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Examining the mental health outcomes of school-based peer-led interventions on immature people: A scoping review of range and a systematic review of effectiveness

• Mina Fazel

Examining the mental health outcomes of schoolhouse-based peer-led interventions on young people: A scoping review of range and a systematic review of effectiveness

• Thomas Rex,
• Mina Fazel

10

• Published: April 15, 2021
• https://doi.org/10.1371/periodical.pone.0249553

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Abstract

Schools worldwide have implemented many different peer-led interventions with mixed results, only the evidence base on their effectiveness as mental wellness interventions remains limited. This study combines a scoping review and systematic review to map the variations of peer-led interventions in schools and to evaluate the quality of the existing bear witness base. This scoping review and systematic review evaluated the existing literature across eleven academic databases. Studies were included if they reported a peer-led intervention that aimed to accost a mental wellness or wellbeing consequence using a peer from the same school setting. Information were extracted from published and unpublished reports and presented equally a narrative synthesis. 54 studies met eligibility criteria for the scoping review, showing that peer-led interventions have been used to accost a range of mental health and wellbeing issues globally. 11 studies met eligibility criteria for the systematic review with a full of 2,239 participants eligible for analysis (929 peer leaders; 1,310 peer recipients). Two studies out of 7 that looked at peer leaders showed pregnant improvements in self-esteem and social stress, with one study showing an increase in guilt. Two studies out of five that looked at peer recipient outcomes showed significant improvements in cocky-confidence and in a quality of life mensurate, with ane study showing an increment in learning stress and a decrease in overall mental health scores. The findings from these reviews show that despite widespread use of peer-led interventions, the evidence base for mental health outcomes is sparse. There appear to exist amend documented benefits of participation for those who are called and trained to be a peer leader, than for recipients. All the same, the small-scale number of included studies ways whatsoever conclusions about effectiveness are tentative.

Citation: King T, Fazel Thousand (2021) Examining the mental wellness outcomes of school-based peer-led interventions on young people: A scoping review of range and a systematic review of effectiveness. PLoS 1 xvi(4): e0249553. https://doi.org/10.1371/journal.pone.0249553

Editor: Danuta Wasserman, Karolinska Institutet, SWEDEN

Received: September xiii, 2020; Accustomed: March 21, 2021; Published: Apr 15, 2021

Copyright: © 2021 Male monarch, Fazel. This is an open access commodity distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in whatever medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this piece of work.

Competing interests: The authors have declared that no competing interests be.

Introduction

Addressing the mental wellness needs of schoolhouse-aged children and adolescents is a global priority [1] with one in eight young people in the United Kingdom experiencing a diagnosable psychiatric disorder [two]. Schools are at present widely recognised as an important setting for early mental health intervention [1, 3]. This has contributed to a rise in the use of peer-led interventions to address mental health needs, a method that is used in schools beyond the globe, both in low and high resources settings with do across Europe, Africa, Asia and North America. An estimated 62% of schools in England have, in a national school survey, stated that they offer peer-led intervention [4]. Peer-led interventions take a diverseness of forms and names, such as peer mentoring, peer buddying, peer counselling and peer education [4, 5]; in this newspaper nosotros will utilise the term 'peer-led' to include all of these activities, and 'peer leaders' or 'peer recipients' (whether giving or receiving an intervention, respectively) to describe participants in these interventions.

Peer-led interventions typically involve the selection, grooming and supervision of a group of pupils in preparation for a supportive or educational function amid similar-aged pupils in their schoolhouse [6]. In training, peer leaders are typically taught basic counselling and communication skills, which are seen equally cardinal skills for the role [seven]. Previously, immature people have been trained to offer back up non only for mental health, but beyond a range of schoolhouse-specific areas, such equally school transition, isolation, and bullying [5]. They take also delivered concrete health promotion interventions, aiming to increase concrete do [8], good for you eating [8, 9], and smoking cessation [9, 10] among their student body. Notwithstanding, despite this apparently broad use, the bear witness base for peer-led interventions to address mental health outcomes remains limited.

Therefore, this review volition focus on the use of peer-led interventions to address mental wellness and well-being in schools. Peer-led programmes have been used in isolation merely are more commonly used alongside other services, such equally school counselling, to address lower-intensity needs and provide simple psychosocial support. This has the potential to allow staff members and professional in-school services to focus on higher level issues [11]. The interventions are typically offered on a 1:1 or group basis. Some have a set up programme whilst others encourage users to arrange appointments or offering a more informal 'drop-in' service. Many programmes are made available to the whole school, while others are targeted at specific populations, such as victims of bullying [12].

