and medicine rests upon peer review, and how these have become vulnerable.

Peer review has been the foundation of scholarly publishing and scientific communication since the 1665 publication of the Philosophical Transactions of the Royal Society. The benefits and advantages of peer review in scientific research, and particularly medical research, are manifold and manifest. 1   Journals, editors, and peer reviewers hold serious responsibility as stewards of valid information, with accountability to the scientific community and an obligation to maintain the public trust. Anesthesiology states its aspiration and its responsibility on the cover of every issue: Trusted Evidence. Quality peer review (more specifically, closed or single-blind peer review, in which the identity of reviewers is confidential) is a foundational tenet of Anesthesiology.

Peer review grounds the public trust in the scientific and medical research enterprise, as well as the substantial public investment in scientific research. Peer review affords patients some degree of comfort in placing their trust in practitioners, knowing that they should be informed by the best possible, vetted evidence.

Quality peer review enriches and safeguards the scientific content, transparency, comprehensibility, and scientific integrity of published articles. It can enhance published research importance, originality, authenticity, scientific validity, adherence to experimental rigor, and correctness of results and interpretations and can identify errors in research execution. Peer review can help authors improve reporting quality, presentation clarity, and transparency, thereby enhancing comprehension and potential use by clinicians and scientists. Careful scrutiny can identify whether research has appropriate ethical principles, regulatory approvals, compliance, and equitable inclusion of both sexes. Peer review should consider the appropriateness of authorship and can detect duplicate publication, fabrication, falsification, plagiarism, and other misconduct.

Peer review should serve as a tempering factor on overenthusiastic authors and overstated conclusions, unwarranted extrapolations, conflation of association with causality, unsupported clinical recommendations, and spin. Spin is a well known, unfortunately common, and often insidious bias in the presentation and interpretation of results that seeks to convince readers that the beneficial effect of an experimental treatment exceeds what has actually been found or that minimizes untoward effects. 2–4  

Manuscripts often change substantially between the initial submission and the revised and improved published version. Improvement during the peer review process is not apparent to readers, who only see the final, published article, but is well known to authors, reviewers, and editors. Peer review is a defining difference in an era of proliferating predatory journals and other forms of research dissemination. Anesthesiology reviewers and editors devote considerable effort in service to helping authors improve their scientific communications, whether published in this journal or if ultimately elsewhere.

In the domain of clinical research, peer review does not change the scientific premise of an investigation, the hypothesis, or the study design, although it frequently improves their communication. Peer review does not change clinical research data, although it often corrects, enhances, or strengthens the statistical analysis of those data and can markedly improve their presentation and clarity. More importantly, peer review can assess, correct, and improve the interpretation, meaning, importance, and communication of research results—and importantly, confirm that conclusions emanate strictly from those results. Peer review may occasionally fundamentally revise or even reverse clinical research interpretations and recommendations. Each of these many functions enhances reader understanding and should ultimately improve patient care.

Peer review is not a guarantee of truth, and it can be imperfect. Medical history provides many examples of peer-reviewed research that was later found to be incorrect, typically through error or occasionally from misconduct. However, peer review certainly was and remains an essential initial check and quality control that has weeded out, or corrected before publication, innumerable reports of research of insufficient quality or veracity that otherwise would have been published and thereby become publicly accessible. Additionally, science should be “self-correcting,” and peer review is one of the most important factors responsible for such correction. Peer review remains an element by which medical science achieves the “self-correction” that drives progress.

Quality peer review does take time. So also do the initial preparation of manuscripts and the modifications made by authors in response to peer review. Anesthesiology endeavors to provide both quality and timely peer review. Our time to first decision averages only 16 days.

The increasing emphasis on fast research dissemination, often absent quality peer review, comes mostly but not exclusively because of the immediacy of the internet and broader media and societal trends. In an era in which the companies whose major product is the immediacy of information are the economic leaders (Facebook, Twitter, Google, and Apple), it is unsurprising that the immediacy of information is challenging that of quality as the value proposition in the research marketplace. Nevertheless, fast is not synonymous with good. We believe that sacrificing quality on the altar of speed is unwise, benefits no one (except perhaps authors), and may ultimately diminish trust in medical research and possibly even worsen clinical care.

Another recent societal problem is the growing spillover of political and media communication trends into scientific communication. Almost half of Americans believe that science researchers overstate the implications of their research, and three in four think “the biggest problem with news about scientific research findings is the way news reporters cover it.” 5   Scientific conclusions may be perverted through internet-based campaigns of disinformation and misinformation and dissemination of misleading and biased information. 6   This threatens the public trust in the scientific enterprise and scientific knowledge. 7   Social media has made science and health vulnerable to strategic manipulation. 7 , 8   It is also “leaving peer-reviewed communication behind as some scientists begin to worry less about their citation index (which takes years to develop) and more about their Twitter response (measurable in hours).” 8   Peer-reviewed journals cannot reverse these trends, but they can at least ensure that scientific conclusions when presented are correct and clearly stated.

In addition to the premium on dissemination speed versus peer review quality, a new variant of rapid clinical research dissemination has emerged that abrogates peer review entirely: preprints. Preprints are research reports that are posted by authors in a publicly accessible online repository in place of or before publication in a peer-reviewed scholarly journal. The preprint concept is decades old, rooted in physics and mathematics, in which authors traditionally sent their hand- or typewritten manuscript draft to a few colleagues for feedback before submitting it to a journal for publication. With the advent of the internet, this process was replaced by preprint servers and public posting. With the creation of a preprint server for biology and the life sciences (bioRxiv.org), the posting of unreviewed manuscripts by basic biomedical scientists has exploded in popularity and practice. Next came the creation of medRxiv.org, a publicly accessible preprint server for disseminating unpublished and unreviewed clinical research results in their “preliminary form” 9   and more so a call for research funders to require mandatory posting of their grantees’ research reports first on preprint servers before peer-reviewed publication. 10   Lack of peer review is the hallmark of preprints.

The main arguments offered by proponents of preprints are the free and near-immediate access to research results, claimed acceleration of the progress of research by immediate dissemination without peer review, and the assumption that articles will be improved by feedback from a wider group of readers alongside formal review by a few experts. Specifically claimed advantages of preprints are that they bypass the peer review process that adversely delays the dissemination of research results and “lifesaving cures” and “the months-long turnaround time of the publishing process and share findings with the community more quickly.” 11   In addition it is claimed that preprints address “researchers recently becoming vocally frustrated about the lengthy process of distributing research through the conventional pipelines, numerous laments decrying increasingly impractical demands of journals and reviewers, complicated dynamics at play from both authors and publishers that can affect time to press” and enable “sharing papers online before (or instead of) publication in peer-reviewed journals.” 11  

Preprints for clinical research have been justifiably criticized. 2 , 12–15   Most importantly, medical preprints lack safeguards afforded by peer review and increase the possibility of disseminating wrong or incorrectly interpreted results. Related concerns are that preprints are unnecessary for and potentially harmful to scientific progress and a significant threat with potential consequence to patient health and safety. Preprint server proponents “assume that most preprints would subsequently be peer reviewed,” 10   possibly before or after formal publication (if published), thus enabling correction or improvement (before or after publication). However, it is estimated that careful peer review of a manuscript takes 5 to 6 h. 1 , 16   It seems highly unlikely that busy scientists will surf the web in search of preprints on which to spend half a day providing concerted informative peer review.

Preprint enthusiasts claim that peer review after posting will provide scholarly input, facilitate preprint improvement, and enhance research quality. In fact, such peer review has been scant with biologic preprints, and it seems naïve to expect it with medical preprints. In reality, most preprints receive few comments, even fewer formal reviews, and many comments that are “counted” to support the notion that preprints do undergo peer review actually come through social media; a tweet is hardly a substantive review. The idea that comments on servers will replace quality peer review is not happening now and seems unlikely to transpire. Moreover, a survey found that the lack of peer review was an important reason why authors deliberately choose to post via preprint. 17   Additionally, postdissemination peer review takes longer than traditional prepublication peer review, and there remains concern by authors who do value peer review about the quality of the post-preprint peer review process and the quality of posted preprints. 17  

Preprint server proponents state “the work in question would be available to interested readers while these processes (peer review) take place, which is more or less what happens in physics today.” 10   The lives of patients are different than the lives of subatomic particles. Preprints deliberately “decouples the dissemination of manuscripts from the much slower process of evaluation and certification.” 10   However, it is exactly that coupling that validates clinical research, benefits patients, improves health, and engenders public trust.

The potential for free and unfettered distribution of raw, unvetted, and potentially incorrect information to be consumed by clinicians and patients cannot be called a medical advance. Use of such information by news outlets and online web services to promote “new” and “latest” research further misinforms the public and patients and is a disservice.

Relegating peer review to the realm of option and afterthought is not in the interest of research quality and integrity or of patients and public health. There is no apparent value in abrogating peer review of clinical research and all its many attendant benefits in ensuring the quality of clinical research available to practitioners and patients. Practitioners and patients have historically not seen the unreviewed manuscript submissions that eventually become revised peer-reviewed publications. Doing so now, given the sizable fraction of clinical research manuscripts that are rejected for publication and the substantial changes in most that are published, by providing the public with unreviewed preprints seems to carry considerable risk.

An additional problem is that the same research report can be posted on several preprint servers or websites or multiple versions may exist on the same preprint site. Various versions may be the same or different, and the final peer-reviewed published article (if it ever exists) may bear little semblance to the various posted versions, which remain freely available. Which version is correct? Availability of various differing reports of the same research risks competing or incorrect information and can only generate confusion. Scientific publishing decades ago banned publication of the same research in multiple journals owing to concerns about data integrity and inappropriate reuse. Restarting this now, via preprints, seems unwise—especially in medicine.

