The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis.
The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis.
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DOI：
10.1186/s12888-020-02923-3
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发表时间：
2020-11-11
期刊：
影响因子：
4.4
通讯作者：
Gillard S
中科院分区：
文献类型：
--
作者：
White S;Foster R;Marks J;Morshead R;Goldsmith L;Barlow S;Sin J;Gillard S
国际上正在将同伴支持引入精神卫生服务，这往往是对劳动力政策的回应。早期的系统性综述包含了不同的同行支持模式（即小组和一对一），提供了不一致的有效性证据，并且还表明当时证据库中存在大量异质性和质量问题。鉴于当前的政策兴趣，一项侧重于一对一同行支持的最新审查是及时的。本研究旨在系统地回顾一对一同伴支持干预对使用心理健康服务的成年人的有效性的证据，并探讨同伴支持干预的异质性。我们检索了MEDLINE、PsycINFO、Embase、CINAHL和科克伦数据库，从开始到2019年6月13日。对纳入的研究进行偏倚风险评估，并在多项试验提供可用数据的情况下进行荟萃分析。23项研究报告了19项试验，提供了3329名参与者的数据。虽然7项试验的偏倚风险为低至中度，但许多研究的数据报告不完整，表明证据基础存在偏倚。同伴支持干预措施包括临床旁角色的同伴工作者（例如病例经理），提供结构化的行为干预或更灵活的恢复支持。对11个结果进行了荟萃分析，有证据表明，一对一的同伴支持可能对自我报告的恢复和赋权产生适度的积极影响。对临床症状或服务使用没有影响。异质性分析表明，同伴支持可能会提高社会网络的支持。心理健康服务中的一对一同伴支持可能会对心理社会结果产生积极影响，但不太可能改善临床结果。为了更好地为将同伴支持引入精神卫生服务提供信息，证据基础的改善需要完整的结果数据报告，选择与干预机制相关的结果，探索实施同伴支持的异质性，并重点审查特定类型的一对一同伴支持。Prospero标识符：CRD 42015025621。补充信息随附于10.1186/s12888-020-02923-3。
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. 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. 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. 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. Prospero identifier: CRD42015025621. Supplementary information accompanies this paper at 10.1186/s12888-020-02923-3.
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