The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis

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Abstract

Background

Peer 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.

Method

We 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.

Results

Twenty-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.

Conclusions

One-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 registration

Prospero identifier: CRD42015025621.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12888-020-02923-3.

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Author and article information

Contributors

Steve Gillard:

ORCID: http://orcid.org/0000-0002-9686-2232

sgillard@sgul.ac.uk

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 11 November 2020

Publication date PMC-release: 11 November 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 534

Affiliations

[1 ]GRID grid.264200.2, ISNI 0000 0000 8546 682X, Population Health Research Institute, , St George’s, University of London, ; Cranmer Terrace, London, SW17 0RE UK

[2 ]GRID grid.28577.3f, ISNI 0000 0004 1936 8497, School of Health Sciences, , City, University of London, ; London, EC1V 0HB UK

Author information

Steve Gillard http://orcid.org/0000-0002-9686-2232

Article

Publisher ID: 2923

DOI: 10.1186/s12888-020-02923-3

PMC ID: 7657356

PubMed ID: 33176729

SO-VID: 4ee24782-5e7f-49e6-9d05-d6cd7e596fe3

License:

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

History

Date received : 24 June 2020

Date accepted : 18 October 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100007602, Programme Grants for Applied Research;

Award ID: RP-PG-1212-20019

Award Recipient : Steve Gillard

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: peer support,peer worker,mental health services,randomised clinical trial,systematic review,meta-analysis,empowerment, recovery,social network

Data availability: