Effectiveness of peer support for people with severe mental health conditions in high-, middle- and low-income countries: multicentre randomised controlled trial.
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Puschner Bernd, Nakku Juliet, Hiltensperger Ramona, Wolf Philip, Adler Ben-Dor Inbar, Bugeiga Faith, Charles Ashleigh, Gai Meir Lion, Garber-Epstein Paula, Goldfarb Yael, Grayzman Alina, Hadas-Grundman Shimri, Haun Maria, Heuer Imke, Iboma Bahati, Kalha Jasmine, Kamwaga Lydia, Korde Palak, Kotera Yasuhiro, Krumm Silvia, Kulkarni Arti, Kwebiiha Eric, Kyara Jennifer, Lachman Max, Mahlke Candelaria, Mayer Benjamin, Moran Galia, Mpango Richard, Mtei Rachel, Müller-Stierlin Annabel, Nanyonga Roseline, Ngakongwa Fileuka, Niwemuhwezi Jackline, Nixdorf Rebecca, Nugent Lena, Pathare Soumitra, Ramesh Mary, Ryan Grace, Schulz Gwen, Wagner Maria, Waldmann Tamara, Wenzel Lisa, Shamba Donat, Slade Mike
Аннотация
AIMS: To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries.
METHOD: This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support.
RESULTS: Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02-0.34).
CONCLUSIONS: Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.