Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder

Judith G Proudfoot, Amisha Jayawant, Alexis E Whitton, Gordon Parker, Vijaya Manicavasagar, Meg Smith, Jennifer Nicholas, Judith G Proudfoot, Amisha Jayawant, Alexis E Whitton, Gordon Parker, Vijaya Manicavasagar, Meg Smith, Jennifer Nicholas

Abstract

Background: The increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder.

Method: This qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study.

Results: Qualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies.

Conclusions: Examples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.

Figures

Figure 1
Figure 1
Directionality of the mechanisms underpinning effective peer support.

References

    1. Messias E, Eaton W, Nestadt G, Bienvenu OJ, Samuels J. Psychiatrists' ascertained treatment needs for mental disorders in a population-based sample. Psychiatr Serv. 2007;58:373–377. doi: 10.1176/appi.ps.58.3.373.
    1. Solomon P. Peer support/peer provided services: underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J. 2004;27:392–401.
    1. Proudfoot J, Parker G, Hyett M, Manicavasagar V, Smith M, Grdovic S. et al.Next generation of self-management education: Web-based bipolar disorder program. Aust NZ J Psychiat. 2007;41:903–909. doi: 10.1080/00048670701634911.
    1. Salzer MS, Shear SL. Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatr Rehabil J. 2002;25:281–288.
    1. Walsh J, Connelly P. Supportive behaviours in natural support networks of people with serious mental illness. Health Soc Work. 1996;21:296–303.
    1. Blakeman T, Macdonald W, Bower P, Gately C, Chew-Graham C. A qualitative study of GPs' attitudes to self-management of chronic disease. Brit J Gen Pract. 2006;56:407–414.
    1. Dasch K, JKendall J. What do newly-diagnosed cancer patients discuss with survivors? Del Med J. 2007;79:489–492.
    1. Cobb S. Social support as a moderator of life stress. Psychosom Med. 1976;38:300–314.
    1. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52:145–161. doi: 10.1177/0022146510395592.
    1. Reblin M, Uchino BN. Social and emotional support and its implication for health. Curr Opin Psychiatr. 2008;21:201–205. doi: 10.1097/YCO.0b013e3282f3ad89.
    1. Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29:377–387. doi: 10.1007/s10865-006-9056-5.
    1. George LK, Blazer DG, Hughes DC, Fowler N. Social support and the outcome of major depression. Brit J Psychiat. 1989;154:478–485. doi: 10.1192/bjp.154.4.478.
    1. Ell K. Social networks, social support and coping with serious illness: The family connection. Soc Sci Med. 1996;42:173–183. doi: 10.1016/0277-9536(95)00100-X.
    1. Weiss MJ. Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism. 2002;6:115–130. doi: 10.1177/1362361302006001009.
    1. Bozo Ö, Anahar S, Ateş G, Etel E. Effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on depressive symptoms of the caregivers of children with Leukemia. J Clin Psychol Med S. 2010;17:23–30. doi: 10.1007/s10880-009-9177-4.
    1. Kumar S, Calvo R, Avendano M, Sivaramakrishnan K, Berkman LF. Social support, volunteering and health around the world: Cross-national evidence from 139 countries. Soc Sci Med. 2012;74:696–706. doi: 10.1016/j.socscimed.2011.11.017.
    1. Cohen S. Social relationships and health. Am Psychol. 2004;59:676–684.
    1. Wood JV. What is social comparison and how should we study it? Pers Soc Psychol B. 1996;22:520–537. doi: 10.1177/0146167296225009.
    1. Watson AC, Corrigan P, Larson JE, Sells M. Self-stigma in people with mental illness. Schizophrenia Bull. 2007;33:1312–1318.
    1. Russell SJ, Browne JL. Staying well with bipolar disorder. Aust NZ J Psychiatr. 2005;39:187–193. doi: 10.1080/j.1440-1614.2005.01542.x.
