Mental Health Sciences Unit, University College London, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
BMC Psychiatry. 2014 Feb 14;14:39. doi: 10.1186/1471-244X-14-39.
Little is known about whether peer support improves outcomes for people with severe mental illness.
A systematic review and meta-analysis was conducted. Cochrane CENTRAL Register, Medline, Embase, PsycINFO, and CINAHL were searched to July 2013 without restriction by publication status. Randomised trials of non-residential peer support interventions were included. Trial interventions were categorised and analysed separately as: mutual peer support, peer support services, or peer delivered mental health services. Meta-analyses were performed where possible, and studies were assessed for bias and the quality of evidence described.
Eighteen trials including 5597 participants were included. These comprised four trials of mutual support programmes, eleven trials of peer support services, and three trials of peer-delivered services. There was substantial variation between trials in participants' characteristics and programme content. Outcomes were incompletely reported; there was high risk of bias. From small numbers of studies in the analyses it was possible to conduct, there was little or no evidence that peer support was associated with positive effects on hospitalisation, overall symptoms or satisfaction with services. There was some evidence that peer support was associated with positive effects on measures of hope, recovery and empowerment at and beyond the end of the intervention, although this was not consistent within or across different types of peer support.
Despite the promotion and uptake of peer support internationally, there is little evidence from current trials about the effects of peer support for people with severe mental illness. Although there are few positive findings, this review has important implications for policy and practice: current evidence does not support recommendations or mandatory requirements from policy makers for mental health services to provide peer support programmes. Further peer support programmes should be implemented within the context of high quality research projects wherever possible. Deficiencies in the conduct and reporting of existing trials exemplify difficulties in the evaluation of complex interventions.
对于同伴支持是否能改善严重精神疾病患者的预后，我们知之甚少。
系统检索和荟萃分析。2013 年 7 月以前，我们没有对发表状态进行限制，检索了 Cochrane 中心注册库、Medline、Embase、PsycINFO 和 CINAHL。纳入了非住院同伴支持干预的随机试验。将试验干预分类并单独分析为：互助同伴支持、同伴支持服务或同伴提供的精神卫生服务。在可能的情况下进行了荟萃分析，并评估了研究偏倚和证据质量的描述。
纳入了 18 项试验，共 5597 名参与者。其中包括 4 项互助计划方案的试验、11 项同伴支持服务的试验和 3 项同伴提供服务的试验。试验参与者的特征和方案内容存在很大差异。结局指标报告不完整，存在高偏倚风险。根据分析中数量有限的研究，几乎没有证据表明同伴支持与住院、总体症状或对服务的满意度有积极影响。有一些证据表明，同伴支持与希望、康复和赋权措施在干预结束时和之后的积极影响有关，尽管在不同类型的同伴支持中，这种影响并不一致。
尽管在国际上推广和采用了同伴支持，但目前的试验并没有关于同伴支持对严重精神疾病患者的效果的证据。尽管有一些积极的发现，但这一综述对政策和实践具有重要意义：目前的证据不支持政策制定者对精神卫生服务提供同伴支持方案的建议或强制性要求。在可能的情况下，应在高质量研究项目的背景下实施更多的同伴支持方案。现有试验在实施和报告方面的不足说明了对复杂干预措施进行评估的困难。
