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. 2014 Jul 30;17(4):123. doi: 10.1136/eb-2014-101802

Review tempers expectations for peer-led services but further studies are required

Anthony O Ahmed 1, Peter F Buckley 1
PMCID: PMC13404022  PMID: 25079066

What is already known on this topic?

Peer-led interventions have emerged in the spirit of the consumer/survivor movement in the past three decades. Their implementation has grown steadily internationally, and in the USA they likely outnumber the number of traditional care services.1 Although several favourable reviews of peer-led interventions exist, they also acknowledge the limited empirical support from rigorous clinical trials.2

What does this paper add?

  • Even though peer-led interventions do not produce significant benefits on symptoms, hospitalisation status and satisfaction with services, peer-led services appear to foster hope, empowerment and experiential recovery at post-treatment and follow-up evaluations.

  • The authors’ assertion that their findings do not support the recommendation for mandatory peer-led services is one-sided. Peer-led interventions are viewed as necessary for the transformation of traditional care systems viewed as paternalistic and fostering disability and dependency into systems that are more inclusive and responsive to consumer choice, civil rights and autonomy.3 They are also viewed as necessary for exposing care recipients to peer mentors—other individuals who are living full meaningful lives and functioning successfully in a community of their choosing despite the challenges imposed by psychiatric illnesses. The provision of peer mentors is a central tenet of peer support and the recovery movement.2 4 Therefore, an evaluation of the clinical benefits of peer-led interventions (ie, evidence-based) is not necessarily germane to their status as services mandated by mental health policy makers.

Limitations

  • Peer-led interventions are not manualised.

  • Several studies of peer-led interventions are plagued by limitations in trial design and problems with reporting that increase the risk of bias in these studies.

  • The review still includes too fewer studies to draw any firm conclusions about the benefits of peer-led interventions for any of the outcomes evaluated.

What's next in research?

  • There is a need for more rigorous, well-designed studies.

  • Peer-led interventions would benefit from some standardisation across studies. For example, the number and extent of peer support or peer-to-peer contact could be kept constant across studies.

  • Absent from the literature is information about the impact that the peer support role has on peer providers. The value of peer-led interventions should be judged not only on their impact on care recipients but on people with psychiatric illnesses who by virtue of being further along in recovery now support others.

Could these results change your practices and why?

Unlikely as our current clinical practice includes encouraging care recipients to use peer support services. To the degree that peer-led interventions foster experiential recovery and provide peers with coping models, mentorship and a voice in mental healthcare, peer-led interventions remain important innovations in mental health.

Footnotes

Competing interests: None.

References

  • 1.Goldstrom ID, Campbell J, Rogers JA, et al. National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services. Adm Policy Ment Health 2006;31:92–103. [DOI] [PubMed] [Google Scholar]
  • 2.Ahmed AO, Doane NJ, Mabe PA, et al. Peers and peer-led interventions for people with schizophrenia. Psychiatr Clin North Am 2012;35:699–715. [DOI] [PubMed] [Google Scholar]
  • 3.Davidson L. What happened to civil rights? Psychiatr Rehab J 2006;30:11–14. [DOI] [PubMed] [Google Scholar]
  • 4.Davidson L, Chinman M, Sells D, et al. Peer support among adults with serious mental illnesses: a report from the field. Schizophr Bull 2006;32:443–50. [DOI] [PMC free article] [PubMed] [Google Scholar]
Evid Based Ment Health. 2014 Jul 30;17(4):123.

Commentary

ABSTRACT FROM: Lloyd-Evans B, Mayo-Wilson E, Harrison B, et al. A systematic review and meta-analysis of randomized controlled trials of peer support for people with severe mental illness. BMC Psychiatry 2014;14:39.

Data sources Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, MEDLINE and PsycINFO were searched from inception to July 2013. Reference lists of reviews, included studies and excluded studies were scanned for additional references.

Study type included Published and unpublished randomised controlled trials. A total of 18 trials (n=5597) were included (median sample size = 178).

Participants Adults with severe mental health problems using secondary mental health services. Peers were currently or had previously accessed secondary mental health services.

Intervention Community-based peer support services to facilitate recovery from severe mental illness. Included trials examined three types: 4 examined mutual support groups, 11 examined peer-support services and 3 examined peer-delivered mental health services.

Comparison Treatment as usual.

Outcomes

Overall the quality of the evidence was poor and included trials had high risk of bias.

Hospitalisation Mutual support had no significant effect (relative risk (RR)=0.50, 95% CI 0.23 to 1.11); neither did peer-delivered services (RR=0.68, 95% CI 0.45 to 1.03). Peer support had no significant effect on hospitalisations (RR=1.07, 95% CI 0.55 to 2.07) or duration of admission (standard mean difference (SMD)=−0.22, 95% CI −0.72 to 0.28).

Psychiatric symptoms Peer support had no significant effect on psychosis (SMD=−0.08, 95% CI −0.27 to 0.03) or overall psychiatric symptoms (SMD=−0.07, 95% CI −0.39 to 0.24).

Quality of life Mutual support had a large effect (SMD=−1.42, 95% CI −1.69 to −1.16), peer support no effect (SMD=0.04, 95% CI −0.16 to 0.24).

Depression and anxiety Mutual support had a medium effect (SMD=−0.42, 95% CI −0.66 to −0.18), peer support no effect (SMD=−0.10, 95%−0.24, 0.03).

Recovery Mutual support had no effect (SMD=−0.11, 95% CI −0.35 to 0.13), peer support small effect (SMD=−0.24, 95% CI −0.39 to −0.09).

Hope Peer support had a small effect (SMD=−0.14, 95% CI −0.27 to −0.02).

Empowerment Mutual support had a large effect (SMD=−1.44, 95% CI −2.79 to −0.09), peer support no effect (SMD=−2.67, 95% CI −7.35 to 2.02).

User satisfaction Peer-delivered services had a small negative effect (SMD=0.48, 95% CI 0.05 to 0.91, peer support no effect (SMD=0.02, 95% CI −0.20 to 0.23).

Articles from Evidence-Based Mental Health are provided here courtesy of BMJ Publishing Group

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