Internet Peer Support for Individuals with Psychiatric Disabilities: A Randomized Controlled Trial

Description of the Problem: Despite the prevalence of Internet support groups for individuals with mental illnesses little is known about the potential benefits, or harm, of participating in such groups.

Objective: To determine the impact of unmoderated, unstructured Internet peer support, similar to what is naturally occurring on the Internet, on the well-being of individuals with psychiatric disabilities.

Design: Randomized controlled trial with a 12 month intervention and three measurement time points at baseline, 4- and 12-months post-baseline.

Setting: A closed online listserv and bulletin board.

Participants: 300 adults diagnosed with a Schizophrenia Spectrum or an Affective Disorder who had access to the Internet and lived within the continental United States were enrolled in the study. Several attrition reducing strategies were in place and likely responsible for high rates of retention – 92% and 83% retention was achieved for 4- and 12-month follow-up data collection periods, respectively.

Interventions: Participants were randomized into one of three conditions: experimental Internet peer support via a listserv, experimental Internet peer support via a bulletin board, or a control condition.

Main Outcomes Measures: Well-being was assessed by standardized psychometrically sound measures of recovery (Recovery Assessment Scale), quality of life (selected items from Lehman's Quality of Life Interview), empowerment (Empowerment Scale), social support (MOS Social Support Survey), and distress (Hopkins Symptoms Checklist).

Results: Time X group interactions in the repeated measures ANOVA analyses showed no differences between the experimental and control conditions on the main outcome measures. Post-hoc repeated measures ANOVAs found that those individuals who participated more in Internet peer support reported higher levels of distress than those with less or no participation (F=3.44; df=284; p=0.03). Those who reported more positive experiences with the Internet peer support group also reported higher levels of psychological distress than those reporting less positive experiences (F=5.31; df=183; p=0.01).

Conclusion & Implications: Study results do not support the hypothesis that participation in an unmoderated, unstructured Internet peer support group for individuals with psychiatric disabilities enhances well-being. Counterintuitive findings demonstrating those who report more positive experiences also experienced higher levels of distress point to the need for additional research. Social Workers need to become more familiar with these Internet groups, discuss their use with clients, and provide strategies for safely navigating online resources and supports to gain maximum benefit, and to ensure client safety from potential predators.