How Is the Efficacy of Peer Support Programs for Mental Health Measured?

Background and Purpose: In 2013, a Cochrane Systematic Review concluded that peer support services offer outcomes no better than those achieved by professionals employed in similar roles. While systematic reviews are one of the highest forms of evidence and a basis for decision making, these studies can be methodologically flawed and limited in scope. For example, of the 11 studies on peer support reviewed, measures of mental health symptom severity was the predominant outcome. Yet, peer support services are holistic. They include facilitating education and support groups and linking people to services as they transition from hospitals or jails into the community. Peers work as role models, mentors, advocates and support people in creating recovery plans. Thus, while the role of peer support services is robust, it is unclear whether this has been captured in scientific literature. The goal of this study is to provide an assessment of the outcomes used to examine peer support services and assess whether these are aligned with the content of peer support services and the roles of its providers.

 Methods: Databases including Pubmed/MEDLINE, Psychinfo, social work abstracts, Education Resources Information Center, social service abstracts, sociological abstracts, and the Cochrane Central Register of Controlled Trials were searched for 20 years of publications from 1999-2019. An examination of literature based on specific criteria yielded 61 publications. Criteria outlined were 1) It must have quantitative results, 2) It must measure outcomes associated with peer support, 3) It must be presented in a peer-reviewed journal and 4) It must be in English. Using the sample of 61 publications, 122 outcome measures were identified. These measures were categorized and examined for validity and reliability. These measures serve as the source for all analyses presented.

 Results: The most likely outcome examined as an outcome for peer support services was mental health symptoms (22%). Additional categories included service satisfaction (13%), quality of life (8%), social support (8%), self-esteem (8%), social connection (6%), psychosocial skills (5%), substance use (5%), service utilization (4%), family functioning (4%), recovery orientation (3%), self-efficacy (3%), stigma (3%), physical health (2%), attendance (1%) and empowerment (1%). About 4% were miscellaneous measures assessing topics such as spirituality. While most measures that assessed mental health symptoms had strong validity and reliability, there were several categories that offered very few or no measures with validity or reliability. These included service satisfaction, social connection, psychosocial skills, family functioning, and service use.

Conclusions and Implications: While the definition of peer support services for mental health is holistic, there remains significant emphasis on a reduction in mental health symptomatology associated with the receipt of peer support. Social work practitioners, especially those working in mental health-related areas may benefit from this work, which calls attention to a more dynamic approach to evaluating peer support outcomes. Additionally, social work practitioners of all areas can build from this work to continue advocacy for increased efforts to better understand the potential effects mental health-related services, including peer support services offers recipients that either directly or indirectly contribute to recovery.