Peer-Administered Interventions for Depression: A Meta-Analytic Review

Abstract

A variety of psychotherapies have been demonstrated to be efficacious and effective treatments for depression. The cost of psychotherapy, however, and its low availability in some contexts pose significant treatment barriers for many depressed individuals. Based on the idea that peers (i.e., individuals who have successfully recovered from similar problems) may be uniquely able to provide empathy and support to those currently receiving treatment, some community mental health centers have implemented peer treatment models that employ recovered former clients as cost-effective adjunct providers. The effectiveness of these and other peer-administered interventions (PAIs) has not been well-established. The current study is a meta-analysis of the existing outcome research on PAIs for depression. Twenty-six studies were identified as eligible for inclusion and yielded 30 between-groups effect sizes and 29 pre-post PAI effect sizes. Study characteristics and methodological quality were coded and random-effects models were used to calculate and compare mean effect sizes. PAIs produced significant pre-to-post treatment reductions in depression symptoms that were comparable to those found in well-established professionally-administered interventions (.4554). In direct comparisons, PAIs performed as well as professionally-administered treatments (.0848). but not significantly better than treatment-as-usual (e.g., periodic physician check-ins or availability of community mental health services) and wait-list control conditions (.0978). These findings did not change after adjusting for the moderate degree of publication bias in the data. Moderation models revealed that professionally-co-administered PAIs produced significantly worse outcomes than those that were purely peer-administered, and that educational/skills-based PAIs (but not supportive PAIs) produced better outcomes compared with professional treatments. Limitations of this analysis included the heterogeneity of the included interventions and the lack of data on mediators and moderators. Still, these findings suggest that PAIs have promise as effective depression treatments and are worthy of further study.