At that place are many compelling reasons why peer-led interventions are popular in the schoolhouse setting. Firstly, these programmes are relatively resources-light and may therefore be more acceptable and feasible to run in schools. Schools can often provide a range of potential delivery locations, which may benefit the sometimes ad hoc nature of the peer-led format. For instance, previous peer-led interventions have taken place in classrooms, playgrounds, mutual room areas, after-school clubs and dining rooms. This flexibility is an important consideration for many educational settings. The low resource requirement also lends itself to scalability, enabling schools to increment the reach of these interventions if needed. Furthermore, schools have a large pool of students from which to select their peer leaders who are oftentimes keen to play this function and contribute to their school customs, with a possible endorsement as proficient schoolhouse citizens.

Secondly, school-aged children accept previously been used to address a range of separate just potentially interconnected problems affecting their peers, such as school connectedness [5, 13], advice and social skills [14, xv], and back up with school transitions [sixteen]. The use of peer leaders to support victims of bullying has also been widely studied, with mixed results [12, 17–nineteen]. Furthermore, peer leaders have been used to assist those with chronic health conditions [20] and also encourage healthy living behaviours [21, 22]. The relatively widespread use of peer-led interventions beyond disciplines, and the absence of whatsoever synthesis of peer-led interventions that target mental health outcomes, catalysed this review.

Lastly, the case for the peer-led approach in schools is strengthened by the increasingly appreciated importance of social influence and peer attachments in the adolescent years [23], combined with evidence showing that young people more than commonly turn to informal sources of support, including friends, for psychological needs [2]. This may subsequently lead young people to be more inclined to seek a similar-anile peer for problems around their mental wellness and wellbeing.

Despite widespread utilise of peer-led programmes suggesting their acceptability in a school environment, there are however a number of barriers to consider. These chronicle both to the implementation of these programmes and the personal effects on its users. Firstly, the increase in social awareness during adolescence may also human activity equally a deterrent to confiding in a peer leader if the immature person fears sentence, ridicule or even rejection from their allocated peer. Secondly, some studies accept encountered low programme usage rates, either due to poor awareness of the program [24], not believing that a peer leader would be able to help them [25], or preferring to seek other sources of support, such as 1's existing friends [18]. I study identified chapters and resourcing issues, as well equally lack of involvement from students, as barriers to maintaining a peer-led plan [11].

Great britain governmental reviews accept pointed to the demand for farther inquiry into peer-led programmes. For example, the 'Future in Mind' [26] study identified the integration of mental wellness back up into schools as a priority, with a detail accent on the evolution of peer support. This culminated in the product of a inquiry review in 2017 which identified some areas of electric current research effectually the development and efficacy of peer-led programmes in the Britain [27]. A key finding of the review was that the show base of operations is sparse and lacks overall quality.

As we were not able to identify any advisable systematic or scoping review of the breadth and quality of peer-led programmes in schools and their mental wellness effects, this review was conducted with the specific aims to:

1. Deport a scoping review of the range of peer-led interventions used to address mental health outcomes in schools.
2. Conduct a systematic review to collate and evaluate the data on the effectiveness of school-based peer-led interventions on mental health outcomes.
3. Map the range of mental health outcomes that have been identified.

Materials and methods

Search strategy and pick criteria

The possible sources of eligible studies are wide, given the potential physical, mental and public health, and educational focus of interventions. Therefore, we searched the following 11 electronic databases for eligible studies: PsycINFO; PubMed; EMBASE; CINAHL; Cardinal; BEI; Scopus; Web of Science; ERIC; Social Sciences Commendation Alphabetize (SSCI); and Social Care Index. The list of search terms [see S1 Appendix for ane database search] was developed after an initial browse of the literature and using online database thesaurus tools. Once the search terms had been compiled, pilot searches were run to ensure that key texts were actualization in the search, specially given the different terms used for these activities and different ways in which they have been evaluated. Any search terms that did not appear to be returning any relevant results were removed from the search. Search strategies such every bit truncations, east.g. 'psych*', and MeSH terms were employed. The searches were kept as similar every bit possible between databases. We did a systematic search of studies published in any language up until 20^th Dec 2018 initially, with a repeated search upward until 12^th May, 2020. No earliest publication date was practical. No restrictions were placed on publication date, country or language. The wide search categories included mental health, schools, and peer-led interventions and included upwardly to 120 search terms. Studies were identified with a wide range of synonymous search terms for 'mental health', 'peer back up', 'adolescent', 'school', and 'intervention'. Programmes with peer leaders from exterior the schoolhouse, whether from the community, another school or a university, were non included. Any intervention that primarily used an adult facilitator to lead and actively guide peer-to-peer discussions were also non eligible.

