Effectiveness of peer support for people with severe mental health conditions in high-, middle- and low-income countries: multicentre randomised controlled trial

Bernd Puschner ORCID logo ; Juliet Nakku ORCID logo ; Ramona Hiltensperger ORCID logo ; Philip Wolf ORCID logo ; Inbar Adler Ben-Dor ORCID logo ; Faith Bugeiga ; Ashleigh Charles ORCID logo ; Lion Gai Meir ORCID logo ; Paula Garber-Epstein ORCID logo ; Yael Goldfarb ORCID logo ; +34 more... Alina Grayzman ORCID logo ; Shimri Hadas-Grundman ; Maria Haun ORCID logo ; Imke Heuer ORCID logo ; Bahati Iboma ; Jasmine Kalha ORCID logo ; Lydia Kamwaga ; Palak Korde ORCID logo ; Yasuhiro Kotera ORCID logo ; Silvia Krumm ORCID logo ; Arti Kulkarni ORCID logo ; Eric Kwebiiha ; Jennifer Kyara ; Max Lachman ORCID logo ; Candelaria Mahlke ORCID logo ; Benjamin Mayer ORCID logo ; Galia Moran ORCID logo ; Richard Mpango ORCID logo ; Rachel Mtei ; Annabel Müller-Stierlin ORCID logo ; Roseline Nanyonga ; Fileuka Ngakongwa ORCID logo ; Jackline Niwemuhwezi ; Rebecca Nixdorf ORCID logo ; Lena Nugent ; Soumitra Pathare ORCID logo ; Mary Ramesh ; Grace Ryan ORCID logo ; Gwen Schulz ; Maria Wagner ; Tamara Waldmann ORCID logo ; Lisa Wenzel ORCID logo ; Donat Shamba ORCID logo ; Mike Slade ORCID logo ; (2025) Effectiveness of peer support for people with severe mental health conditions in high-, middle- and low-income countries: multicentre randomised controlled trial. The British journal of psychiatry : the journal of mental science. pp. 1-9. ISSN 0007-1250 DOI: 10.1192/bjp.2025.10299
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Background: Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak.

Aims: To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries.

Method: This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support.

Results: Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02–0.34).

Conclusions: Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.


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