Elsevier

Journal of Psychiatric Research

Volume 84, January 2017, Pages 80-89
Journal of Psychiatric Research

Peer-based health interventions for people with serious mental illness: A systematic literature review

https://doi.org/10.1016/j.jpsychires.2016.09.021Get rights and content

Abstract

Health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals can help improve the physical health of people with serious mental illness (SMI). Yet, the quality of the studies examining these health interventions and their impact on health outcomes remains unclear. To address this gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. We rated the methodological quality of studies, summarized intervention strategies and health outcomes, and evaluated the inclusion of racial and ethnic minorities in these studies. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to conduct our systematic literature review. Electronic bibliographic databases and manual searches were used to locate articles that were published in English in peer-reviewed journals between 1990 and 2015, described peer-based health interventions for people with SMI, and evaluated the impact of the interventions on physical health outcomes. Two independent reviewers used a standardized instrument to rate studies' methodological quality, abstracted study characteristics, and evaluated the effects of the interventions on different health outcomes. Eighteen articles were reviewed. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Mixed and limited intervention effects were reported for most health outcomes. The most promising interventions were self-management and peer-navigator interventions. Efforts to strengthen the evidence of peer-based interventions require a research agenda that focuses on establishing the efficacy and effectiveness of these interventions across different populations and settings.

Introduction

People with schizophrenia and other serious mental illnesses (SMI; e.g., schizoaffective disorder, bipolar disorder) have shortened life expectancies compared to the general population largely due to preventable medical conditions (e.g., cardiovascular disease (CVD), diabetes) (Colton and Manderscheid, 2006, Druss et al., 2011, Janssen et al., 2015). This mortality gap has worsened in recent decades despite advances in medical care for the general population (Saha et al., 2007). A constellation of behavioral, pharmacological, social, and health care factors contribute to these health disparities. Unhealthy behaviors, including tobacco smoking, physical inactivity, poor dietary habits, and risky sexual behaviors are more prevalent in people with SMI than in the general population (Brown et al., 1999, Daumit et al., 2005). The metabolic side-effects of psychiatric medications also contribute to the elevated rates of obesity, high cholesterol, hypertension, and diabetes mellitus in people with SMI (Morden et al., 2009, Newcomer and Hennekens, 2007). Poverty levels are higher among people with SMI compared to the general population (Draine et al., 2002, Luciano et al., 2014) and the social conditions related to living in poverty (e.g., unemployment, unstable housing), negatively impact physical health and quality of life (Cabassa et al., 2014, Draine et al., 2002). Lastly, people with SMI face serious barriers accessing, utilizing, and receiving high quality medical care (Institute of Medicine, 2006, Morden et al., 2009).

Various approaches (e.g., health care manager programs, healthy lifestyle interventions) are being used worldwide to promote the physical health of people with SMI (Cabassa et al., 2010, Druss et al., 2010a). One approach is the use of health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals (e.g., nurses, social workers). Peer specialists are individuals with lived experiences recovering from mental illness who are trained to deliver services that promote recovery, resiliency, and wellness (SAMHSA-HRSA Center for Integrated Health Solutions, 2016). Peer specialists are an added value to health interventions as they bring credibility, trust, resiliency and hope to people with SMI. They also serve as positive role models that use their experiences to provide instrumental, informational, and emotional support. (Cook, 2011). Peer specialists are a growing segment of the mental health workforce in the U.S. and other countries (Repper and Carter, 2011). For example, in the United States more than 30 states have some level of Medicaid reimbursement for peer specialists, and this number is expected to grow with the implementation of the Affordable Care Act (Chinman et al., 2013, National Association of State Mental Health Program Directors., 2014).

Peer-based programs for people with SMI produce as good or better results than non-peer-based programs for certain outcomes (e.g., hospitalizations, engagement in care, empowerment), particularly when peer specialists deliver evidence-based interventions (Chinman et al., 2014, Davidson et al., 2006). For instance, Cook et al. (2012) reported that a manualized peer-led self-management program was superior to usual care services at lowering the severity of mental health symptoms and producing greater hopefulness and quality of life. Despite these promising results, the impact of peer-based interventions on the physical health of people with SMI remains unclear. To address this important gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. The aims of this review were to: rate the methodological quality of peer-based health intervention studies, summarize the intervention strategies and study outcomes, and evaluate the inclusion of racial and ethnic minorities in these studies.

Section snippets

Data sources and search methods

We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to inform our systematic literature review (Moher et al., 2009). Electronic bibliographic databases, including PsychInfo, Web of Science, PubMed, and Google Scholar were used to locate articles written in English and published in peer-reviewed journals from 1990 to November 2015. Our search strategy included terms for SMI (e.g., schizophrenia, schizoaffective disorder), health interventions

Study characteristics

The characteristics of the 18 studies included in our review are displayed in Table 1. Study samples ranged in size from 12 to 844 participants, with a median sample size of 57 participants. Studies were conducted in a variety of settings, including community mental health clinics, primary care clinics, psychiatric emergency departments, and programs for first episode psychosis. Twelve studies were conducted in the US and six in Australia. Participants' average age across studies ranged from 21

Discussion

Despite the growth and valuable contributions peer specialists bring to the mental health workforce, little is currently known about the state of the evidence of health interventions delivered or co-facilitated by peer specialists. Our systematic literature review addresses this important gap. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Beneficial intervention effects were reported for a limited number

Conclusion

To our knowledge, this is the first systematic literature review of peer-based health interventions for people with SMI. Our findings indicate that the strength of the evidence generated from these studies is limited due to a variety of methodological limitations associated with the use of pilot study designs and the lack of racial, ethnic, and language diversity in the samples included in these studies. Mixed and limited intervention effects were reported for most health outcomes examined in

Contributors

Dr. Cabassa developed the research questions and conceptualized the idea for this systematic literature review. He was also involved in screening and selecting articles for the review, abstracting article information, rating the methodological quality of selected articles and drafting and editing the manuscript. Mr. Camacho conducted the literature search, abstracted information from articles, constructed the article's figure, and helped write the manuscript. Mrs. Vélez-Grau and Dr. Stefancic

Role of funding source

The sponsoring agency had no role in the writing of this paper or in the decision to submit this paper for publication. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Conflict of interest

The authors report no conflict of interest.

Acknowledgements

This work was supported in part by a grant from the National Institute of Mental Health (R01MH104574). Authors thank Edgar Galvis for helping in the development of this systematic literature review and rating the methodological quality of studies included in this review.

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