peer support – part 4 – research

In prior posts I have provided a basic intro to peer support, some highlights from its history, and theories related to how it can contribute to suicide prevention. The next step is to provide research evidence that provide the foundation for describing this as a promising practice worthy of investment.

Note: As described here and consistent with others, a “promising practice” is a program or other intervention that has the potential to effectively address suicidal thinking and behavior. They can logically be tied to outcomes used in suicide prevention directly (e.g., fewer suicide attempts) or indirectly (e.g., changing known risk or protective factors). For example, an attempt survivor support group has been developed based on the evidence-based Wellness Recovery Action Plan (WRAP) program. In other words, a promising practice is a great candidate for further exploration and evaluation.

What we need is the funding to conduct the type of research and evaluation studies on peer supports that could move them from promising practices to evidence-based programs and policies.

To begin with, as noted in The Way Forward:

Positive reports from groups for suicidal individuals were published as early as 1968. One study found that groups were beneficial, with only 5% of the 105 attempt survivors having a re-attempt in the one-year follow-up (compared to approximately 15% in a year in general)… An ongoing group for attempt survivors in Toronto, Canada, with a peer co-facilitator has reported improvements in mood, thinking, impulsivity, connectedness/belonging, and hope. Another attempt survivor group with a peer co-facilitator in Los Angeles, California, has reported increased connectedness, decreased suicidal desire, and improved safety planning…

Research findings indicate that warm lines are associated with decreased loneliness, increased connectedness, decreased use of crisis services (e.g., emergency departments, police, and hotlines), and increased recovery…

Additionally, studies show that the recipients of peer specialist services may have increased quality of life, decreased life problems, and increased engagement with traditional care systems… Research indicates that [peer support at discharge] can result in fewer re-admissions to the hospital, fewer hospital days, and increased use of traditional programs…

Further discussion about peer- or consumer-operated services, including evidence for their benefits and effectiveness, can be found in the SAMHSA Consumer-Operated Services Evidence-Based Practices (EBP) Kit.

To further support the potential impact on suicidal thinking and behavior, below is a comparison between here is a comparison of known risk factors for suicidal behavior(conditions that make it more likely) with known benefits of peer support that could address those conditions.

Risk Factors for suicidal behavior
Benefits of Peer Support
Suicidal thoughts Talking to others and peer support as coping strategies
Mental disorders Fewer symptoms of mental disorders, fewer hospitalizations, shorter hospitalizations, providing support associated with decreased depression
Alcohol and other substance use disorders Less substance abuse, less binge drinking, better results when more involved in AA
Hopelessness Better quality of life, better satisfaction with life, increased self-esteem, increased self-efficacy, increased empowerment
Impulsive and/or aggressive tendencies Increased problem solving and coping skills
History of trauma or abuse Decreased anxiety, increased self-esteem
Some major physical illnesses Increased daily functioning
Lack of social support / isolation Increased social support, increased social networks, increased social functioning
Stigma of help seeking behavior Increased communication with doctors, increased medication adherence, increased acceptance of illness
  Other Benefits
  Fewer crisis events, increased employment, increased knowledge about disorder
Note: References from first 2 rows reappear throughout and thus aren’t linked again

Yet, further study is not something we have been opposed to. The Way Forward explicitly calls for additional “research and evaluation studies on supports for individuals who have survived a suicidal crisis.” (Recommendation 6.4). This was also something that I emphasized in the guest posting at the SPRC Director’s Blog, and a webinar for the Injury Control Research Center for Suicide Prevention (see May 14, 2014).

Again, what we need is the funding to conduct the type of research and evaluation studies on peer supports that could move them from promising practices to evidence-based programs and policies.

In the upcoming final post (#5) in this series I will present a few gaps in suicide prevention where peer supports could play a vital role.