Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
Soc Psychiatry Psychiatr Epidemiol. 2022 Sep;57(9):1731-1747. doi: 10.1007/s00127-022-02294-y. Epub 2022 Apr 29.
This review aimed to evaluate interventions led by peer counselors (PCs) for adults with common mental disorders in low- and middle-income countries (LMICs) along indices of overall effectiveness and key implementation outcomes (acceptability, feasibility, cost, fidelity, sustainability).
This review followed a mixed-methods systematic review design. MEDLINE/PubMed, Embase, PsycINFO, and Global Health databases were searched for PC-led interventions for adults in LMICs targeting depressive and/or anxiety disorders or PTSD. Quantitative data was narratively synthesized, and qualitative data was thematically synthesized separately. The results from the qualitative and quantitative syntheses were then combined in a cross-study synthesis.
Twenty-four papers describing thirteen PC-led interventions were included for review. Narrative synthesis results indicated mixed effectiveness of PC-led interventions in reducing depressive, anxiety, PTSD symptoms and high PC competency. Thematic synthesis revealed five descriptive themes: (1) Preferred PC characteristics; (2) Incentives and motivation for PCs; (3) Barriers to PC-led intervention implementation; (4) Helpful supervision/training practices; and (5) Overall high acceptability of PC-led interventions. Cross-study synthesis revealed high acceptability, feasibility, and fidelity, but cost and sustainability outcomes were underreported in included papers.
PC-led interventions seem to show initial promise in terms of effectiveness, acceptability, feasibility, cost, fidelity, and sustainability. Future research should focus on standardizing measurements of implementation outcomes to facilitate cross-study analysis. Additional empirical attention should be paid to underrepresented implementation outcomes (e.g., cost, sustainability). Finally, researchers should adopt a participatory approach that elevates the perspectives of PCs throughout all stages of the implementation process.
本综述旨在评估在中低收入国家（LMICs）中由同伴辅导员（PCs）领导的针对常见精神障碍成人的干预措施，其评估指标包括总体效果和关键实施结果（可接受性、可行性、成本、保真度、可持续性）。
本综述采用混合方法系统综述设计。在 MEDLINE/PubMed、Embase、PsycINFO 和全球健康数据库中搜索针对 LMICs 中成年人的以抑郁和/或焦虑障碍或 PTSD 为目标的由 PC 领导的干预措施。对定量数据进行叙述性综合，对定性数据进行单独主题综合。然后将定性和定量综合的结果合并到跨研究综合中。
共纳入 24 篇描述 13 种由 PC 领导的干预措施的论文进行综述。叙述性综合结果表明，PC 领导的干预措施在降低抑郁、焦虑、PTSD 症状和提高 PC 能力方面的效果不一。主题综合揭示了五个描述性主题：（1）首选 PC 特征；（2）PC 的激励和动机；（3）PC 领导的干预措施实施障碍；（4）有益的监督/培训实践；（5）PC 领导的干预措施总体上高度可接受。跨研究综合结果显示，干预措施具有较高的可接受性、可行性和保真度，但纳入研究中成本和可持续性结果报告不足。
PC 领导的干预措施在效果、可接受性、可行性、成本、保真度和可持续性方面似乎显示出初步的前景。未来的研究应侧重于标准化实施结果的衡量标准，以促进跨研究分析。应特别关注代表性不足的实施结果（例如，成本、可持续性）。最后，研究人员应采用一种参与式方法，在实施过程的所有阶段都提升 PC 的观点。
