Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis
Open accessAbstract
Purpose: To evaluate the effectiveness of peer-delivered interventions in improving clinical and psychosocial outcomes among individuals with severe mental illness (SMI) or depression. Methods: 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. Results: 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, I 2 = 0 %, n = 639) and hope (SMD 0.24, 95 % CI 0.02–0.46, p = 0.03, I 2 = 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, I 2 = 0 %, n = 84) and quality of life (SMD −0.11, 95 % CI −0.42 to 0.20, p = 0.56, I 2 = 0 %, n = 164). No effect of peer-delivered interventions for depression was observed on any outcome. Conclusions: 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.
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Level 2 Evidence supports peer interventions as a second-line adjunctive treatment for MDD.
“peer interventions are recommended as a second-line adjunctive treatment for MDD (Level 2 Evidence).”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [135]
The Results section, ‘Effect of peer-delivered interventions on depression’ (page unavailable), reports no effect on clinical outcomes or loneliness compared with usual care. The paper does not assign a Level 2 evidence grade or recommend peer interventions as a second-line adjunctive treatment for MDD; its reported depression findings run contrary to that recommendation. (LLM, conf=0.86)
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Experimental — accuracy not yet measuredAn initial meta-analysis of peer support for depression was positive, but subsequent results are mixed.
“An initial meta-analysis of peer support for depression was positive, but subsequent results are mixed.[134][135][136]”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [135]
The Results section, ‘Effect of peer-delivered interventions on depression’ (page not provided), reports no significant effect on clinical outcomes or loneliness, supporting the claim that later findings were not uniformly positive. The Introduction mentions earlier reviews but does not say an initial meta-analysis of peer support for depression was positive. (LLM, conf=0.84)
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- Authors
- Fuhr, D. C., Salisbury, T. T., De Silva, M. J., Atif, N., van Ginneken, N., Rahman, A., & Patel, V.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- King's College London (GB)
- Human Development Research Foundation (PK)
- Corresponding author
- Fuhr, Daniela C.
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2014-03-17
- Volume
- 49
- Issue
- 11
- Pages
- 1691-1702
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- PMC
- PMC4167169
- OpenAlex
- W2163176726
- Cited by
- 209
- References
- 40
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 12 · 2023: 31 · 2022: 33 · 2021: 23 · 2020: 27 · 2019: 15 · 2018: 13 · 2017: 9 · 2016: 14 · 2015: 3 · 2014: 1
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- London School of Hygiene and Tropical Medicine
- Wellcome Trust (084674, 100714, 091834)
- Department for International Development
- National Institutes of Health
- Medical Research Council
- National Institute of Mental Health (U19MH095687)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- peer-mediated intervention, severe mental illness, depression, peer support, quality of life, hope, clinical outcomes, psychosocial outcomes, equivalence trials, resource-limited settings
- MeSH terms
- Mental Disorders, Depression, Humans, Peer Group, Psychotherapy, Quality of Life, Treatment Outcome
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