Suporte interpares na doença mental

Campos, Filipa Alexandra Lourenço; Sousa, Ana Rita Pinto de; Rodrigues, Vânia Patrícia da Costa; Marques, António José Pereira da Silva; Dores, Artemisa Agostinha Monteiro da Rocha; Queirós, Cristina Maria Leite

doi:10.1590/0101-60830000000009

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Archives of Clinical Psychiatry (São Paulo)

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Sumário

Review Articles • Rev. psiquiatr. clín. 41 (2) • mar-apr 2014 • https://doi.org/10.1590/0101-60830000000009 copiar

Suporte interpares na doença mental

Autoria SCIMAGO INSTITUTIONS RANKINGS

Contexto

O suporte interpares é um sistema de ajuda mútua baseado na crença de que alguém que enfrentou/superou adversidades pode oferecer apoio, encorajamento e orientação a outros que enfrentam situações similares.

Objetivo

Realizar uma revisão sistemática que caracterize o suporte interpares como prática, analise a sua eficácia e caracterize os pares prestadores de suporte interpares.

Método

Pesquisa nas bases de dados ISI Web of Science, EBSCO Psychology and Behavioral Sciences Collection e Medline (2001 a dezembro de 2013), utilizando as palavras-chave “mental illness”, “mental health”, “psychiatric disability”, “mental health services”, combinadas com “peer support”, “mutual support”, “self-help groups”, “consumers as providers”, “peer-run services”, “peer-run programs” e “social support”.

Resultados

Encontraram-se 1.566 artigos e foram aplicados os critérios de exclusão (artigos com crianças, adolescentes e idosos; doença mental em comorbidade; suporte interpares em doenças físicas ou familiares/cuidadores) e de inclusão (revistas científicas com texto integral disponível; suporte interpares ou grupos similares dirigidos a esquizofrenia, depressão, transtorno bipolar e outras perturbações psicóticas), resultando em 165 documentos. Excluíram-se 22 por repetição e 31 por texto incompleto, resultando em 112, os quais se identificaram como principais categorias do suporte interpares: caracterização, prestador de suporte, práticas e eficácia.

Conclusão

Existe interesse crescente pelo tema, embora alguns domínios não sejam consensuais, sugerindo necessidade de mais estudos.

Suporte interpares; transtornos mentais; recuperação pessoal; revisão sistemática

Characterization	Results	Authors
Definition	Peer support definitions can be conceptualised into three main groups:	Mead et al.¹ (2001)
	– a system for giving and receiving help based on the principles of respect, shared responsibility and mutual aid	Davidson et al.² (2006)
	– emotional and instrumental support, mutually offered or provided to people with similar experiences of mental illness, with the goal of producing the desired personal or social changes	Grant et al.¹⁴ (2012)
	– a system based on the belief that people who have faced and overcome adversity can offer useful support, encouragement and hope to others who are in similar situations	Kemp and Henderson¹⁵ (2012)
		Kern et al.¹⁶ (2013)
		Loumpa¹⁷ (2012)
		Moran et al.¹⁸ (2013)
		Moran et al.¹⁹ (2012)
		Moran et al.²⁰ (2012)
		Repper and Watson²¹ (2012)
		Solomon²² (2004)
		Swarbrick²³ (2013)
		Stastney²⁴ (2012)
		Scott and Doughty²⁵ (2012)
		Weingarten²⁶ (2012)

Types	In literature there are different types of peer support:	Davidson et al.² (2006)
	– mutual help group	Moran et al.¹⁸ (2013)
	– on-line and phone support groups	Moran et al.¹⁹ (2012)
	– peer-provided services	Solomon²² (2004)
	– operationalization of peer-provided services/programmes	Scott and Doughy²⁵ (2012)
	– peer partnerships	Coniglio et al.²⁷ (2012)
	– employability of peer supporters in health services	DeAndrea and Anthony²⁸ (2013)
		Mancini et al.²⁹ (2013)
		Rabenschlag et al.³⁰ (2012)
		Walker and Bryant³¹ (2013)
Objetives	The objectives are mainly centred around the concepts of personal recovery, empowerment and advocacy, seeking to improve social functioning in daily life activities, self-esteem and self-efficacy	Brown et al.³² (2008)
		Chinman et al.³³ (2006)
		Corrigan et al.³⁴ (2013)
		Fukui et al.³⁵ (2010)
		Henderson and Kemp³⁶ (2013)
		Hodges and Segal³⁷ (2002)
		Ostrow and Adams³⁸ (2012)

