Dr. Chinman, Dr. McCarthy, Dr. Bachrach, and Ms. Mitchell-Miland are with the Center for Health Equity Research and Promotion and the Mental Illness Research, Education and Clinical Center, all at the U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh. Dr. Chinman is also with RAND Corporation, Pittsburgh. Dr. Schutt is with the Department of Sociology, and Dr. Ellison is with the Department of Psychiatry, University of Massachusetts, Boston.
Psychiatr Serv. 2018 Dec 1;69(12):1238-1244. doi: 10.1176/appi.ps.201800118. Epub 2018 Oct 5.
Peer specialists are individuals with mental illness and substance use disorders trained to use their experiences to help others with similar disorders. Evidence for the effectiveness of peer specialist services has been mixed in previous randomized trials using intent-to-treat analyses, possibly because of variation in the intensity of treatment delivered. This study, which was part of a larger randomized trial, assessed whether level of peer specialist engagement was associated with reliable positive change on measures of psychiatric symptoms and hope.
The Reliable Change Index was used to compute whether veterans (N=140) achieved reliable positive change on standardized baseline-to-posttest assessments of psychiatric symptoms and hope. Logistic regression analyses were conducted to predict positive change in symptoms and hope by level of peer specialist engagement, with controls for relevant demographic factors, several baseline mental health and substance abuse measures, and service use during the study.
Logistic regression models showed that veterans with higher peer specialist engagement were more likely than those in a control group to show reliable positive change in psychiatric symptoms but not in hope. Compared with the control group, those with lower peer specialist engagement did not show positive change on either measure. White veterans were less likely than those from minority groups to exhibit positive change in psychiatric symptoms.
Results suggest that peer specialists can benefit those with mental illnesses and substance use disorders who engage in more frequent interactions. Studies are needed to further assess the circumstances under which peer specialists can be effective.
同伴专家是指经过培训，能够利用自身经验帮助其他有类似障碍的人的精神疾病和物质使用障碍患者。在以前使用意向治疗分析的随机试验中，同伴专家服务的有效性证据参差不齐，这可能是由于所提供治疗的强度不同。这项研究是一项更大规模的随机试验的一部分，评估了同伴专家的参与程度是否与精神症状和希望方面可靠的积极变化有关。
使用可靠变化指数来计算退伍军人（N=140）是否在精神病症状和希望的标准化基线后评估中取得可靠的积极变化。进行逻辑回归分析，以根据同伴专家参与程度预测症状和希望的积极变化，同时控制相关人口统计学因素、几种基线心理健康和物质滥用措施以及研究期间的服务使用。
逻辑回归模型表明，与对照组相比，参与程度较高的退伍军人更有可能在精神病症状方面表现出可靠的积极变化，但在希望方面则不然。与对照组相比，参与程度较低的退伍军人在这两个衡量标准上都没有表现出积极的变化。白人退伍军人在精神病症状方面表现出积极变化的可能性低于少数族裔群体。
结果表明，同伴专家可以使那些更频繁互动的精神疾病和物质使用障碍患者受益。需要进一步研究以评估同伴专家在何种情况下可以有效。