The public cannot and should not be expected to differentiate between posting and peer-reviewed publication. Unfortunately, and worse, even some practitioners do not understand the difference. Posting is often referred to erroneously as publication. Indeed, even the world’s most prestigious scientific journals refer to posting as publication. 18   Such conflation blurs the validity of information. That peer-reviewed publications and preprints both receive digital object identifiers further blurs their distinction and may give the latter more apparent credibility in the eyes of the lay public. The preprint community (servers and scientists) continues to claim simultaneously that preprints are and are not publications, depending on how such claims meet their proclivities. Although the bioRxiv server contains the disclaimer “readers should be aware that articles on bioRxiv have not been finalized by authors, might contain errors, and report information that has not yet been accepted or endorsed in any way by the scientific or medical community” on a web page, 19   it is not on the preprint itself for readers to see (perhaps this disclaimer, and the one below, should appear on the cover page of every preprint and as a footnote on every page). Fortunately, the medRxiv home page ( http://www.medrxiv.org ) states the following disclaimer: “Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.” Then why bother?

The popularity of preprints in the basic science world has exploded in the last 5 yr, with the number of documents posted to preprint servers increasing exponentially. 20   While acknowledging the noble reasons given by preprint servers and authors for the dissemination of research by posting, three other apparent reasons are less noble. The first is competition for research funding. Major research funders ( e.g. , the National Institutes of Health) do not allow citation of unpublished manuscripts in grant applications but do allow citation of preprints. 21 , 22   The second is the preoccupation of authors with the speed of availability. There is a growing (and disappointing) trend of authors perceiving a need to claim priority (“we are the first to report…”), grounded perhaps on fear of being “scooped.” The third is the pursuit of academic promotion, which is based largely on the number of peer-reviewed publications listed on a curriculum vitae . We now see faculty listing preprints in the peer-reviewed research publications section of their curriculum vitae. All these drivers (priority, science advancement, reputational reward, and financial return) 7   are investigator centric. They are neither quality-centric nor patient-centric.

Who benefits if clinical research quality is sacrificed at the altar of speed? Certainly, it is not patients, public health, or the public trust in science, medicine, and the research enterprise. Enthusiasm for preprints seems to be emanating mostly from investigators, presumably because of academic or other incentives, 23   including the desire for prominence and further funding. Is this why we do medical research? Should we be investigator- or patient-centric?

Little in the argumentation espoused by proponents of clinical preprints attends to their benefit to patients. Indeed, posted preprints without all the scrutiny and benefits of peer review may lack quality and validity and may report flawed data and conclusions, which may hurt patients. 17 , 23   As stated previously, “clinical studies of poor quality can harm patients who might start or stop therapy in response to faulty data, whereas little short-term harm would be expected from an unreviewed astronomy study.” 12  

The importance of peer review in clinical research and the downside of its absence in posted preprints is illuminated by the COVID-19 pandemic. As of this date (October 1, 2020), there are 9,222 unreviewed COVID-19 SARS–CoV-2 preprints posted: 7,257 on medRxiv and 1,965 on bioRxiv. 24   To date, 33 COVID-19 articles have been retracted (0.37%), and 5 others have been temporarily retracted or have expressions of concern. 25   Of the 33 retractions, 11 (33%) were posted on an Rxiv server. The overall retraction rate in the general peer-reviewed literature is 0.04%. 26  

Based upon one of the unreviewed COVID-19 medical preprints, 27   the Commissioner of the U.S. Food and Drug Administration (the government agency entrusted more than any other to protect public health) and the President of the United States announced that convalescent plasma from COVID-19 survivors was “safe and very effective” and had been “proven to reduce mortality by 35%.” 28   Although the Commissioner later, after scientific uproar over that misinformation, “corrected” his comment in a tweet (a back page retraction to a front page headline), 29   the preprint was used to justify a Food and Drug Administration decision to issue an emergency use authorization for convalescent plasma to treat severe COVID-19. Would these errors have been prevented by peer review? We will never know.

Even if priority in clinical (and basic) research is valued, compared to the unquestionable value of quality, clinical preprints have questionable necessity in establishing precedence in contemporary times. Clinical trials registration, which makes fully public the existence of all such research, establishes both who is doing what and when. Some investigators may even publish their entire clinical protocol, to further make their studies known and by whom and when.

For hundreds of years, patent medicines (exotic concoctions of substances, often addicting and sometimes toxic) were claimed to prevent or cure a panoply of illnesses, without any evidence of effectiveness or safety or warning of potential harm. These medical elixirs, the magic potions of snake oil salesmen and charlatans, were heavily advertised and promoted to ailing, sometimes desperate, and thoroughly unsuspecting citizens—all without any oversight, regulation, quality control, or peer review. It was not until the 20th century that medical peer review and the requirement for evidence of effectiveness and safety reigned in the “Wild West” and launched the modern era of medicine, yielding the scientific discovery, progress, and improvement in human health seen today. This era rests on the bedrock of peer review, the quality ideal, and the evidence that constitutes the foundation for evidence-based medicine.

Will clinical preprints become the patent medicines of the new millennium? Do they portend the unrestricted and unregulated spillage of anything claimed as research, by anyone, and absent the quality control afforded by peer review? Like the patent medicines of a bygone era, which were heavily promoted by the newly developed advertising industry, will “posted” clinical research become fodder for the medical advertising industry and media at large, pushing who knows what information and claims on practitioners and a public already deluged with endless promotions and claims with which they cannot keep up or verify? An unsuspecting public is incapable of differentiating between the “posting” of any research observation by anyone with access to a computer and proper scholarly “publication” of peer-reviewed results and conclusions. This is particularly true of vulnerable patients with severe and/or incurable diseases, who may grasp at anything. Moreover, continuous claims of “breakthroughs” and “proven treatments” based on preprints, followed by backpedaling after challenges and outcries, further reduces public confidence in the scientific endeavor as a whole. This can create the perception that clinical science is unreliable and might be a matter of turf wars and politics instead of reliable valid evidence.

Over the past century and throughout the world, legislation has been passed and government agencies have been created to protect the public and maintain their trust in the medicines they take. Few would advocate dismantling the protections against patent medicines. Why now consider dismantling the peer review process in clinical research?

In 2019, the editors of several journals expressed a well articulated principle that they will not accept clinical research manuscripts that had been previously posted to a preprint server. 30   Their rationale was that the benefit of preprint servers in clinical research did not outweigh the potential harm to patients and scientific integrity. Major specific concerns included: “1) Preprints may be perceived by some (and used by less scrupulous investigators) as evidence even though the studies have not gone through peer review and the public may not be able to discern an unreviewed preprint from a seminal article in a leading journal; 2) It seems unlikely that the kind of prepublication dialogue that has taken place in other academic disciplines (e.g. mathematics and physics) will take place in medicine or surgery because the incentives are very different; 3) Preprints may lead to multiple competing, and perhaps even conflicting, versions of the ‘same’ content being available online at the same time, which can cause (at least) confusion and (at most) grave harm; and 4) For the vast majority of medical diagnoses, a few months of review of a study’s findings do not make a difference; the pace of discovery and dissemination generally is adequate.” These editors’ concerns and approach merit consideration if not more widespread adoption.

The potential for practitioner and public confusion regarding the difference between unregulated preprints and peer-reviewed publication is substantial. Indeed, the posting of preprints is often incorrectly termed “publication.” Peer-reviewed publications versus posted “publications” will soon become a difference without a distinction. Moreover, authors cannot have it both ways. They cannot claim a preprint as a publication for purposes of a grant (and now in some universities potentially for purposes of a degree, appointment, and/or promotion), yet claim it is not a publication for the purposes of submission to a peer-reviewed journal that does not allow prior publication. More importantly, the peer review imperative in clinical research and the role it plays in research quality, the evidence base, and patient care, constitutes an obligation to patient safety that cannot and should not be abrogated.

Peer review, clinical research quality, and the public trust in clinical research all now face an unprecedented assault. Quality peer review is a foundational tenet of Anesthesiology and underlies the Trusted Evidence we publish. Quality, timely, and unpressured peer review will continue to be a hallmark of Anesthesiology , in service to readers, patients, and the public trust.

Acknowledgments

We thank Ryan Walther, Managing Editor, and Vicki Tedeschi, Director of Digital Communications, for their valuable insights.

Competing Interests

Dr. Clark has a consulting agreement with Teikoku Pharma USA (San Jose, California). Dr. Levy reports being on Advisory and Steering Committees for Instrumentation Laboratory (Bedford, Massachusetts), Merck & Co. (Kenilworth, New Jersey), and Octapharma (Lachen, Switzerland). Dr. London reports financial relationships with Wolters Kluwer UptoDate (Philadelphia, Pennsylvania) and Springer (journal honorarium; New York, New York). The remaining authors declare no competing interests.

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The mission of NIH is to seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to enhance health, lengthen life, and reduce illness and disability . In support of this mission, Research Project Grant (RPG) applications to support biomedical and behavioral research are evaluated for scientific and technical merit through the NIH peer review system.

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Chemistry Education Research and Practice (CERP) is the journal for teachers, researchers and other practitioners at all levels of chemistry education. It is published free of charge electronically four times a year, thanks to sponsorship by the Royal Society of Chemistry's Education Division. Coverage includes the following:

• Research, and reviews of research, in chemistry education
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The objectives of the journal:

• To provide researchers with the means to publish their work in full in a journal exclusively dedicated to chemistry education
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• To bridge the gap between the two groups so that researchers will have their results seen by those who could benefit from using them, and practitioners will gain from encountering the ideas and results of those who have made a particular study of the learning process

Guidance on the nature of acceptable contributions can be found in Recognising quality in reports of chemistry education research and practice .

