Previously submitted to: JMIR Mental Health (no longer under consideration since Jul 30, 2021)
Date Submitted: Jul 30, 2021
Open Peer Review Period: Jul 30, 2021 - Jul 30, 2021
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Effectiveness, acceptability and potential harms of peer support for self-harm in non-clinical settings: A systematic review
ABSTRACT
Background:
Many people who have self-harmed prefer informal sources of support, or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed, and what might be the risks of peer support interventions in non-clinical settings.
Objective:
The aims of this review are to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.
Methods:
We searched two bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary sector organisations, providing one-to-one or group support, or via moderated online peer support forums. We excluded peer support within clinical settings, peer support provided by relatives or friends who self-harm, or peer support from unmoderated online forums. Quality appraisal was conducted on included papers, and study findings were summarised using a narrative synthesis.
Results:
Ten papers met the inclusion criteria for this review, and most (n=8) were conducted in the United Kingdom. Eight of the papers focused on peer support that was delivered through online mediums and two examined face-to-face self-harm recovery/support groups. Limited conclusions about the effectiveness of peer support interventions for self-harm can be made, as we found no studies comparing this to other treatments or a control group. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a reduction of loneliness, a sense of community and empowerment, improvements in interpersonal skills, and access to information and support. The most commonly perceived risk associated with peer support for self-harm was the potential for triggering self-harm. Other potential risks identified were being re-traumatised by listening to other people’s stories, not having the knowledge or skills to help others, and misunderstandings or disagreements with other peers/group members.
Conclusions:
Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. This justifies investment in the provision of such resources, supported by safeguards to mitigate the potential risks from peer support interventions. Suggestions include organisations using professional facilitators for groups, including trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people whilst maintaining their own emotional health. Clinical Trial: CRD42021235441 (PROSPERO)
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