Cooper RE, Saunders KRK, Greenburgh A, et al. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. BMC Med. 2024;22(1):72. doi:10.1186/s12916-024-03260-y
This umbrella review sought to understand three main things about peer social support approaches for mental health in the United Kingdom (UK); the currently available review literature on the effectiveness and cost-effectiveness of these approaches, the influences on implementation, and the acceptability in the eyes of peer coaches, healthcare employees, service users, and carriers. The eligibility criteria included articles that were peer-reviewed systematic, scoping, or realist reviews assessing efficacy, acceptability, and implementation of peer social support interventions in individuals with mental health or substance use disorders. Article quality was assessed using an adaptation of the A MeaSurement Tool to Assess Systematic Review 2. Thirty-five reviews were included in the final analysis, 29 systematic reviews (13 with meta-analysis, 13 without meta-analysis, 3 with qualitative synthesis), and 6 scoping reviews. Most of the reviews (97%) were low, or critically low quality. Most failed to register protocols before beginning the review (n=21), lacked justification for inclusion or exclusion criteria (n=28), and had a high risk of bias (n=13). Effectiveness results were available in 66% of the studies and generally reported poor efficacy. Despite this, there were consistent findings that peer support may improve clinical outcomes for postpartum depression, decrease hospitalization risk for severe mental illness, and aid with self-efficacy, stigma, and recovery outcomes. While all nine reviews including implantation-related assessments were rated as critically low quality, the authors were able to construct a table of the implementation outcomes by CFIR domain. In general, training and supervision, a recovery-oriented workplace, strong leadership, and trust between peer and non-peer staff were critical for successful implementation. Barriers to implementation included time, money, resources, and certification for coaches. Eleven reviews assessed acceptability, which was generally positive, with some negative feedback around a sick stigma maintained by being labeled as a peer counselor. This article provides summaries and concerns about the quality of reviews of peer social support interventions, digital and otherwise. Future research should explore the role of the peer support worker and aim to clarify implementation strategies that successfully aid new interventions.