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Find out who is on the editorial and advisory boards for the  Chemistry Education Research and Practice (CERP) journal.

David F Treagust ,  Curtin University of Technology, Australia

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Nicole Graulich , Justus-Liebig Universität Gießen, Germany

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Jack Barbera , Portland State University, USA

Mageswary Karpudewan , Universiti Sains Malaysia (USM)

James Nyachwaya , North Dakota State University, USA

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Mei-Hung Chiu , National Taiwan Normal University, Taiwan

Resa Kelly , San Jose State University, USA

Gwen Lawrie , University of Queensland, Australia

David Read , University of Southampton, UK

Bill Byers , University of Ulster, UK

Melanie Cooper , Michigan State University, USA

Onno de Jong, University of Utrecht, Netherlands Iztok Devetak , University of Ljubljana, Slovenia

Odilla Finlayson , Dublin City University, Ireland

Loretta Jones , University of Northern Colorado, USA

Orla Catherine Kelly , Church of Ireland College of Education, Ireland

Scott Lewis, Editor, University of South Florida, USA

Iwona Maciejowska, Jagiellonian University, Poland Rachel Mamlok-Naaman , The Weizmann Institute of Science, Israel

David McGarvey, Keele University, UK Mansoor Niaz , Universidad de Oriente, Venezuela MaryKay Orgill , University of Nevada, Las Vegas, USA George Papageorgiou , Democritus University of Thrace, Greece Ilka Parchmann , University of Kiel, Germany Michael K. Seery , University of Edinburgh, UK

Keith Taber , University of Cambridge, UK Daniel Tan , Nanyang Technological University, Singapore

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Georgios Tsaparlis , (Founding Editor), University of Ioannina, Greece

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The intended emphasis is on the process of learning, not on the content. Contributions describing alternative ways of presenting chemical information to students (including the description of new demonstrations or laboratory experiments or computer simulations or animations) are unlikely to be considered for publication. All contributions should be written in clear and concise English. Technical language should be kept to the absolute minimum required by accuracy. Authors are urged to pay particular attention to the way references are cited both in the text and in the bibliography.

The journal has three objectives.

First  to provide researchers a means to publish high quality, fully peer reviewed, educational research reports in the special domain of chemistry education. The studies reported should have all features of scholarship in chemistry education, that is they must be:

• original and previously unpublished
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The last requirement means that the studies should have an interest for and an impact on the global practice of chemistry, and not be simply of a regional character. Contributions must include a review of the research literature relevant to the topic, and state clearly the way(s) the study contributes to our knowledge base. Last but not least, they should conclude with implications for other research and/or the practice of chemistry teaching.

Second   to offer practitioners (teachers of chemistry at all levels) a place where they can share effective ideas and methods for the teaching and learning of chemistry and issues related to these, including assessment.

The emphasis is on effectiveness, the demonstration that the approach described is successful, possibly more so than the alternatives. Contributions are particularly welcome if the subject matter can be applied widely and is concerned with encouraging active, independent or cooperative learning.

Of special interest are methods that increase student motivation for learning, and those that help them to become effective exploiters of their chemical knowledge and understanding. It is highly desirable that such contributions should be demonstrably based, wherever possible, on established educational theory and results.

Third  to help to bridge the gap between educational researchers and practitioners by providing a single platform where both groups can publish high-quality papers with the realistic hope that researchers will find their results seen by those who could benefit from using them.

Also, practitioners will gain from encountering the ideas and results of those who have made a particular study of the learning process in finding better ways to improve their teaching and the learning experience of their students.  

Articles should be submitted using ScholarOne , the Royal Society of Chemistry's article review and submission system. A printed copy of the manuscript will not be required. Your submission will be acknowledged as soon as possible. 

Exceptions to normal Royal Society of Chemistry policy

Submissions to Chemistry Education Research and Practice do not require a table of contents entry. Submissions to the journal should use Harvard referencing.

Citations in the text should therefore be made by use of the surname of the author(s) and the year of the publication, at the appropriate place. Note that with one or two authors the name(s) are given, while if the source has three or more authors, it is cited with the first named author as 'Author et al. '

When more than one source is cited in the text, they should be listed in chronological and then alphabetical order for example, '(Jones, 2001; Smith, 2001; Adams, 2006)'. The references themselves are given at the end of the final printed text, in alphabetical and, if the same author is cited more than once, chronological order. An example of a journal article reference as it would be presented is Taber K. S., (2015), Advancing chemistry education as a field, Chem. Educ. Res. Pract. , 16 (1), 6–8.

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Chemistry Education Research and Practice  publishes:

Perspectives

Review articles.

Perspectives are short readable articles covering current areas of interest. They may take the form of personal accounts of research or a critical analysis of activity in a specialist area. By their nature, they will not be comprehensive reviews of a field of chemistry. Since the readership of Chemistry Education Research and Practice is wide-ranging, the article should be easily comprehensible to a non-specialist in the field, whilst at the same time providing an authoritative discussion of the area concerned.

We welcome submissions of Perspective articles that:

• Communicate new challenges or visions for teaching chemistry framed in current chemistry education research or theories with evidence to support claims.
• Propose frameworks (theoretical, conceptual, curricular), models, pedagogies or practices informed by personal expertise and supported by research outcomes (either the author’s own research or the wider body of education research).
• Argue theoretical stances accompanied by recommendations for how these can be applied in teaching practice or measured in student conceptualisation of knowledge, with examples.

For more information on Perspective articles please see our 2022 Editorial (DOI: 10.1039/D2RP90006H )

These are normally invited by the Editorial Board and editorial office, although suggestions from readers for topics and authors of reviews are welcome.

Reviews must be high-quality, authoritative, state-of-the-art accounts of the selected research field. They should be timely and add to the existing literature, rather than duplicate existing articles, and should be of general interest to the journal's wide readership.

All Reviews and Perspectives undergo rigorous peer review, in the same way as regular research papers.

Review articles published in Chemistry Education Research and Practice include narrative, integrative or systematic reviews and meta-analyses and should align with the goals and scope of the journal.

Thought experiments outlining a theoretical position or personal opinion without including a literature basis, pedagogical recommendations or evidence of implementation are not considered in the journal.

For more information on preparing a review-style article please see our 2021 Editorial (DOI: 10.1039/D1RP90006D )

Full papers contain original scientific work that has not been published previously.

Comments and Replies are a medium for the discussion and exchange of scientific opinions between authors and readers concerning material published in Chemistry Education Research and Practice. 

For publication, a Comment should present an alternative analysis of and/or new insight into the previously published material. Any Reply should further the discussion presented in the original article and the Comment. Comments and Replies that contain any form of personal attack are not suitable for publication. 

Comments that are acceptable for publication will be forwarded to the authors of the work being discussed, and these authors will be given the opportunity to submit a Reply. The Comment and Reply will both be subject to rigorous peer review in consultation with the journal’s Editorial Board where appropriate. The Comment and Reply will be published together.

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Chemistry Education Research and Practice is free to access thanks to sponsorship by the Royal Society of Chemistry's Education Division

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• NATURE INDEX
• 01 May 2024

Plagiarism in peer-review reports could be the ‘tip of the iceberg’

• Jackson Ryan 0

Jackson Ryan is a freelance science journalist in Sydney, Australia.

You can also search for this author in PubMed   Google Scholar

Time pressures and a lack of confidence could be prompting reviewers to plagiarize text in their reports. Credit: Thomas Reimer/Zoonar via Alamy

Mikołaj Piniewski is a researcher to whom PhD students and collaborators turn when they need to revise or refine a manuscript. The hydrologist, at the Warsaw University of Life Sciences, has a keen eye for problems in text — a skill that came in handy last year when he encountered some suspicious writing in peer-review reports of his own paper.

Last May, when Piniewski was reading the peer-review feedback that he and his co-authors had received for a manuscript they’d submitted to an environmental-science journal, alarm bells started ringing in his head. Comments by two of the three reviewers were vague and lacked substance, so Piniewski decided to run a Google search, looking at specific phrases and quotes the reviewers had used.

To his surprise, he found the comments were identical to those that were already available on the Internet, in multiple open-access review reports from publishers such as MDPI and PLOS. “I was speechless,” says Piniewski. The revelation caused him to go back to another manuscript that he had submitted a few months earlier, and dig out the peer-review reports he received for that. He found more plagiarized text. After e-mailing several collaborators, he assembled a team to dig deeper.

Meet this super-spotter of duplicated images in science papers

The team published the results of its investigation in Scientometrics in February 1 , examining dozens of cases of apparent plagiarism in peer-review reports, identifying the use of identical phrases across reports prepared for 19 journals. The team discovered exact quotes duplicated across 50 publications, saying that the findings are just “the tip of the iceberg” when it comes to misconduct in the peer-review system.

Dorothy Bishop, a former neuroscientist at the University of Oxford, UK, who has turned her attention to investigating research misconduct, was “favourably impressed” by the team’s analysis. “I felt the way they approached it was quite useful and might be a guide for other people trying to pin this stuff down,” she says.

Peer review under review

Piniewski and his colleagues conducted three analyses. First, they uploaded five peer-review reports from the two manuscripts that his laboratory had submitted to a rudimentary online plagiarism-detection tool . The reports had 44–100% similarity to previously published online content. Links were provided to the sources in which duplications were found.