One reviewer screened titles and abstracts for relevance for both the scoping review and systematic review, so screened the remaining full texts (see Figs ane and 2). Whatever that were unclear were brought to the second reviewer for give-and-take. For both reviews, sources were screened against the respective eligibility criteria and relevant data were extracted from included studies. Study authors were contacted where any further information or details were needed. Forward and backward referencing was performed on all included and any relevant studies. A range of grey literature sources were searched, including conference proceedings, dissertations, and government documents. The protocol for the systematic review is available online [28].

Role of the funding source

There was no funding source for this study.

Scoping review

Inclusion criteria

The scoping review included peer-led interventions targeting mental health or wellbeing outcomes. The interventions must have taken place within a primary or secondary schoolhouse and have been predominantly led by students within that school. Equally definitions of 'mental health' and 'wellbeing' can vary, the studies included were those that had identifiable mental health outcomes. Whatsoever programmes with an online element were included as long every bit they were peer-led and based within the schoolhouse. There were no restrictions based on inquiry design or quality for the scoping review [29].

Results

The results of the scoping review are in Table 1. A full of 54 studies are included that show the range of peer-led interventions beyond the globe.

The interventions included those to support positive behaviours and wellness (buddy benches; wellbeing focus; connectedness focus) also as targeting higher risk populations such as those with suicidal thoughts. They often involved grooming the peer leader to behave a further educational or preparation/workshop intervention for their peers. A number of interventions addressed the mental health impact of specific experiences, such as bullying and school transitions, while others aimed to improve mental health in order to prevent certain negative outcomes, such as school dropout. Of the included studies, 46 out of 54 were conducted in loftier-income countries, of which half were in Northward America. In total, the included interventions took place more often than not in secondary schools (89.1%) with approximately i fifth also or exclusively in principal schools (19.6%).

Systematic review

Methodology

We followed the PICO (Population, Intervention, Comparator and Outcome) format to develop our research question [78]. Nosotros completed the systematic review in accordance with the 2009 PRISMA statement [28, 79] and registered it with PROSPERO (CRD42018116243).

Inclusion criteria

The systematic review included randomised controlled trials (RCTs), observational studies, quasi-experimental studies and studies with a pre- and post-exam design. All eligible studies had to include at least ane mental wellness or wellbeing outcome (either observational or self-report). The intervention nether evaluation must have been at to the lowest degree partly peer-led; therefore, programs jointly led by a peer and an adult were eligible. Studies prepare in a master, secondary or special education schoolhouse, or further education institution for those under 18 years erstwhile, were included. School interventions that had an online delivery element were included but if a peer leader was involved. The format of the intervention could be either one-to-one or group-based, as long every bit any groups were at least partly peer-led. Any studies where an adult facilitated peer-to-peer contact, such as a teacher leading a discussion group, were not included.

We included studies that looked at either leader or recipient outcomes, or both. Studies were eligible even if they evaluated merely the training component for a peer-led plan. Within our protocol, we specified that all peers had to be of school age (4–18 years quondam) and a current student within the intervention school. Notwithstanding, nosotros expanded the age range to include slightly older students if a study was based in a land or civilization where it was not uncommon to be at school beyond 18 years. Both quantitative and qualitative studies were included.

Studies including young people with or without a diagnosis of any psychological, emotional or behavioural conditions were eligible, so long every bit they attended school. We included studies with a minimum sample size of 50 peer pairs in the intervention group, or 50 peer leaders or recipients if only one grouping was reported.

Risk of bias assessments

A comprehensive take a chance of bias assessment was carried out using validated and well-established assessment tools. TK and MF independently assessed each written report in order to establish inter-rater reliability. All risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for randomised controlled trials [fourscore], the Joanna Briggs Found (JBI) Critical Appraisal Checklist for quasi-experimental studies [81], and the NIH Quality Cess Tool for studies with a pre-postal service pattern [82]. The evaluations are included in S2 Appendix.

