Moir Fiona, Henning Marcus, Hassed Craig, Moyes Simon A, Elley C Raina
a Department of General Practice and Primary Health Care , University of Auckland , Auckland , New Zealand.
b Centre for Medical and Health Sciences Education , University of Auckland , Auckland , New Zealand.
Teach Learn Med. 2016 Jul-Sep;28(3):293-302. doi: 10.1080/10401334.2016.1153475. Epub 2016 Apr 19.
There is evidence that peer-support programs can improve mental health indices and help-seeking behavior among students in some secondary school and university settings and that mindfulness can improve mental health in medical students. Peer-led programs have not been formally assessed in a medical student population, where psychological issues exist and where it has been shown that students approach peers for help in preference to staff members or professional services.
Medical students elected peer leaders who underwent training and then provided the intervention. The peer leaders provided support to students in the intervention group, as well as offering teaching in mindfulness meditation.
An exploratory study was conducted with 2nd- and 3rd-year medical students at 1 medical school in New Zealand randomized into 2 groups. In addition to existing mental health resources, intervention participants received a program including peer support and peer-taught mindfulness practice. Study participants not offered the intervention participants could use existing mental health resources. Primary measures included depression (PHQ-9) and anxiety (GAD-7) scores. Secondary measures were quality of life, resilience (15-item resilience scale), academic self-concept, and motivation to learn, assessed at baseline and 6 months.
Of the 402 students eligible, 275 (68%) participated and 232 (58%) completed the study. At baseline, 53% were female and mean age was 21 years (SD = 3)-PHQ-9 score (M = 5.2, SD = 3.7) and GAD-7 score (M = 4.5, SD = 3.4). Twelve peer leaders were elected. There was good participation in the intervention. One fourth of intervention students used the face-to-face peer support and more than 50% attended a peer social event and/or participated in the mindfulness program. Although improvements in mental health were seen in the intervention group, the difference between the intervention and nonintervention groups did not reach statistical significance.
Although evidence exists for effectiveness of peer support and mindfulness in other contexts, this exploratory study was not able to show a statistically significant effect. Future studies could consider using a longer training period for the peer leaders, as well as targeting the study population to those most likely to benefit such as those with poorer mental health, or using a more intensive intervention or larger sample size. A cluster randomized study design would also reduce the risk of contamination.
有证据表明，同伴支持项目可以改善一些中学和大学环境中学生的心理健康指标和求助行为，正念可以改善医学生的心理健康。同伴主导的项目尚未在医学生群体中进行正式评估，在这个群体中存在心理问题，而且有研究表明，学生更倾向于向同伴而非教职员工或专业服务机构求助。
医学生选举出经过培训的同伴领袖，由他们提供干预。同伴领袖为干预组的学生提供支持，并教授正念冥想。
在新西兰的一所医学院，对二、三年级医学生进行了一项探索性研究，将他们随机分为两组。除了现有的心理健康资源外，干预组参与者还接受了一个包括同伴支持和同伴教授的正念练习的项目。未接受干预的研究参与者可以使用现有的心理健康资源。主要测量指标包括抑郁（PHQ-9）和焦虑（GAD-7）得分。次要测量指标是生活质量、复原力（15项复原力量表）、学业自我概念和学习动机，在基线和6个月时进行评估。
在402名符合条件的学生中，275名（68%）参与了研究，232名（58%）完成了研究。基线时，53%为女性，平均年龄为21岁（标准差=3）——PHQ-9得分（中位数=5.2，标准差=3.7）和GAD-7得分（中位数=4.5，标准差=3.4）。选举出了12名同伴领袖。干预参与情况良好。四分之一的干预组学生使用了面对面的同伴支持，超过50%的学生参加了同伴社交活动和/或参与了正念项目。虽然干预组的心理健康状况有所改善，但干预组与非干预组之间的差异未达到统计学显著性。
虽然在其他背景下有证据表明同伴支持和正念有效，但这项探索性研究未能显示出统计学上的显著效果。未来的研究可以考虑为同伴领袖延长培训时间，以及将研究对象针对最有可能受益的人群，如心理健康较差的人群，或者使用更密集的干预措施或更大的样本量。整群随机研究设计也将降低污染风险。