The researchers drilled down further. They broke one of the suspicious peer-review reports down to fragments of one to three sentences each and searched for them on Google. In seconds, the search engine returned a number of hits: the exact phrases appeared in 22 open peer-review reports, published between 2021 and 2023.

The final analysis provided the most worrying results. They took a single quote — 43 words long and featuring multiple language errors, including incorrect capitalization — and pasted it into Google. The search revealed that the quote, or variants of it, had been used in 50 peer-review reports.

Predominantly, these reports were from journals published by MDPI, PLOS and Elsevier, and the team found that the amount of duplication increased year-on-year between 2021 and 2023. Whether this is because of an increase in the number of open-access peer-review reports during this time or an indication of a growing problem is unclear — but Piniewski thinks that it could be a little bit of both.

Why would a peer reviewer use plagiarized text in their report? The team says that some might be attempting to save time , whereas others could be motivated by a lack of confidence in their writing ability, for example, if they aren’t fluent in English.

The team notes that there are instances that might not represent misconduct. “A tolerable rephrasing of your own words from a different review? I think that’s fine,” says Piniewski. “But I imagine that most of these cases we found are actually something else.”

The source of the problem

Duplication and manipulation of peer-review reports is not a new phenomenon. “I think it’s now increasingly recognized that the manipulation of the peer-review process, which was recognized around 2010, was probably an indication of paper mills operating at that point,” says Jennifer Byrne, director of biobanking at New South Wales Health in Sydney, Australia, who also studies research integrity in scientific literature.

Paper mills — organizations that churn out fake research papers and sell authorships to turn a profit — have been known to tamper with reviews to push manuscripts through to publication, says Byrne.

The fight against fake-paper factories that churn out sham science

However, when Bishop looked at Piniewski’s case, she could not find any overt evidence of paper-mill activity. Rather, she suspects that journal editors might be involved in cases of peer-review-report duplication and suggests studying the track records of those who’ve allowed inadequate or plagiarized reports to proliferate.

Piniewski’s team is also concerned about the rise of duplications as generative artificial intelligence (AI) becomes easier to access . Although his team didn’t look for signs of AI use, its ability to quickly ingest and rephrase large swathes of text is seen as an emerging issue.

A preprint posted in March 2 showed evidence of researchers using AI chatbots to assist with peer review, identifying specific adjectives that could be hallmarks of AI-written text in peer-review reports .

Bishop isn’t as concerned as Piniewski about AI-generated reports, saying that it’s easy to distinguish between AI-generated text and legitimate reviewer commentary. “The beautiful thing about peer review,” she says, is that it is “one thing you couldn’t do a credible job with AI”.

Preventing plagiarism

Publishers seem to be taking action. Bethany Baker, a media-relations manager at PLOS, who is based in Cambridge, UK, told Nature Index that the PLOS Publication Ethics team “is investigating the concerns raised in the Scientometrics article about potential plagiarism in peer reviews”.

How big is science’s fake-paper problem?

An Elsevier representative told Nature Index that the publisher “can confirm that this matter has been brought to our attention and we are conducting an investigation”.

In a statement, the MDPI Research Integrity and Publication Ethics Team said that it has been made aware of potential misconduct by reviewers in its journals and is “actively addressing and investigating this issue”. It did not confirm whether this was related to the Scientometrics article.

One proposed solution to the problem is ensuring that all submitted reviews are checked using plagiarism-detection software. In 2022, exploratory work by Adam Day, a data scientist at Sage Publications, based in Thousand Oaks, California, identified duplicated text in peer-review reports that might be suggestive of paper-mill activity. Day offered a similar solution of using anti-plagiarism software , such as Turnitin.

Piniewski expects the problem to get worse in the coming years, but he hasn’t received any unusual peer-review reports since those that originally sparked his research. Still, he says that he’s now even more vigilant. “If something unusual occurs, I will spot it.”

doi: https://doi.org/10.1038/d41586-024-01312-0

Piniewski, M., Jarić, I., Koutsoyiannis, D. & Kundzewicz, Z. W. Scientometrics https://doi.org/10.1007/s11192-024-04960-1 (2024).

Article   Google Scholar  

Liang, W. et al. Preprint at arXiv https://doi.org/10.48550/arXiv.2403.07183 (2024).

Download references

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• Published: 01 May 2024

Addressing loneliness and social isolation in 52 countries: a scoping review of National policies

• Nina Goldman   ORCID: orcid.org/0000-0002-3058-1251 1 , 2   na1 ,
• Devi Khanna   ORCID: orcid.org/0000-0002-9254-0869 1   na1 ,
• Marie Line El Asmar   ORCID: orcid.org/0000-0002-0733-3911 3 ,
• Pamela Qualter   ORCID: orcid.org/0000-0001-6114-3820 1 &
• Austen El-Osta   ORCID: orcid.org/0000-0002-8772-4938 2  

BMC Public Health volume  24 , Article number:  1207 ( 2024 ) Cite this article

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Even prior to the advent of the COVID-19 pandemic, there was ample evidence that loneliness and social isolation negatively impacted physical and mental health, employability, and are a financial burden on the state. In response, there has been significant policy-level attention on tackling loneliness. The objective of this scoping review was to conduct a loneliness policy landscape analysis across 52 countries of the UN European country groups. Our policy analysis sought to highlight commonalities and differences between the different national approaches to manage loneliness, with the goal to provide actionable recommendations for the consideration of policymakers wishing to develop, expand or review existing loneliness policies.

We searched governmental websites using the Google search engine for publicly available documents related to loneliness and social isolation. Seventy-eight documents were identified in total, from which 23 documents were retained. Exclusion of documents was based on predetermined criteria. A structured content analysis approach was used to capture key information from the policy documents. Contextual data were captured in a configuration matrix to highlight common and unique themes.

We could show that most policies describe loneliness as a phenomenon that was addressed to varying degrees in different domains such as social, health, geographical, economic and political. Limited evidence was found regarding funding for suggested interventions. We synthesised actionable recommendations for the consideration of policy makers focusing on the use of language, prioritisation of interventions, revisiting previous campaigns, sharing best practice across borders, setting out a vision, evaluating interventions, and the need for the rapid and sustainable scalability of interventions.

Conclusions

Our study provides the first overview of the national loneliness policy landscape, highlighting the increasing prioritisation of loneliness and social isolation as a major public health and societal issue. Our findings suggest that policymakers can sustain this momentum and strengthen their strategies by incorporating rigorous, evidence-based intervention evaluations and fostering international collaborations for knowledge sharing. We believe that policymakers can more effectively address loneliness by directing funds to develop and implement interventions that impact the individual, the community and society.

Peer Review reports

Introduction

The significant increase in research on loneliness and social isolation over the last decade, and especially following the advent of the COVID-19 pandemic [ 1 , 2 , 3 ] highlighted the detrimental consequences of loneliness to individuals, society and governments worldwide. For older adults, the pandemic led to feelings of loneliness due to a lack of companionship and connections, which can negatively impact cognition, and mental health [ 4 ]. The paradox of social distancing, intended to protect older adults, further isolated them and exacerbated the negative effects of loneliness [ 5 ]. A longitudinal study on adolescents showed that they also experienced social isolation from peers, and that resulted in increases of loneliness due to COVID-related school closures [ 6 ]. Evidence shows that a lack of social connection impacts physical and mental health [ 7 ], employability opportunities [ 8 ], and how it is related to social disparities [ 1 , 9 ]. In response, there has been significant policy-level attention on loneliness, with, for example, the United Kingdom of Great Britain and Northern Ireland (GB) [ 10 ] and Japan [ 11 ] both appointing a Minister for Loneliness in 2018 (GB) and 2021 (Japan) respectively. In a joint press statement, both an EU Commissioner and the Japanese Loneliness Minister agreed that “loneliness and social isolation pose crucial challenges to the cohesion, economy and mental and physical health in 21st century societies across the world” [ 12 ]. In November 2023, the World Health Organization highlighted the importance of social connection, recognising the significant and often underestimated impact of loneliness and isolation on our health and well-being. This recognition led to the launch of its Commission on Social Connection (2024–2026), which aims to address this issue as a public health concern [ 13 ]. However, little is known about the extent that loneliness is currently included in national strategies and policies across the world.

Loneliness is often defined in psychological terms as an unpleasant feeling that people experience when they perceive their social relationships to be qualitatively or quantitatively inadequate [ 14 ]. The quality, rather than the quantity, of social relationships plays a greater role in loneliness [ 15 ]. While temporary loneliness is a natural human experience, chronic loneliness has serious negative consequences for health and life expectancy. There are three main types of loneliness: intimate (also known as emotional) loneliness, relational (also known as social) loneliness and collective loneliness, first identified by McWhirter (1990) [ 16 ], and empirically validated by Hawkley et al. (2005) [ 17 ] and Panayiotou et al. (2023) [ 18 ]. Loneliness is distinct from social isolation, which Nicholson Jr. (2009) [ 19 ] defines as “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships” (p. 1346). This does not mean that socially isolated individuals necessarily feel lonely and vice versa.

There are different scales to measure loneliness and social isolation. The most commonly used instruments for measuring loneliness are the indirect measures from De Jong Gierveld Loneliness Scale [ 20 ] and the full UCLA Loneliness Scale [ 21 ], as well as the direct measure from the UK Office for National Statistics [ 22 ]. However, what these definitions fail to measure is the “intensity, frequency and duration of loneliness. Loneliness can be acute (i.e., transient) or chronic (i.e., enduring), and it can be mild to severe in its intensity” [ 23 , p.2]. There are also a variety of scales to measure social isolation, but there is no consensus on which should be used [ 24 ]. Some common scales include the Lubben Social Network Scale [ 25 ], the Cudjoe social isolation typology [ 26 ] or a social isolation index used by Shankar et al. [ 27 ].