Systematic review results

Description of studies

A total of 45,597 studies were identified after the initial search and 11 were eligible for inclusion in the final assay (see Fig ii for menses diagram of search). The included studies had an estimated total sample size of 2,239 participants (929 peer leaders, 1,310 recipients) (see Table 2 for included studies). Of these, four studies used a randomised controlled design [xx, 39, 71, 83]; six studies used a quasi-experimental design [v, 12, 66, 84–86]; and one operated a pre- and post-exam design [87]. Iii of the identified studies were unpublished dissertations [66, 84, 87]. Educatee sample sizes ranged from 55 [83] to 372 [12] and the number of experimental schools evaluated per study ranged from 1 [77] to 22 [36]. An unpublished dissertation [84] reported on several components of one study, nonetheless merely the component examining the result of the program on the peer leaders is included here. One peer support program, 'Natural Helpers', was included in two studies; both were doctoral dissertations on unlike samples [66, 87]. All studies evaluated interventions in secondary schools, with two also evaluating a chief schoolhouse programme [11, 12]. Only ane intervention was co-led with a teacher [84]. All other interventions were exclusively peer-delivered, although most included an element of adult supervision or guidance for the peer leaders. The age of peer leaders ranged from 12 to xviii; recipients were anile between nine and 20 years and were ordinarily younger than the peer leaders. Peer leaders were selected based on a range of criteria (shown in Fig iii). Interventions addressed mental health and wellbeing outcomes in the context of bullying [12], sexual wellness [71], physical wellness [twenty, 83], general psychological needs [5, eleven, 66, 84, 87] and academic functioning [85, 86]. Interventions were delivered through 1-to-one sessions, group work, ad hoc drop-ins and school-wide 'messaging', e.m. disseminating information using posters, plays, announcements etc. 1 written report was included where peers besides worked in local municipal youth clubs merely the majority of the intervention was conducted inside a schoolhouse [86]. It was not possible to perform a meta-analysis due to loftier levels of cross-study heterogeneity. It was therefore deemed most appropriate to deport a narrative synthesis. In order to address the research question, the results are presented past outcome.

Outcomes

Peer leader outcomes.

Self-esteem and cocky-confidence. A written report in Israel reported mixed findings, with a pregnant betwixt-group effect (F = 16.71; p < .001) on self-esteem at the end of a paired tutoring programme [86]. Within-grouping changes were non-pregnant for peer leaders and a control group. The results as well showed that the self-esteem of male person tutors significantly increased compared to female tutors.

An RCT in S Africa measured the effects of training secondary school students to become peer leaders for a sexual health and wellbeing programme [71]. Self-esteem changes were compared betwixt the group of students receiving the training (Due north = 203) and a control group (Northward = 302) who received none. They establish no meaning divergence betwixt the experimental and command groups later on preparation.

Ii studies evaluated the 'Natural Helpers' programme [66, 87], neither with significant findings, although one written report reported a trend towards improved self-confidence in peer leaders (M = 143.98, SD = 13.96) compared to a matched comparing grouping (Thou = 135.92, SD = 15.28) [66]. This is similar to findings of a peer back up scheme on the self-confidence of peer leaders anile 16 and 17 [84], where student leaders reported non-significant higher self-conviction scores than the command groups later on the intervention and at follow-upwards.

Positive and negative affectivity. A quasi-experimental study measured positive and negative affectivity in peer leaders following a peer support programme [87]. No significant changes were found betwixt groups of 'New Natural Helpers' (n = 54) and 'Experienced Natural Helpers' (due north = 56) (those who were already in the office) when compared with two control groups (students who were nominated to be leaders but were non called past the inquiry team (n = 51), and those who were not peer nominated (due north = 61)).

Social Stress. A study in China found a pregnant decrease in mentors' 'social stress' scores (Chiliad = -0.497, SD = 0.209; p<0.05) following a one-to-i tutoring plan [85], simply no significant alter was observed in their 'overall mental health scores' (Yard = 64.32, SD = 13.85, treatment effect = -0.0952).