    1. Cook J, Jonikas J, Razzano L. A randomized evaluation of consumer versus nonconsumer training of state mental health service providers. Community Ment Hlt J. 1995;31:220–238.
    1. Dixon L, Krauss N, Lehman A. Consumers as service providers: the promise and challenge. Community Ment Hlt J. 1994;30:615–625. doi: 10.1007/BF02188599.
    1. Dixon L, Hackmann A, Lehman A. Consumers as staff in assertive community treatment programs. Adm Policy Ment Hlth. 1997;25:199–208. doi: 10.1023/A:1022243106341.
    1. Skovholt T. The client as helper: A means to promote psychological growth. Couns Psychol. 1974;13:58–64.
    1. Krause NM, Herzog A, Baker E. Providing support to others and wellbeing in later life. J Gerontol. 1992;47:P300–P311. doi: 10.1093/geronj/47.5.P300.
    1. Henderson A. Abused women and peer-provided social support: The nature and dynamics of reciprocity in a crisis setting. Issues Ment Health Nurs. 1995;16:117–128. doi: 10.3109/01612849509006929.
    1. Mowbray CT, Moxley DP, Thrasher S, Bybee D, McCrohan N, Harris S. et al.Consumers as community support providers: Issues created by role innovation. Community Ment Hlt J. 1996;32:47–67. doi: 10.1007/BF02249367.
    1. Peterson MG, Horton R, Englehard E, Lockshin MD. et al.Effect of counselor training on skills development and psychosocial status of volunteers with systemic lupus erythematosus. Arthrit Care Res. 1993;6:38–44. doi: 10.1002/art.1790060108.
    1. Weinberger M, Hiner SL, Tierney WM. Improving functional status in arthritis: The effect of social support. Soc Sci Med. 1986;23:899–904. doi: 10.1016/0277-9536(86)90218-2.
    1. Schwartz CE, Keyl PM, Marcum JP, Bode R. Helping others shows differential benefits on health and wellbeing for male and female teens. J Happiness Stud. 2009;10:431–448. doi: 10.1007/s10902-008-9098-1.
    1. Schwartz CE, Sendor M. Helping others helps oneself: Response shift effects in peer support. Soc Sci Med. 1999;48:1563–1575. doi: 10.1016/S0277-9536(99)00049-0.
    1. Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr. Social ties and susceptibility to the common cold. JAMA: J Am Med Assoc. 1997;277:1940–1944. doi: 10.1001/jama.1997.03540480040036.
    1. René J, Weinberger M, Mazzuca SA, Brandt KD, Katz BP. Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable. Arthrit Rheum. 1992;35:511–515. doi: 10.1002/art.1780350504.
    1. Pyle DI, Mitchell PB. Maintenance treatments for bipolar disorders. Aust Prescr. 2007;30:70–73.
    1. Rouget BW, Aubry J-M. Efficacy of psychoeducational approaches on bipolar disorders: A review of the literature. J Affect Disorders. 2007;98:11–27. doi: 10.1016/j.jad.2006.07.016.
    1. Simon GE, Ludman EJ, Goodale LC, Dykstra DM, Stone E, Cutsogeorge D. et online recovery plan program: Can peer coaching increase participation? Psychiatr Serv. 2011;62:666–669. doi: 10.1176/appi.ps.62.6.666.
    1. Titov N, Andrews G, Choi I. Shyness 3: randomized controlled trial of guided versus unguided internet-based CBT for social phobia. Aust NZ J Psychiatr. 2008;41:1030–1040.
    1. Perini S, Titov N, Andrews G. Clinician-assisted Internet-based treatment is effective for depression: randomized controlled trial. Aust NZ J Psychiatr. 2009;4:3571–3578.
    1. Rowe LS, Morris AM. Patient and partner correlates of couple relationship functioning in bipolar disorder. J Fam Psychol. 2012;26:328–337.
    1. Hammen C, Cohen AN. In: Psychological treatment of bipolar disorder. Johnson SL, Leahy RL, editor. New York: Guilford Press; 2004. Psychosocial functioning; pp. 17–34.
    1. Kupfer DJ, Frank E, Grochocinski VJ, Cluss PA, Houck PR, Stapf DA. Demographic and clinical characteristics of individuals in a bipolar disorder case registry. J Clin Psychiatr. 2002;63:120–125. doi: 10.4088/JCP.v63n0206.