Our study contributes to existing literature by presenting an overview of current governmental documents that address loneliness and social isolation. Our intention is that the scoping review would be used by federal agencies or local communities who want to develop their own strategies to address loneliness and social isolation, or by researchers to gain an overview of the policy landscape.

The aim of this study was to characterise the policy landscape relevant to tackling loneliness and social isolation across the UN European country groups to identify commonalities and differences between national approaches to loneliness. A secondary aim was to provide actionable recommendations including their implications based on the scoping review for the consideration of policy makers to help promote the rapid and widescale adoption and diffusion of sustainable, scalable and evidence-based interventions to manage loneliness.

We conducted a scoping review based on Mak and Thomas’ recommendations (2022) [ 28 ] to identify (i) how loneliness and social isolation are defined, (ii) the common characteristics between loneliness policies across countries, (iii) which population groups were targeted, and (iv) whether there was an identifiable commitment to action and funding. We contextualised findings using five domains (geographic, social, health, economic, political) that all affect or are affected by experiences of loneliness and social isolation. We have taken every step to make the scoping review as clear and reproducible as possible, following the PRISMA-ScR guidelines [ 29 ] [see file: Supplementary Material _PRISMA-ScR-Checklist].

Eligibility criteria

A multi-method review approach inspired by Schnable et al. (2021) [ 30 ], including a qualitative policy analysis, was used to identify and describe the characteristics of a collection of national-level government documents with reference to loneliness and social isolation. As national policy documents and commissioned governmental strategies and action plans are not available on a central database, a systematic review was not feasible.

We retrieved and reviewed policy documents that address loneliness or social isolation from a total of 52 countries from the UN European Country Groups: Albania (AL), Andorra (AD), Armenia (AM), Australia (AU), Austria (AT), Azerbaijan (AZ), Belarus (BY), Belgium (BE), Bosnia and Herzegovina (BA), Bulgaria (BG), Canada (CA), Croatia (HR), Czechia (CZ), Denmark (DK), Estonia (EE), Finland (FI), France (FR), Georgia (GE), Germany (DE), Greece (GR), Hungary (HU), Iceland (IS), Ireland (IE), Israel (IL), Italy (IT), Latvia (LV), Liechtenstein (LI), Lithuania (LT), Luxembourg (LU), Malta (MT), Monaco (MC), Montenegro (ME), Netherlands (NL), New Zealand (NZ), North Macedonia (MK), Norway (NO), Poland (PL), Portugal (PT), Republic of Moldova (MD), Romania (RO), Russian Federation (RU), San Marino (SM), Serbia (RS), Slovakia (SK), Slovenia (SI), Spain (ES), Sweden (SE), Switzerland (CH), Türkiye (TR), Ukraine (UA), United Kingdom of Great Britain and Northern Ireland (GB), and United States of America (US). We chose this geographic focus of Europe because the European Union was the first supranational union of states to put loneliness on its agenda with a policy brief published in 2018 [ 31 ]. To ensure comprehensive coverage of European nations, we chose the UN European country groups, recognising that they include some members beyond the continent’s geographical borders.

Articles including policies, reports, strategies and policy briefs were included in the analysis if they were (i) from the two UN country groups under study, (ii) officially published or commissioned by a national government, (iii) publicly available, (iv) published between 1 January 2003 and 1 July 2023, (v) related directly to loneliness and social isolation or indirectly by using other language such as social connection, (vi) published in any language.

Information sources

The main information sources were governmental websites of relevant ministries and departments of the 52 selected countries. Additionally, we used the Google search engine for all publicly available national policies related to loneliness and social isolation.

We conducted desktop research using the key terms “loneliness” and “social isolation” for all publicly available national policies, including a review of government websites to generate an asset map of key policy documents and white papers from each country. Online searches were conducted between 1st February 2023 and 1st July 2023.

Internet searches, using the Google search engine, included the following keywords: [(“loneliness” OR “social isolation” OR “social connection”)] and [(“policy” OR “strategy” OR “actions” OR “reports”) and “Country”]. If this did not yield any results for a specific country, we searched for the government website of that country using primary (loneliness and social isolation) and secondary (strategy/policy) terms to determine if governments published documents on loneliness and social isolation. The Google website translator was used to navigate non-English governmental websites.

Selection of sources of evidence

The documents were not limited to policies, but also included national strategies, technical reports, brochures and webpages published by government agencies, studies commissioned by a government agency, governmental press releases, and parliamentary enquiries from politicians to federal ministers or councillor regarding data on loneliness in their respective countries. If multiple strategies/policies from the same government were found, the most recently published one was included. We focused on national level documents only (excluding any regional strategies).

Where documents retrieved were not in English, they were translated into English using a paid (subscription) version of DeepL Pro, a powerful and sophisticated online translator. For reasons of pragmatism, no attempt was made to quality assure the translation with native speakers.

We excluded 40 documents after a first round of reviews where there was no disagreement between the researchers. For 20 documents there was no consensus, so a third researcher reviewed the documents. After reviewing each document, consensus was reached to exclude 16 of the 20 documents. Documents were excluded for the following reasons: (i) loneliness and social isolation were only mentioned in passing and did not elaborated on the issue of loneliness, or loneliness was not part of a proposed intervention, (ii) highlighted or acknowledged loneliness as a problem but we could not identify any detail or strategies or commitments on how to address it, (iii) short news piece or press releases that did not specifically touch on loneliness or social isolation, (iv) documented queries raised by political representatives addressed to parliament, (v) research articles not commissioned by the government, (vi) local focus, not national, (vii) NGO reports not commissioned by a government and (viii) older versions of included documents.

Data charting process

The principal investigator (NG) developed a coding matrix using Excel based on the study objectives and considerations from Braun and Clarke (2006) [ 32 ]. This matrix was first tested on the British documents (NG, DK, MLEA), as we knew these to be extensively detailed. In an iterative process this matrix was reviewed and adapted after testing it on a random selection of five sources of evidence (NG, DK, MLEA, PQ). After a final round of reviewing and adapting, all authors agreed by consensus that they have captured all desired variables needed to address the study objectives. Each policy document was coded independently by at least two investigators (NG, DK, MLEA) to minimise human error in information extraction.

The configuration matrix was completed for all sources of evidence containing information on: (i) document overview (title, publisher, year of publication, original language of publication), (ii) recommended measurement tool for loneliness, (iii) definitions for loneliness, social isolation and other language around social connection, (iv) target group of policy, (v) proposed or suggested actions by government (raising awareness, funding pledge, call for a development of a loneliness measure, proposed interventions or actions, type of evidence cited, commitment to work with specific charities), and (vi) five key domains (geographic, social, health, economic, political) that affect or are affected by experiences of loneliness and social isolation. We also coded whether the documents referred to five domains (geographic, social, health, economic, political) that have been shown to affect or are affected by experiences of loneliness and social isolation.

Synthesis of results

The data of the configuration matrix were consolidated and are presented as Table  1 , Supplementary Table A [see file: Supplementary Material_Table   A ], and within the text where a presentation in table format was not deemed useful (for data items 3–5 as detailed above). We used the document analysis as proposed by [ 33 ] to analyse all the included documents. This approach is based on an iterative processes of qualitative content analysis [ 34 ], with a specific thematic analysis [ 32 ]. The configuration matrix captured all extracted data from which the authors (NG, DK, MLEA) could identify emerging sub-themes within these broad pre-defined domains of loneliness (geographic, social, health, economic and political domain) using thematic analysis [ 32 ]. To create recommendations, two authors (NG, PQ) reviewed the extracted data, with the team revisiting the sources of evidence where needed.

Our scoping review identified 79 sources of evidence that discussed loneliness and social isolation from across 32 countries in both UN European country groups. We excluded a total of 56 documents after two review rounds for reasons shown in the PRISMA flowchart Fig.  1 . This yielded a subset of 23 documents that were included in our final analysis.

PRISMA flow chart based on [ 24 ]

Wider awareness of loneliness and social isolation in our study area

Here, we delve into the sources of evidence that were excluded from our study, but which are nonetheless noteworthy because they illustrate the momentum of the international conversations around loneliness. In some countries (AT, CH), we found parliamentary enquiries asking about data on loneliness in their respective countries, and whether there were any strategies in place to alleviate loneliness. DE does not have a loneliness strategy, but the governmental Committee for Family Affairs, Senior Citizens, Women and Youth has partially funded the organisation (the Competence Network on Loneliness (KNE)) which looks at the causes and consequences of loneliness and promotes the development and exchange of possible prevention and intervention measures in DE. NZ is a good example where there was no specific policy, despite there being great public awareness. They have an established nationwide trust called “Loneliness New Zealand Charitable Trust”. While some countries had excellent resources targeted at policy makers (e.g. CA), they have not yet been translated into a nationwide policy to address loneliness and social isolation. In countries where there was no national strategy, some cities have designed their own regional strategies or organisations, e.g. Barcelona [ 57 ], Helsinki [ 58 ], or Vancouver [ 59 ]. A map highlighting the loneliness policy development landscape across 52 countries of the UN European Country Groups is shown in Fig.  2 .