Guilt. Song et al. (see 'Social Stress' department) also measured levels of guilt experienced by peer leaders [85]. The peer leaders experienced significantly higher levels of guilt following the program (M = 0.952, SD = 0.397; p = 0.05), which the authors suggested might be due to their matched recipients not improving equally much as they had hoped or because they had become more aware of inequalities amongst their peers.

Anxiety. Song et al. as well included a cursory, mail-intervention survey evaluation, in which only over 42% of peer leaders reported that existence a 'peer tutor' made them feel 'a petty anxious', with 2.6% responding with 'very much' [85].

Recipient outcomes.

Self-esteem & self-confidence. An Australian study establish that a peer support programme had no pregnant firsthand or long-term effect on the self-esteem of students who received support from peer leaders [five]. A sub-group analysis of cocky-conviction in 12 and 13 year sometime students receiving the intervention showed that, although the intervention had no early furnishings, it had significant positive effects at follow-up (K .047, SD .017, p < .01). These positive changes were likewise supported past qualitative findings [five].

Suicidality. An RCT sought to evaluate the whole-schoolhouse effect of the 'Sources of Force' suicide prevention plan in 18 high schools across the U.s. [39]. Students reporting 'some suicidal ideation' (over the previous 3 or 12 months) decreased in both the intervention (N = 268) and control (N = 185) groups over three months, with non-significant differences between weather condition (experimental: pre: 14.8%, post: 11.vi%; command: pre: 12.8%, postal service: 12.two%).

Life satisfaction. A study in England examined levels of life satisfaction in a sample of pupils (Due north = 372) who received an anti-bullying, peer-mentoring programme in master (N = vi) and secondary (North = sixteen) schools [12]. Non-meaning improvements to life satisfaction were seen in the student recipients compared to non-mentored students afterwards one yr, primarily in males. There were besides non-significant results suggesting that recipients who attended a low number of meetings had higher levels of life satisfaction than those who took part in a 'medium' (p = .14) or 'loftier' (p = .74) number of meetings.

Quality of Life. A cluster RCT reported an improvement in overall quality of life for Australian secondary school students with self-reported asthma symptoms following a peer-led intervention [twenty]. A total of 113 students reporting a 'contempo wheeze' received the intervention and completed all assessments. A significant improvement was reported for male recipients in the 'emotions' domain of the questionnaire (2.2% to 37.four%; 95% CI; p = 0.02).

A separate RCT measured the health-related quality of life of female peer recipients post-obit an intervention to increase levels of physical activity [83]. The results showed a very small outcome size in the intervention group betwixt post-study (cease of year 8) and follow-upwardly (beginning of year 9) (Cohen'south d = 0.088).

Learning Stress. A study in China (see 'Social Stress' section) found a significant increase in recipients' levels of 'learning stress' (1.027, SD 0.413; p<0.05) [85]. The authors suggest this may be due to increased daily study time or stress from wanting to improve operation. They besides found that recipients' overall mental health worsened significantly over the class of the intervention (M = 61.45, SD 15.22; effect size = -iv.115; p< 0.01).

Anxiety. Song et al. also included a cursory, post-intervention survey evaluation in which around 43.5% of peer recipients reported that being a 'peer tutee' fabricated them experience 'a piddling anxious', with almost 4.5% stating 'very much' [85].

Training of peer leaders

At that place were a wide range of preparation approaches used across the studies, with sure common themes. Well-nigh focused on teaching the peer leaders basic counselling and psychosocial skills, such as active listening and creating a supportive, non-judgemental environment. Some also focused on helping the peer leaders to recognise when someone may need extra support and the correct referral channels to pursue in these circumstances. All preparation programmes in the systematic review included interactive elements, such as discussion groups, games, exercises, and role-play. The duration and intensity of training periods varied widely, ranging from one-off sessions lasting a few hours to multiple training sessions across the duration of the intervention period. None of the studies reported that the grooming they delivered was testify-based. The evidence gathered in this review is not sufficient to determine the exact relationship betwixt the nature of the training, e.one thousand. duration, content or style of delivery, and subsequent mental health outcomes.

Role of peer leaders

The role of the peer leaders depended largely upon the aim of the intervention. Some interventions employed a universal health promotion strategy, for which peer leaders appeared to be useful every bit role models of positive behaviours and for spreading information, such as suicide awareness, amidst the student body. Other interventions provided support for those already experiencing a mental health difficulty, in which instance the peer leaders generally took on the function of lay counsellors. While peer leaders took a key function in the delivery of these interventions, it is not clear from the detail included in the studies to what extent their interest, or any other element of the intervention, had a direct consequence on mental health outcomes. This is made especially difficult by the lack of pregnant positive outcomes. In this sense, the mechanisms of peer-led interventions, i.e. the elements of change, are still unclear.

