Abstract
BackgroundPeer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions.MethodWe searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data.ResultsTwenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery.Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support.ConclusionsOne-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support.Trial registrationProspero identifier: CRD42015025621.
Highlights
Peer support is being introduced into mental health services internationally, often in response to workforce policy
In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support
The quality of reporting, both of trial methods and design of peer support interventions, has improved somewhat but needs to continue to do so - especially with respect to complete reporting of outcome measurements - in order to maximise the usefulness of the evidence base for service providers and policymakers
Summary
Peer support is being introduced into mental health services internationally, often in response to workforce policy. The peer support literature has been reviewed before, with Pitt and colleagues [7] finding a small reduction in emergency service use where peer workers were compared with other mental health professionals working in similar roles (primarily case management), while Lloyd Evans and team [8] found a modest positive effect of peer-provided interventions on self-reported recovery and hope Both reviews combined studies of individual and group-based peer support – noting substantial heterogeneity in both intervention and trial population – and in both reviews authors cautioned that the majority of trials were of low to moderate quality and that reporting bias in particular might explain these results. A recent, informal review has indicated that a number of new trials of one-to-one peer support in mental health services have been reported [11], offering a timely opportunity for a systematic review focusing on one-to-one peer support in order to provide an evidence base for the ongoing introduction of peer workers into mental health services internationally
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