Current state of the loneliness policy landscape across the study area. Map created with [ 28 ]

It is important to note that for many countries in the study area we could not identify any resources that met the inclusion criteria. It is difficult to assess why loneliness and social isolation are not on the policy agenda of more national governments. Connel and t’ Hart [ 60 ] have developed a typology of policy inaction. Three of the five types may apply to our context: Type I: Calculated inaction. Governments may make a strategic decision not to act, or not to act now, because they believe that the costs of action outweigh the perceived benefits, or because they want to see a stronger evidence base on an issue. Type II: Ideological inaction. Government inaction as a product of ideology, where governments rely on non-governmental and not-for-profit organisations to address the issue of loneliness. The strong third or social-economy sector in the European Union [ 61 ], which includes more volunteers than paid employees, could give the impression that loneliness and social isolation can be managed without government policies. Type IV: Reluctant inaction. Governments do not act because they perceive an absolute or relative lack of resources to fund loneliness and social isolation policies. This may be the case for the less economically strong countries in our study area that do not have policies in place.

Characteristics of sources of evidence

Table  1 gives an overview of the 23 documents that we included in our analysis. Half the documents were published after 2020. Seven documents had to be translated into English. Certain countries released documents in conjunction with one another. For instance, Denmark published a National Strategy and an Action Plan simultaneously in 2023 that were complementary. Similarly, GB’s 2021 Action Plan builds on the GB Loneliness Strategy published in 2018.

Results of individual sources of evidence

For each of the included sources of evidence, we extracted information with our configuration matrix presented in the section Data items . We believe that presenting the results this way will better suit our study objectives, i.e., to highlight common and unique themes.

Target group of policies

Eight documents (from AL, CA, IT, MT, US) were targeted specifically at the older adult population, often classified as age 65 + years. Definitions, causes and proposed interventions for loneliness and social isolation in those documents were contextualised within the framework of old age. The other documents addressed the general population, often highlighting that there are specific groups that are more vulnerable to becoming lonely or socially isolated. Five of the documents identified target groups at increased risk of loneliness (AU, IE, CH, GB, DK). For instance, children (IE), young adults ages 18–25 years (AU, DK, IE, GB), older adults ages 65 + years (AU, CH, IE, GB), people with disabilities & special needs (AU, DK), people suffering from mental illness (CH), those with long-term illness (GB), migrants and refugees (AU, CH, GB), lower income households (AU), and people living alone (AU, CH), people with lower levels of schooling (CH), single parents (CH), young single men (CH), care leaver (GB), victims of domestic violence (US), LGBTQ + individuals (US) and minorities (DK, US).

Defining loneliness and social isolation

Of the 23 documents included in the review, 11 documents from seven countries (AU, AT, CA, DE, NL, GB, US) provided specific definitions of loneliness and social isolation. Those definitions were based on academic sources, explicitly referenced and cited, except for AT which based their definition on general “experts” rather than a specific source. Peplau and Perlman (1982)’s widely used framework is drawn upon in multiple documents, and some countries (AU, DE, NL, GB) go further in their definitions to distinguish between different types of loneliness, (e.g., social, emotional, and existential loneliness in the NL document).

The 11 documents that used a specific definition of loneliness used the Peplau and Perlman (1982) definition that highlights differences between loneliness and social isolation. Documents noted social isolation as an objective lack of social relationships, while loneliness is considered to be the subjective feelings as a result of that social isolation.

Across all the documents included in our review, both with and without specific definitions of loneliness, other language used around social connection can be classified as follows:

Inclusion in wider society, which includes the terms social inclusion (CZ, DK, IE, MT), social integration (CA) and social participation (DE, NL, CH).

Connecting with others, which includes the terms social networks (CA, DK, DE), social support (CH, US), social connection (AU, US), and social contacts (AT, DE, NL, GB).

Existing resources, which includes the terms social resources (CH), social capital (CH, CA), and social skills (CA, NL).

Covering a deficit, which includes the terms social exclusion (AL, CZ, CA), social vulnerability (IT, CA) and social recovery (AU).

Relationship between loneliness and mental health, which includes the term social wellbeing (GB), and discussions of social prescribing (GB) and the contribution of loneliness to poor mental health (IE).

Mental health, which includes the term social wellbeing (GB), and discussions of social prescribing (GB) and the contribution of loneliness to poor mental health (IE).

Funding pledges

Despite the governmental strategies and action plans to reduce loneliness and social isolation, we found little evidence of a commitment to funding. We identified concrete funding pledges or already provided funding for AL (0.75 m USD for 5 years), DK (145 m USD for 2014–2025), GB (24.8 m USD in 2018; 44.5 m USD in 2020), and NL (10.7 m USD per year for 2022–2025; 5.5 m USD 2018–2022) governments. DK provided a detailed overview of initiatives that can be achieved within the already approved budget, initiatives that could be delivered within existing financial frameworks and over 80 initiatives that should be advanced but required additional funding. The Australian government has not yet made a funding pledge but has received a specific budget and initiative proposal for funding from an alliance of three different national organisations. Other government strategies either stated that different ministries are to ensure the necessary financial and human resources for initiatives that fall under their respective jurisdiction (MT) or did not specify funding pledges, merely stating that adequate funding needs to be identified (IT). We identified that some governments (DE, SE) are (partially) funding research on loneliness to gather scientific evidence to help them build their own policy.

Interventions and partnerships

Strategies, policies and action plans proposed a variety of interventions, while technical reports focused on reviewing existing evidence. We have provided many intervention examples across various domains in the policy landscape analysis section below. Of those countries and documents included in our analysis, only AU and GB have committed to work with specific charities, organisations or initiatives to address loneliness and social isolation. Other governments (CA, IE, IT, MT) stated their intention to work with NGOs and local services, but did not mention any specific organisations.

Development of a loneliness and social isolation measure

None of the documents called for the development of new tools to measure loneliness or social isolation. US, DK and GB reviewed existing measures of loneliness for use in possible interventions and strategies. Notably, GB described its own use of a consistent and direct measure of loneliness, developed by the Office of National Statistics (ONS) in 2018. The Direct Measure of Loneliness is a single item measure developed by the ONS that should be used in conjunction with three questions from the University of California Los Angeles (UCLA) Loneliness Scale. A US documents considered multiple ways in which loneliness and social isolation should be measured in research and recommended the appropriate choice of measures in targeted interventions and in major health strategies. The US did not call for the creation of a new measure, but rather recommended the use of existing validated tools tailored to the purpose of proposed interventions. DK’s national strategy considered the applicability of adult measures to adolescents and children.

Policy landscape analysis

This section highlights the wider policy context of the loneliness debate. All 14 countries that have published documents on loneliness are aware that loneliness touches many different dimensions (geographical, health, social, economic, and political; see Table  2 for a brief overview). In 91% ( n  = 21) of the analysed documents, the social and health dimension was most prominent, highlighting the impact of loneliness on various aspects of people’s lives and across age groups, as well as the health implications. However, not all dimensions were addressed with the same level of detail. An extensive overview of the different dimensions touched upon in every document can be found in the Supplementary Table A . For each of the five dimensions, we have identified themes that recur across the documents. We have also added some intervention examples to show how loneliness could be addressed in this dimension from a policy perspective.

Geographic dimension

Most documents (74%, n  = 17) touched on various geographic dimensions that influence or are influenced by loneliness. Four governments observed geographical variation in loneliness prevalence within their country (AU, CA, DE, GB). Only one document suggested reforming the digital environment (US). Within the geographic dimension the following themes were most often mentioned as being influential regarding loneliness and social isolation in the context of geography: (i) place or residence and housing, (ii) public transport, (iii) community services, and (iv) urban planning.

Place of residence and housing

Four governments (AU, CA, DE, GB) reported that the place of residence (urban or rural) significantly influences loneliness. Loneliness levels were also considered to vary due to population changes (AT, DE) but acknowledged that regional distribution was complex and cannot be solely attributed to urban-rural differences. Relocating to a new place was also reported to lead to feelings of being disconnected from familiar social networks and support systems. Additionally, insufficient affordable and suitable housing contributed to social isolation. Living conditions were mostly mentioned in connection with older adults where the effect of the type of housing was mentioned to affect social interactions and feelings of loneliness (CA, DK). Intervention examples to manage loneliness as a result of a change in residence, or loss of housing include working within local municipal authorities’ strategies on housing policies and reform plans (IT, DK, NL), creating models of apartments that foster community life (AL, DK), creating flexible housing solutions to support life transitions, e.g. homes that can be adjusted in size or adapted to changing needs (DK).

Public transport

The impact of public transport, especially access and affordability, was mentioned as a key issue for social integration, especially for older people (AL, CA). The place of residence (especially if rural) was recognised as a barrier to public transport use. Intervention examples that were put in place to address this issue include an increase of public transport access for the poorer older adults by subsidising the costs locally (AL, DK), and further strengthening accessible transport for communities in residential areas specifically (DK, GB).

Community services

Limited awareness of or access to community services contributed to loneliness. Financial support and grants for rural projects are needed to promote social inclusion. GB, DK and NL documents highlight the importance of the central government working together with local authorities, as the latter play a key role in actively supporting local transport, voluntary groups and initiatives that promote social cohesion and reduce isolation. Intervention examples included subsidies for community work to promote social inclusion specifically in rural areas (CZ), expanding the services in and of community centres (AL), and promoting the use of tailored community-based services (US).

Urban planning

There was general awareness that the physical environment can pose challenges to social participation, especially for the more vulnerable groups, e.g. older adults (CA), in terms of access to public toilets or walkability. Intervention examples included cultivating a sense of belonging that should be considered by urban planners (CA, IT), ensuring proximity to public services (IT), access to public toilets (CA), establishment of healthy and active movement paths (IT) aimed at encouraging walking groups (IT, CH), maximising the use of underutilised community spaces (GB), and use of participatory design in the development of child-friendly neighbourhoods in local environments (CH).