Risks

The potential risks associated with these interventions are too non clear from the included studies. However, one written report's findings present some concern over the potential iatrogenic effects of taking office in a peer-led intervention [85]. The study found a pregnant subtract in the overall mental health scores of peer recipients post-obit a tutoring program. The authors suggested this may accept been due to their classification equally the lowest achieving in their class, equally levels of 'learning stress' were likewise seen to increment significantly in this group. This may therefore reverberate a response to possibly being singled out as under-achieving, which bears serious consideration both in a research context and in real-world application. In the aforementioned report a group of peer leaders, who were trained every bit tutors after having been identified every bit in the top one-half of the class, reported significantly higher feelings of guilt following the intervention. The authors suggest this may accept developed from non feeling that their input helped their tutees succeed academically. This sense of responsibility over the outcomes of an intervention is a major consideration when recruiting young people as primary commitment agents and suggests that combining the commitment betwixt pupils and adults, e.g. teachers, might alleviate some of this responsibility. Across these findings, it is non possible to depict any house conclusions effectually the potential take a chance of peer-led interventions due to a paucity of information in this area, making this a central inquiry priority given the sensitive nature of these interventions and their placement within schools. Indeed, it seems highly of import to consider the unique context of these interventions and if, for example, at that place is transference of confidential information between school peers, and the complex confidentiality and safeguarding issues this could pose.

Discussion

This review has evaluated the evidence for peer-led mental health interventions in schools. The scoping review of 54 studies highlighted the various uses of these interventions and that student peers accept tried to play both supportive and educational roles using a range of intervention designs, for example from facilitating peer connections to suicide prevention. However, when examining efficacy of peer-led school-based interventions in the systematic review, only 11 studies were identified as eligible for inclusion; seven explored peer leader outcomes, five explored peer recipient outcomes (ane study looked at both). Nigh studies were assessed as at low take a chance of bias. The majority of studies were conducted in loftier-income nations.

In the seven studies reporting on peer-leader effects, only two [85, 86] reported significant findings—these were on improved self-esteem, decreased social stress and increased guilt. Of note, both these studies were of academic tutoring programmes. In the five studies reporting on peer-recipient outcomes, ii studies [five, 20] reported positive pregnant findings on cocky-conviction and a measure of quality of life; and one study [85] reported on negative impacts on learning stress and general mental health.

The findings from the included studies are therefore not adequate to make any firm conclusions about the effectiveness of these interventions, particularly given the modest number of significant results and the heterogeneity of measured outcomes which is of some concern given their seemingly widespread application in many school systems. All reported outcomes were related to wellbeing problems and emotional difficulties, with no studies measuring a diagnosable psychiatric disorder, such as a depressive or anxiety disorder.

Based on the findings of this review, it is clear that farther inquiry using rigorous scientific methodology is needed. Only 3 RCTs met our eligibility criteria and the sample sizes across the reviewed studies varied. Farther research to explore the potential risks of these interventions would also need to be considered, as one study reported multiple pregnant negative effects of taking role in a tutoring intervention and determining if this was because of the school environment, the intervention, or cultural factors needs to exist explored.

If peer-led interventions are developed, a focus on establishing all-time practices for fundamental elements such as peer selection, preparation and supervision, and delivery would exist important. Little rationale was given across the studies for these key pattern decisions and little evidence exists in the wider literature as a guide. Furthermore, most studies included in the systematic review failed to describe core elements of their implementation procedures or comport any evaluation of them. The bulk of studies chose peer leaders based on a set of criteria adult either by the school or the inquiry team, and predominantly the teachers would make the selection. In instances where peer nominations were involved, the terminal selection was typically still made by the school staff. None of the studies in the systematic review included whatsoever qualitative information on young people's perceptions of what a 'peer' is, although this would provide essential insight into what would be adequate to pupils. Futurity enquiry could compare outcomes of interventions using solely instructor-selected, partly pupil- and teacher-selected, and solely pupil-selected peers, equally it is unclear which method of option is most effective.

