Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Prospero identifier: CRD42015025621 .

中文翻译：

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心理健康服务中一对一同伴支持的有效性：系统评价和荟萃分析


国际上正在将同伴支持引入心理健康服务，这通常是为了响应劳动力政策。早期的系统评价纳入了不同形式的同行支持（即小组和一对一），提供了不一致的有效性证据，并且还表明了当时证据库中的实质性异质性和质量问题。鉴于当前的政策兴趣，以一对一同行支持为重点的更新审查是及时的。本研究旨在系统地审查使用心理健康服务的成年人一对一同伴支持干预措施有效性的证据，并探讨同伴支持干预措施的异质性。我们检索了 MEDLINE、PsycINFO、Embase、CINAHL 和 Cochrane 数据库，从开始到 2019 年 6 月 13 日。对纳入的研究进行了偏倚风险评估，并在多个试验提供可用数据的情况下进行了荟萃分析。报告 19 项试验的 23 项研究符合资格，提供了来自 3329 名参与者的数据。虽然七项试验存在低至中度偏倚风险，但许多研究中数据报告的不完整表明证据基础存在偏差。同伴支持干预包括担任临床旁角色的同伴工作人员（例如病例经理），提供结构化的行为干预或更灵活的康复支持。对十一项结果进行了荟萃分析，有证据表明一对一的同伴支持可能对自我报告的康复和赋权产生适度的积极影响。对临床症状或服务使用没有影响。对异质性的分析表明，同伴支持可能会改善社交网络支持。心理健康服务中一对一的同伴支持可能会对心理社会结果产生积极影响，但不太可能改善临床结果。 为了更好地为将同伴支持引入精神卫生服务提供信息，完善证据基础需要完整报告结果数据、选择与干预机制相关的结果、探索同伴支持实施中的异质性以及对具体内容进行集中审查。一对一同伴支持的类型。 Prospero 标识符： CRD42015025621 。