Social dimension

Most documents (90.9%, n  = 20) highlighted a range of interrelated social factors associated with loneliness; the social determinants covered various aspects of people’s lives that shape experiences of loneliness across age groups. Throughout these documents were notes on groups more vulnerable to loneliness as well as everyday life transitions and triggers. Some risk factors for loneliness such as lacking contact with family and friends, the negative impact of unemployment, and inadequate income support were also prominently highlighted.

Groups vulnerable to loneliness

Many governments identified groups more vulnerable to loneliness and social isolation, in line with research findings (AL, CA, IT, MT, NL, CH, GB, US). The following groups were identified as more vulnerable to becoming lonely or socially isolated: single parents, widows, newly retirees, single households, those living in changing family structures, immigrants with language barriers or low socioeconomic status, individuals dealing with addiction, those from the LGBTIQ + community, young adults (around 18 to 29), older adults (above 80), individuals that experience bullying or harassment, and individuals with criminal records. The importance of cultivating inclusive communities and establishing safe spaces for individuals, particularly for groups like migrants, single parents, and older adults was emphasized. Interventions were often tailored to specific groups. For example, community-led interventions targeted older adults who were homebound or in residential long-term care (MT). Others strengthened the resources of older people caring for relatives (CH), invested in a Carers Action Plan (GB), levelled up the volunteering infrastructure through collaboration of the voluntary sector and the government especially for those out-of-work (GB), developed social prescribing pilots and peer support groups (GB, US), facilitated befriending and socializing (AU), and linked vulnerable groups of people in the form of self-help and enabled them to help each other (CH). Here are some examples of targeted interventions for specific groups:

Women: language classes for women who do not speak the local language with crèche facilities alongside the classes (GB), Mitigate the risks of lifelong gender inequalities that result in female old-age poverty and gender pension gaps by ensuring adequate levels of income security for older women (MT).

Men: increase offers for older (single) men such as Men’s Meeting Places or Men’s Communities (DK), active aging centres to mitigate against the tendency of older men to experience difficulties in seeking help and talking about loneliness (MT).

Young people: Strengthen detection of loneliness in day care, primary schools and educational institutions (DK), provide education courses as a source of mitigating loneliness among children (DK), create more binding communities for young people without education and jobs (DK).

Older adults and low-income households: offer free local cultural and leisure activities (CH), increase public transport access (AL), guaranteeing the living minimum and gradual improvement of lowest pensions (AL), activation of computer literacy paths (IT).

Everyday life

The impact of events like the pandemic on individuals and communities was noted, with reference to mental well-being and social interactions, including potential changes in post-pandemic work patterns that might limit personal engagement. The absence of support or opportunities within society, communities, and workplaces is discussed as hindering social integration and fosters loneliness. The role of technology and social media as both a potential mitigating and exacerbating factor was recognized. Intervention examples include enhancement of popular traditions by developing new forms of technologically-oriented interactions, while still including cultural heritage (IT), expansion of existing community interventions (MT) including specific funding allocated to national, local, and community levels (AU), development of national and community awareness or anti-stigma campaigns (AU, CA, DK, DE, IE, NL, GB, US), and awareness spreading specifically towards politicians, administrations, managers, health care providers and others who work on loneliness (DK, US).

Health dimension

The health dimension of loneliness was very prominent in most documents (91%, n  = 21), often noting that socially isolated individuals faced an increased risk of engaging in negative health behaviours. The evidence of interconnection between chronic illnesses, mental health and social isolation was also highlighted. Overlapping with recommendations identified in the social domain, the need for policy development to prioritize social function among older individuals, aiming to enhance their overall health and well-being, was mentioned by (AT, DE, IE).

Institutional intervention examples included the development of an integrated health and social system on a community basis (AL, DK), national training for health practitioners and community care services to systematically identify, monitor and direct people experiencing loneliness (AU, DK, MT, US), linking healthcare practitioners with researchers to further evaluate and use loneliness assessment tools in clinal settings (US), and the inclusion of loneliness and social isolation in electronic health records (AU, US).

Physical health

Documents noted the evidence that individuals with higher levels of chronic diseases, geriatric syndromes, reduced mobility, chronic pain, frailty, hearing and sight impairment, urinary incontinence, or other health issues necessitating long-term care were more susceptible to loneliness. Governments acknowledged these links, often targeting interventions to support disabled people. Intervention examples included the provision of sensory impairment guides for those whose social lives are impacted by a change in their senses due to accidents or disabilities (GB), strengthening bridge-building for civil society and other actors was recommended in the context of in-system transitions and among high-risk groups (DK), the establishment of mobility centres to help people stay mobile or provide information on alternative modes of transport (GB), increased focus on digital inclusion of older and disabled to reduce loneliness as they face reduced mobility (GB), and the advancement of physical activity interventions, especially promising for improving the health outcomes of older adults (US).

Mental health

The policy documents showed empirical evidence that individuals experiencing depression, mental health problems and addiction were at risk of social exclusion. Depression and anxiety are specifically mentioned as significant factors in the context of loneliness; the consequences of loneliness are also discussed, with reference to the increased risk of depression, suicide, anxiety disorders, dementia, and reduced cognitive abilities. Intervention examples included the introduction of community care for people with mental health problems (CZ), while others focused attention on cognitive behavioural therapy, interpersonal psychotherapy and mindfulness (US). The reduction of addictive substances in populations at risk of social exclusion was targeted (CZ); mental health literacy programs were also discussed (DE, IE), specifically in reference to school education initiatives such as social emotional learning programs for use in preschool, school, and youth settings (IE); mental health literacy campaigns were also highlighted (DE, IE).

Economic dimension

Economic factors relating to loneliness were also addressed most documents (74%, n  = 17). In line with research evidence, documents noted that unemployment, receiving income support, and dissatisfaction with financial situation contribute to loneliness. The need for allocating more resources to combat poverty and address the loneliness experienced by older individuals was emphasised, with reference to the fact that it plays a crucial role in enhancing their overall well-being and quality of life. The following themes were prominent within this dimension.

Economic poverty stemming from insufficient income was identified as a key concern for the older adult population. Notably, social exclusion and family poverty were found to be directly linked, posing a risk to children as well. One document (AU) noted that men ages 25–44 years with high incomes and women of all ages with low incomes have been to be more susceptible to loneliness, revealing a discrepancy based on gender. The economic burden of loneliness extended to health service utilization costs, especially for mental health services. Intervention examples included allocating more resources to combat poverty and address the loneliness of older people specifically (IT), guaranteeing dignified living conditions through the adoption of the minimum pension and the gradual improvement of the lowest pensions by offering sustainable support for the poorer elderly was also suggested within the economic domain (AL), early support interventions for children from disadvantaged families, including support for their parents (CH), and more widely to reduce risk of social exclusion due to over-indebtedness (CZ).

Unemployment

Lack of affordable and suitable housing and care options was noted as being linked to social isolation. Loneliness and lack of social support could lead to reduced community participation, hindering employment prospects and workplace progress. This can result in reduced productivity, lower job satisfaction, increased absenteeism, and longer recovery times due to stress and health issues, which in turn negatively affects the economy. Intervention examples included facilitation of the integration of vulnerable individuals into the workforce (CZ, DK), prevention of loneliness among the unemployed through volunteerism and community initiatives (GB, DK), focus on ensuring a smooth transition from work to retirement (DK), working in collaboration with job centres (GB), and creating a cultural shift in work environments for employees at risk of social exclusion (CZ).

Political dimension

Political factors pertaining to loneliness and social isolation were only identified in few documents (30%, n  = 7), indicating less governmental awareness of the political implications of loneliness. Instances of elderly individuals being denied many rights were observed to be associated with loneliness (AL). Additionally, the effects of COVID-19 lockdown policies were connected to the loneliness because of social isolation. DE mentioned the political relevance of loneliness as it correlates with decreased political engagement of individuals. Thus, it was stated that implementing political measures at the federal level is imperative to effectively foster a more socially connected society (DE). One of the documents mentioned the need for the government to establish a comprehensive national strategy targeting loneliness, accompanied by the allocation of sufficient funding, with active engagement from regions and municipalities, especially when it comes to implementation (DK). Furthermore, the same document underscored the contribution of various other key stakeholders, including research institutions, foundations, employers, and civil society, in combating loneliness (DK). Multiple countries acknowledged the relevance of working across government bodies and levels in combatting loneliness (AU, DE, NL, GB). One document highlighted the need for a “connection-in-all-Policies” [ 62 , p.49] approach as social connection, an antidote to loneliness and social isolation, is relevant in all sectors (US).

To our knowledge, this is the first study to characterise the loneliness policy landscape across the UN European country groups (52 countries). The scoping review provided comprehensive coverage of how countries address loneliness and social isolation on a national level, allowing for a much clearer understanding of the diversity in country-level strategies and better coordination across countries in tackling loneliness. This is particularly important because loneliness and social isolation have been increasingly identified as a public health concern [ 63 , 64 ]. The findings of this review can be used by a wide range of stakeholders including federal agencies and local community groups who want to develop their own strategies to address loneliness and social isolation, or by researchers to gain an overview of the policy landscape.

Summary of principal findings

While not all governments (14 of 52 countries; 27%) had official documents that addressed loneliness, the vast number of documents we identified (79 documents) highlight the growing momentum in the loneliness discourse in the study area. The inclusion of research findings in the vision and strategy documents from different nations suggests widespread evidence-to-policy across the world and calls for a cross-disciplinary approach to addressing loneliness, including efforts to leverage asset-based community development and place-based approaches to tackling loneliness [ 65 ].