    1. Coryell WH, Scheftner W, Keller M, Endicott J, Maser J, Klerman GL. The enduring psychosocial consequences of mania and depression. Am J Psychiatr. 1993;150:720–727.
    1. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, Petukhova M. et al.Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatr. 2007;64:543–552. doi: 10.1001/archpsyc.64.5.543.
    1. Beyer JL, Kuchibhatia M, Looney C, Engstrom E, Cassidy F, Krishnan KRR. Social support in elderly patients with bipolar disorder. Bipolar Disord. 2003;5:22–27. doi: 10.1034/j.1399-5618.2003.00016.x.
    1. Coryell W, Turvey C, Endicott J, Leon AC, Mueller T, Solomon D. et al.Bipolar I affective disorder: Predictors of outcome after 15 years. J Affect Disord. 1998;50:109–116. doi: 10.1016/S0165-0327(98)00043-3.
    1. Morriss R, Scott J, Paykel E, Bentall RP, Hayhurst H, Johnson T. Social adjustment based on reported behaviour in bipolar affective disorder. Bipolar Disord. 2007;9:53–62. doi: 10.1111/j.1399-5618.2007.00343.x.
    1. Keenan-Miller D, Miklowitz DJ. Interpersonal functioning in pediatric bipolar disorder. Clin Psychol: Sci Prac. 2011;18:342–356. doi: 10.1111/j.1468-2850.2011.01266.x.
    1. Arnstein P, Vidal M, Wells-Federman C, Morgan B, Caudill M. From chronic pain patient to peer: benefits and risks of volunteering. Pain Manag Nurs. 2002;3:94–103. doi: 10.1053/jpmn.2002.126069.
    1. Johnson SL, Roberts JE. Life events and bipolar disorder: implications from biological theories. Psychol Bull. 1995;117:434-449.
    1. Johnson SL, Winett CA, Meyer B, Greenhouse WJ, Miller I. Social support and the course of bipolar disorder. J Abnorm Psychol. 1999;108:558–566.
    1. Proudfoot J, Parker G, Manicavasagar V, Hadzi-Pavlovic D, Whitton A, Nicholas J, Smith M, Burkhardt R. Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: a randomized controlled trial. J Affect Disorders. 2012;142:98–105. doi: 10.1016/j.jad.2012.04.007.
    1. Proudfoot JG, Parker GB, Benoit M, Manicavasagar V, Smith M, Gayed A. What happens after diagnosis? Understanding the experiences of patients with newly-diagnosed bipolar disorder. Health Expect. 2009;12:120–129. doi: 10.1111/j.1369-7625.2009.00541.x.
    1. Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS one. 2010;5:e10939. doi: 10.1371/journal.pone.0010939.
    1. Andersson G, Cuijpers P. Internet-based and other computerised psychological treatments for adult depression: a meta-analysis. Cog Behav Ther. 2009;38:196–205. doi: 10.1080/16506070903318960.
    1. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med: J Res Psychiatr Allied Sci. 2007;37:319–328.
    1. Parker G, Hadzi-Pavlovic D, Tully L. Distinguishing bipolar and unipolar disorders: an isomer model. J Affect Disorders. 2006;96:67–73. doi: 10.1016/j.jad.2006.05.014.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288. doi: 10.1177/1049732305276687.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health C. 2007;19:349–357. doi: 10.1093/intqhc/mzm042.
    1. Rummel CB, Hansen W-P, Helbig A, Pitschel-Walz G, Werner K. Peer-to-peer psychoeducation in schizophrenia: a new approach. J Clin Psychiatr. 2005;66:1580–1585. doi: 10.4088/JCP.v66n1214.
    1. Reissman F. The "helper" therapy principle. Soc Work. 1965;10:27–32.
    1. Mowbray CT, Moxley DP, Collins M. Consumers as mental health providers: First-person accounts of benefits and limitations. J Behav Health Serv Res. 1998;25:397–411. doi: 10.1007/BF02287510.
    1. Armstrong ML, Korba AM, Emard R. Mutual benefit: The reciprocal relationship between consumer volunteers and the clients they serve. Psychiatr Rehabil J. 1995;19:45–49.
    1. Whitehead LC. Methodological and ethical issues in Internet-mediated research in the field of health: An integrated review of the literature. Soc Sci Med. 2007;65:782–791. doi: 10.1016/j.socscimed.2007.03.005.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다