Telephone-based Mutual Peer Support for Depression: A Pilot Study

Major depression (MDD) is a highly prevalent disorder which is projected to become the leading cause of disability worldwide by 2030.1, 2 Despite the availability of evidence-based treatments for depression, approximately one-third of treated patients fail to achieve remission after several medication trials, and 40–60% of patients who achieve remission relapse within a year.3 Like patients with other chronic conditions, patients with continuing depressive symptoms may benefit from proactive, frequent, and supportive contacts to encourage treatment retention and to maintain the motivation and skills necessary to manage their symptoms, increase functional capacity, and achieve valued life goals.4, 5 Unfortunately, reimbursement limits and scarce clinician time make frequent contact with patients difficult between face-to-face encounters. One way to provide frequent supportive contacts for patients coping with longer-term depressive symptoms is through peer support services. Interest in peer support programs has grown in recent years, and peer support initiatives were specifically recommended by the President’s New Freedom Commission on Mental Health.6 Several studies have established a relationship between social support and improved outcomes among patients with a variety of medical conditions, including depressive disorders. Social support has been shown to be protective against the development of depression among adults facing severe stressors.7–9 Prospective trials among patients with depression have shown peer support interventions to be associated with improvements in depressive symptoms.10–18 Additionally, previous studies of telephone-based psychotherapy and care management, which allow for more frequent contacts at a lower cost, indicate that telephone contacts between professional staff and patients are acceptable and effective substitutes for in-person psychotherapy and care management.19–22 Thus, preliminary findings suggest that telephone-based peer support programs may represent a safe, efficacious way to provide additional support to patients with depression. However, prior trials of peer support for depression have most often been conducted among selected groups of depressed individuals such as post-partum women or patients with chronic medical illnesses in addition to depression and it is uncertain whether the results of these trials can be generalized to the broader population of depressed individuals.11–14, 16 Furthermore, previous intervention trials of peer support for depression frequently relied on professional group leaders or trained “peer mentors” to provide support to “novice” patients. An important mechanism by which peer relationships improve depression may be the act of helping others, in addition to receiving support.9, 23–26 Dyadic mutual support may provide more opportunity for reciprocal support than mentored relationships or groups but has not been previously studied among depressed patients. We conducted a pilot study to evaluate the feasibility of a telephone-based, mutual peer support intervention among patients who experience continued depressive symptoms despite receiving routine mental health care. Specifically, we examined whether pairs of patients with ongoing depressive symptoms would participate in weekly mutual support telephone sessions. We also assessed whether patients were satisfied with the program and found it to be a useful addition to their care, and whether program participation resulted in improvements in patients’ depressive symptoms and overall quality of life.