All 14 countries that published documents on loneliness demonstrated an awareness that loneliness impacted various dimensions including geography (through place of residence and housing, public transport, community services, urban planning), social (some groups are more vulnerable to loneliness than others, social support, technology), health (physical and mental), economics (income, unemployment) or politics (effects of COVID policies, political engagement, working across sectors to address loneliness). Notably, none of the documents reviewed acknowledged that (i) most research on physical health and loneliness is cross-sectional, where the researcher measures both the outcome and the exposures of the study participants at the same time, and thus, the findings of these studies cannot be used to make causal inferences, and (ii) such work does not control for other predictors of health, including, for example, socioeconomic status and actual health conditions. These are important considerations because (a) we cannot be certain that healthy individuals are more likely to get sick if they experience loneliness compared to other healthy individuals who do not experience loneliness, and (b) whether the link between loneliness and health is actually driven by structural inequalities that determine our physical and social environments. We have also found that the documents rarely mention the transient nature of loneliness and the discourse often seems to frame loneliness like an illness that can be treated. The documents also did not address the cultural context (i.e. beliefs, values, religion) that can shape expectations of relationships and the welfare regime.

Policy targets proposed in the documents

Most countries in our sample showed some attempt at raising public awareness about loneliness (AL, AU, CA, DK, DE, IE, IT, MT, NL, CH, UK, US). Such policies are often informative, but there appeared to be a lack of deadlines and appropriate funding. That means the strategy cannot be evaluated. Another point of concern is the perception that loneliness is something that only affects older adults. Some documents lacked information about how to address loneliness, probably because here is limited evidence of what works and for whom. Also absent was a commitment to evaluation of interventions, which is crucial to verify the effects of any intervention and any risks related to action.

Recommendations for policy makers

Despite the adoption of an evidence-to-policy approach to loneliness, given the issues noted above, we encourage policymakers to be cautious in making claims in relation to loneliness, and to ensure that part of their strategy includes the funding of research that fill the gaps in knowledge. Policymakers should also ensure that the work they quote includes study populations that are well-represented in all relevant demographics and that the research is able to make causal claims about how loneliness impacts health. The World Health Organisation (WHO) and the European Union have identified the limits of their own knowledge and skills in this field, commissioning experts to write evidence gap reports [ 66 , 67 ] or GB and DK for example have had loneliness researchers help write their vision and strategy.

Policymakers should also adopt a similar approach in relation to interventions that address loneliness. A recent meta-analytic review [ 68 ] suggested that in order for interventions designed to reduce loneliness to be effective, matching the intervention to the loneliness type is essential, whereas a one size fits all will not be effective. For example, social support interventions and social and emotional skills training are all promising interventions for reducing loneliness, albeit they are usually only appropriate for loneliness that is linked to the perceived absence of a close friend or partner and perceived lack social encounters and acquaintances respectively. Such an understanding of the nuances surrounding loneliness interventions is absent from the documents we evaluated, and policymakers will want to fill that gap in their knowledge so that appropriate decisions about intervention work, and suitable funding, can be provided. The effects of current interventions have been shown to be only moderate, highlighting the need for funding for rigorous and systematically developed interventions that are also appropriately evaluated.

Based on our scoping review and underlying evidence we propose a list of actionable recommendations for national and regional governments wishing to establish or incorporate loneliness into their policy documents (Table  3 ). In sum, we believe that revisiting previous national and local campaigns to identify connection points for loneliness interventions is an effective way to include loneliness into the policy agenda. For example, a walkability campaign that focuses on making cities more pedestrian friendly will benefit individuals in terms of physical health and mental health but it also increases the likelihood of social encounters when walkability is higher [ 69 ]. We also believe that sharing best-practice approaches internationally and accessible to everyone ensures the development of a strong knowledge base. The EU has taken the lead as the first supranational union to address loneliness amongst its member states by recently organizing various roundtables and conferences around loneliness [ 70 ]. Globally, WHO has recently published an evidence gap report on in-person interventions for reducing social isolation and loneliness [ 67 ]. Lastly, we argue that policies would be meaningless if there are no concrete funding streams allocated towards evidence generation, intervention design and implementation and the evaluation thereof. Because our review could not identify clear funding streams for all countries, we strongly encourage policy makers to make the funding streams transparent within their loneliness policies.

Limitations

The primary limitation of our scoping review was concerned with identifying documents from countries that did not provide information in English. That limitation was partially overcome by the use of Google’s website translator. Another limitation is the reliance on machine translation for the identified documents. Documents were translated into English from German, Danish, Finnish, French, Dutch and Norwegian using DeepL. For German and French, the quality of the translation was checked by the author team and considered sufficient to meet our study aim. The cross-sectional design of our scoping review also does not account for how a country’s policy may have changed over time. This is a general issue in policy evaluation. That limitation can be overcome by conducting this review every two to four years. Another challenge with our study is that the data reflect the existence of policies and not the effectiveness of their implementation. Further, only funding that was explicitly allocated to reducing loneliness and social isolation was considered. We acknowledge that other initiatives that received governmental funding pledges, such as establishing community centres for older adults, might also reduce feelings of loneliness. However, it is beyond the scope of the current paper to identify which initiatives specifically reduce loneliness and how much funding has been allocated to them, especially as evidence on which interventions have proven successful are scarce. Additionally, there may be other funding streams we are not aware of or that might have been part of other documents (e.g., state budgets) not included in this analysis.

More work is needed to assess if the various proposed interventions are implemented and successful. Evaluating interventions is crucial if we want to effectively use the pledged funding, to identify what tools (online or other) are being developed to promote loneliness interventions on national and regional levels and to map out the role of the emerging national loneliness networks.

Our study provides the first comprehensive overview of the national loneliness policy landscape across 52 countries, highlighting the increasing prioritisation of loneliness and social isolation as significant public health and societal issues. While the momentum in addressing loneliness is evident, with most policies being informed by scientific evidence, gaps remain, particularly around intervention strategies and their effectiveness. Our findings urge policymakers to not only sustain this momentum but to also strengthen their strategies by incorporating rigorous, evidence-based intervention evaluations and fostering international collaborations for knowledge sharing. This approach can enhance the understanding and addressing of loneliness, ensuring interventions are well-targeted, effective, and scalable. By addressing these issues, policymakers can more effectively manage loneliness by directing funds to develop and implement interventions that impact the individual (e.g. through therapy or befriending services, thereby improving public health outcomes) and the community and society by making them genuinely inclusive, thereby increasing social cohesion.

Availability of data and materials

The references to the documents supporting the conclusions of this article are provided in Table  1 . Should a link have expired, contact the corresponding author for a pdf version of the translated and original document in question.

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Acknowledgements

The authors thank the following students for assisting with compiling the dataset of government documents: Selma Akbas and Laura Baldini. The authors also thank the following students for assisting with the first round of document coding: Kim Aleppo, Izma Ahmed, Angela Benson, Emma Marchong, Sathana Sivanantham, Keyi Le, Yaxuan Shi, Ruifeng Ding and Yiming Bi. The authors would also like to thank Mahmoud M M Al Ammouri for creating the map displayed as Fig.  2 . The lead author also thanks Claudia Kessler from Public Health Services based in Switzerland for insightful discussions on the Danish and Dutch national loneliness policies.

This research was unfunded. Nina Goldman is supported by the Swiss National Science Foundation (SNSF), Bern (Grant #: 214225). Austen El-Osta is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London. The views expressed are those of the authors and not necessarily those of the SNSF, NHS, NIHR or the Department of Health and Social Care. AEO is the guarantor.

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Nina Goldman, Devi Khanna and Marie Line El Asmar contributed equally to this work.

Authors and Affiliations

Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Devas Street, Manchester, M13 9PL, United Kingdom

Nina Goldman, Devi Khanna & Pamela Qualter

School of Public Heath, Faculty of Medicine, Imperial College London, Charing Cross Hospital, Reynolds Building, St Dunstan’s Road, London, W6 8RF, United Kingdom

Nina Goldman & Austen El-Osta

North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom

Marie Line El Asmar

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All authors contributed substantially to this study: Conception (N.G., A.EO.) and design of the work (N.G., A.EO., P.Q.); Data collection (N.G.); Data analysis and interpretation (N.G., D.K., M.L.EA.); Drafting the article (N.G., D.K., M.L.EA.); Critical revision of the article (P.Q., A.EO.); Final approval of the version to be submitted (N.G., D.K., M.L.EA., A.EO., P.Q.)

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The authors span multiple nationalities and levels of seniority. All authors are based at three UK institutions (University of Manchester, Imperial College London and Hampshire Hospitals NHS Foundation Trust). The lead author is a human geographer researching loneliness from a spatial perspective, the second author has a background in international social and public policy, the third author is a medical doctor conducting mixed methods research in the area of public health, the fourth author is the UK's leading scientific expert on child and adolescent loneliness and the last author is a mixed methods public health researcher and is principal investigator of the Measuring Loneliness in the UK (INTERACT) study.

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Correspondence to Nina Goldman or Devi Khanna .

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Goldman, N., Khanna, D., El Asmar, M.L. et al. Addressing loneliness and social isolation in 52 countries: a scoping review of National policies. BMC Public Health 24 , 1207 (2024). https://doi.org/10.1186/s12889-024-18370-8

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Received : 06 December 2023

Accepted : 17 March 2024

Published : 01 May 2024

DOI : https://doi.org/10.1186/s12889-024-18370-8

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• Social isolation
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