Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis.
Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis.
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DOI：
10.1007/s00127-014-0857-5
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发表时间：
2014-11
影响因子：
4.4
通讯作者：
Patel, Vikram
中科院分区：
文献类型：
--
作者：
Fuhr, Daniela C.;Salisbury, Tatiana Taylor;De Silva, Mary J.;Atif, Najia;van Ginneken, Nadja;Rahman, Atif;Patel, Vikram
评估同伴干预在改善重度精神疾病（SMI）或抑郁症患者临床和心理社会结局方面的有效性。比较同行干预与常规治疗或健康专业人员治疗的随机对照试验的系统综述和荟萃分析。分别对SMI和抑郁干预进行随机效应荟萃分析。14项研究（10项SMI研究，4项抑郁症研究）均来自高收入国家，符合纳入标准。对于SMI，来自三项高质量优效性试验的证据显示，对生活质量而言，支持同行提供的干预措施的积极影响较小（SMD 0.24，95% CI 0.08-0.40，p = 0.003，I2 = 0%，n = 639）和hope（SMD 0.24，95% CI 0.02-0.46，p = 0.03，I2 = 65%，n = 967）。两项SMI等效性试验的结果表明，在改善临床症状方面，同行可能等同于卫生专业人员（SMD −0.14，95% CI −0.57至0.29，p = 0.51，I2 = 0%，n = 84）和生活质量（SMD −0.11，95% CI −0.42至0.20，p = 0.56，I2 = 0%，n = 164）。同伴干预对抑郁症的任何结果都没有影响。有限的证据基础表明，同龄人可能有一个小的额外影响病人的结果相比，在高收入环境中的标准精神病护理。未来的研究应探讨使用和适用性的同行提供的干预措施，在资源贫乏的设置，标准的护理可能是较低的质量和覆盖面。等效性试验的积极结果要求在这一领域进行进一步研究，以巩固同行提供与专业提供的干预措施的相对价值。本文的在线版本（doi：10.1007/s 00127 -014-0857-5）包含补充材料，可供授权用户使用。
To evaluate the effectiveness of peer-delivered interventions in improving clinical and psychosocial outcomes among individuals with severe mental illness (SMI) or depression. Systematic review and meta-analysis of randomised controlled trials comparing a peer-delivered intervention to treatment as usual or treatment delivered by a health professional. Random effect meta-analyses were performed separately for SMI and depression interventions. Fourteen studies (10 SMI studies, 4 depression studies), all from high-income countries, met the inclusion criteria. For SMI, evidence from three high-quality superiority trials showed small positive effects favouring peer-delivered interventions for quality of life (SMD 0.24, 95 % CI 0.08–0.40, p = 0.003, I2 = 0 %, n = 639) and hope (SMD 0.24, 95 % CI 0.02–0.46, p = 0.03, I2 = 65 %, n = 967). Results of two SMI equivalence trials indicated that peers may be equivalent to health professionals in improving clinical symptoms (SMD −0.14, 95 % CI −0.57 to 0.29, p = 0.51, I2 = 0 %, n = 84) and quality of life (SMD −0.11, 95 % CI −0.42 to 0.20, p = 0.56, I2 = 0 %, n = 164). No effect of peer-delivered interventions for depression was observed on any outcome. The limited evidence base suggests that peers may have a small additional impact on patient’s outcomes, in comparison to standard psychiatric care in high-income settings. Future research should explore the use and applicability of peer-delivered interventions in resource poor settings where standard care is likely to be of lower quality and coverage. The positive findings of equivalence trials demand further research in this area to consolidate the relative value of peer-delivered vs. professional-delivered interventions. The online version of this article (doi:10.1007/s00127-014-0857-5) contains supplementary material, which is available to authorized users.
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