A large Great britain study of an initiative to encourage schools to promote and run peer-led interventions in 89 chief, secondary, and special education schools, as well every bit in community groups, complement these findings [eleven]. Each school designed and implemented their own peer support programme based on guidelines provided by a national delivery partner, who likewise ran trainer-preparation sessions. It was at the discretion of schools to determine the well-nigh advisable methods for the recruitment, preparation and supervision of peer mentors, matching arrangements with mentees, and the mode, frequency and duration of each local intervention. The report therefore measured a heterogeneous group of peer-led interventions, some of which might have fulfilled our inclusion criteria, just information technology was not possible to obtain disaggregated data. A pre-postal service design was used to measure a range of mental wellness and wellbeing outcomes across peer leaders, recipients, young people who performed both roles inside the programme, and non-participants. Of the different measures collected, the but statistically significant comeback observed was in a Community Connectedness sub-scale of a resilience measure out, at both 3 and nine month follow-up, in primary aged children (north = 373) who could have been either peer leaders, recipients or neither. Qualitative data collected from immature participants involved in the interventions seemed to betoken that peer leaders were generally more positive well-nigh the plan, although the recipients interviewed frequently wanted to have been able to spend more than time with their matched peer. There was likewise some emphasis on the importance of young people leading the implementation of the programmes to ensure success.

This review has a number of strengths. Firstly, the systematic review is the first of its kind to isolate the mental wellness furnishings of schoolhouse-based, peer-led programmes, which is of import given their widespread apply. Our literature search was extensive, roofing eleven academic databases and thus increasing the likelihood of all relevant studies existence captured. Secondly, by likewise conducting a scoping review nosotros were able to provide a novel and timely map of the many ways in which these interventions accept been used. This review has sought to address a electric current and urgent inquiry gap in an area of national interest, substantial activeness and investment in time. It hopes to inform the evaluation of these programmes going forward.

Limitations

This review has several limitations. Firstly, although every attempt was fabricated to capture equally many mental wellness and wellbeing outcomes within the search every bit possible, the linguistic communication around mental health is broad and fluid which means we may take missed sure terms. However, we have made an case of our search terms available for replication or adaptation (S1 Appendix). Secondly, the number of results returned from the initial literature search suggest that the search strategy may demand to be refined. However, nosotros chose to ensure a large return given the broad nature of the subject, poor reporting of outcomes in abstracts and that the search was applied to a large number of databases. Studies of broader types of peer support might have been missed if they included mental health outcomes amongst a number of other reported areas. Thirdly, a very small number of search terms that appeared after 'exploding' sure terms during the initial literature search were not available when we decided to repeat the search at a subsequently date. Where an exact term was non available, it was omitted from the search. However, these were generally highly specific terms that are unlikely to take acquired key texts to be missed. Lastly, the exclusion of studies with smaller sample sizes may accept also been a limitation. Of the studies excluded based on sample size, the bulk had very small samples, however nosotros sought to summarise any study excluded based on sample size that were closer to our inclusion threshold. This procedure identified four studies (in Canada, Republic of ireland, England and Malaysia) that had slightly larger sample sizes (range of N = 27–46) but were insufficient for inclusion [53, 59, 64,^,68]. I study establish a pregnant reduction in exam anxiety in an adolescent group exposed to 'peer coaching'; however, none of the remaining studies reported any significant mental health or wellbeing outcomes.

Conclusion

Given their seemingly widespread use in schools, peer-led mental health interventions need to be better assessed and their impacts understood so equally to ensure that if used, they can target those children most likely to benefit. Although young people are a potentially important resource to provide depression-intensity mental wellness support in school settings, the current prove base does not support widespread implementation and therefore farther evaluation of existing programmes needs to exist prioritised. Despite peer-led mental health interventions being often adult to help peer recipients, the data shows that the peer leaders can too benefit. It might exist that with the preparation and supervision oft provided to peer leaders, forth with a possible improvement in their self-esteem, that more vulnerable children should exist asked to be peer leaders and not just recipients. Agreement the results and the future blueprint of interventions would probably benefit most from the straight input of young people who are well-placed to co-design such intervention decisions [88].

Supporting information

Acknowledgments

The authors would like to give thanks Laurie Day, Diarmid Campbell-Jack and Professor Yang Song for providing further information about their enquiry, besides as Julia Hallam for helping to develop the search strategy.

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