Table 5High-Level Overview of Trial Findings and GRADE Assessments

Outcome Time point Number of participants (trials) Certainty of the evidence (reasons) Conclusion
Personal recovery outcomes
Self-stigmaPost-intervention191 (2 RCTs39,40,50) Very low

(a, b, c, d)

The findings for effect of formal peer support vs. control (waitlist or TAU) on self-stigma are inconsistent, and the evidence is very uncertain.
Post-booster97 (1 RCT39) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. control (waitlist or TAU) on self-stigma, but the evidence is very uncertain.
Longest follow-up117 (2 RCTs40,50) Very low

(a, b, c, d)

The findings for effect of formal peer support vs. control (waitlist or TAU) on self-stigma at the longest follow-up are inconsistent, and the evidence is very uncertain.
Stigma stressPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to stigma stress at post-intervention, but the evidence is very uncertain.
Longest follow-up117 (2 RCTs40,50) Very low

(a, b, c, d)

The findings for effect of formal peer support vs. control (waitlist or TAU) on stigma stress at the longest follow-up are inconsistent, and the evidence is very uncertain.
Self-efficacy related to secrecy or disclosing mental illnessPost-intervention107 (1 RCT39) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. waitlist control on self-efficacy about disclosing mental illness post-intervention, but the evidence is very uncertain.
Post-booster97 (1 RCT39) Very low

(a, b, c, d)

Formal peer support may be favoured vs. waitlist control with respect to self-efficacy about disclosing mental illness at post-booster, but the evidence is very uncertain.
Longest follow-up55 (1 RCT40) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. waitlist control on self-efficacy about disclosing mental illness at 2 months follow-up, but the evidence is very uncertain.
Attitudes to disclosurePost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to attitudes to disclosure post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on attitudes to disclosure at post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to attitudes to disclosure at longest follow-up but the evidence is very uncertain.
Disclosure-related distressPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to disclosure-related distress post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on disclosure-related distress post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to disclosure-related distress at longest follow-up but the evidence is very uncertain.
SecrecyPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respects to reducing secrecy post-intervention but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on secrecy at post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respects to reducing secrecy at longest follow-up, but the evidence is very uncertain.
Other personal recovery outcomes
HRQoLPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on HRQoL post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on HRQoL at post-booster follow-up.
Longest follow-up84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to HRQoL at longest follow-up, but the evidence is very uncertain.
EmpowermentPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on feeling of empowerment post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on feeling of empowerment at post-booster follow-up.
Longest follow-up84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on feeling of empowerment at longest follow-up, but the evidence is very uncertain.
Social withdrawalPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to social withdrawal at post-intervention but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on social withdrawal at post-booster follow-up.
Longest follow-up84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on social withdrawal at longest follow-up, but the evidence is very uncertain.
Help-seekingPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to help-seeking at post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on help-seeking at post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to help-seeking at 6 weeks follow-up, but the evidence is very uncertain.
HopelessnessPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on feelings of hopelessness post-intervention, but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on feelings of hopelessness at post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on feelings of hopelessness at longest follow-up, but the evidence is very uncertain.
Stage of recoveryPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on self-identified stage of recovery at post-treatment but the evidence is very uncertain.
Post-boosterNo trials were identified NA No trials were identified containing data on self-identified stage of recovery at post-booster follow-up.
Longest follow-up62 (1 RCT50) Very low

(a, b, c, d)

Formal peer support may be favoured vs. TAU with respect to self-identified stage of recovery at follow-up, but the evidence is very uncertain.
Clinical outcomes
AnxietyPost-interventionNo trials were identified NA No trials were identified containing data on self-reported anxiety symptoms at post-booster follow-up.
Post-booster97 (1 RCT39) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on self-reported anxiety symptoms post-intervention, but the evidence is very uncertain.
Longest follow-up55 (1 RCT40) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. waitlist control on self-reported anxiety symptoms at follow-up, but the evidence is very uncertain.
DepressionPost-intervention84 (1 RCT50) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on self-reported depressive symptoms at post-intervention, but the evidence is very uncertain.
Post-booster97 (1 RCT39) Very low

(a, b, c, d)

There may be little to no difference in the effect of formal peer support vs. TAU on self-reported depressive symptoms post-booster, but the evidence is very uncertain.
Longest follow-up117 (2 RCTs40,50) Very low

(a, b, c, d)

The findings for effect of formal peer support vs. control (waitlist or TAU) on depressive symptoms at the longest follow-up are inconsistent, and the evidence is very uncertain.
Health care resource utilization outcomes
Health care resource utilization outcomesAll time pointsNo trials were identified NA No trials were identified containing data on health care resource utilization.
Social outcomes
Social outcomesAll time pointsNo trials were identified NA No trials were identified containing data on social outcomes.
Safety
SafetyAll time pointsNo trials were identified NA No trials were identified containing data on safety of peer support programs.

GRADE = Grading of Recommendations Assessment, Development and Evaluation; HOP = Honest, Open, Proud; HOP-C = Honest, Open, Proud–College; HRQoL = health-related quality of life; NA= not applicable; RCT = randomized controlled trial; TAU = treatment as usual.

Note: a = risk of bias; b = inconsistency; c = indirectness; d = imprecision.

From: Peer Support Programs for Youth Mental Health

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Peer Support Programs for Youth Mental Health: Health Technology Assessment [Internet].
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