Target group	The studies analyse the severity, stage and type of mental illness to which peer support is most suited:	Corrigan et al.³⁴ (2013)
	– it is used in people with serious mental illness	Burns-Lynch and Salzer³⁹ (2001)
	– it is used in first-episode psychosis, acute crisis or chronic and persistent psychosis	Chinman et al.⁴⁰ (2002)
	– people with mood disorders, psychotic disorders (schizophrenia) and anxiety disorders	Chinman et al.⁴¹ (2001)
		Finn et al.⁴² (2009)
		Lucock et al.⁴³ (2007)
		Pistrang et al.⁴⁴ (2008)
		Shahar et al.⁴⁵ (2006)
		Yip et al.⁴⁶(2004)

Peer supporter	Results	Authors
Characteristics	Information regarding the stage of the disease, the contractual relationship and the role of individuals in organisations is structured as follows:	Davidson et al.² (2006)
	– Peer supporters must suffer from the same pathology as the target population, but they must be at an advanced stage of the recovery process	Grant et al.¹⁴ (2012)
	– In the case of mutual help or self-help groups, peer providers work on a volunteer basis, without any compensation – In the remaining types of peer support, peer supporters employees, earning a monetary remuneration	Repper and Watson²¹ (2012)
	– There are also some organisations where volunteer work and employment of people with experience of mental illness coexist	Solomon²² (2004)
	– The service rendering scheme is generally organised in part-time shifts	Walker and Bryant³¹ (2013)
	– The role of peer supporters is to promote group activities, provide support in daily life activities, at work and in the community with their peers. They also assist their peers in making informed decisions and developing new strategies for dealing with symptoms	Brown et al.³² (2008)
		Chinman et al.³³ (2006)
		Chinman et al.⁴¹ (2001)
		Chinman et al.⁴⁷ (2008)
		Hodges and Hardiman⁴⁸ (2006)
		Lawn et al.⁴⁹ (2008)
		Moll et al.⁵⁰ (2009)
		Nestor and Galletly⁵¹ (2008)

Selection process	Few references were found regarding the methods and procedures to adopt or the most valued characteristics, and it is not clear who should be responsible for the selection process References found value the following selection criteria for this role:	Franke et al.⁹ (2010)
	– personal experience with the pathology	Repper and Watson²¹ (2012)
	– readiness to professional development	Lawn et al.⁴⁹ (2008)
	– good social and communication skills	Moll et al.⁵⁰ (2009)
	– motivation to take on this role	Ahmed et al.⁵² (2013)
		Barber et al.⁵³ (2008)
		Dennis⁵⁴ (2003)
		Gillard et al.⁵⁵ (2013)
		Simoni and Franks⁵⁶ (2011)

Training	Training must be administered by health professionals and by more experienced peer supporters, although it is not clear who should be in charge. There is no consensual information on the methods, type and duration of the training, and we found only one article that mentions a 40-hour training programme. In general, relevance is given to topics such as:	Franke et al.⁹ (2010)
	– dealing with/sharing one’s experience with mental illness	Bouchard et al.¹⁰ (2010)
	– communication and group leadership skills	Grant et al.¹⁴ (2012)
	– the educational process regarding mental illness	Kern et al.¹⁶ (2013)
	– personal recovery, suicide prevention	Repper and Watson²¹ (2012)
	– definition of the role of the peer supporter	Weigarten²⁶ (2012)
		Rabenschlag et al.³⁰ (2012)
		Ostrow and Adams³⁸ (2012)
		Chinman et al.⁴¹ (2001)
		Chinman et al.⁴⁷ (2008)
		Lawn et al.⁴⁹ (2008)
		Nestor and Galletly⁵¹ (2008)
		Gillard et al.⁵⁵ (2013)
		Cook et al.⁵⁷ (2010)
		Fukkink⁵⁸ (2011)
		Pickett et al.⁵⁹ (2010)
		Rabenschlag et al.⁶⁰ (2012)
		Robinson et al.⁶¹ (2010)
		Swarbrick et al.⁶² (2009)

Supervision	Supervision provides information on:	Mead et al.¹ (2001)
	– Methods vary according to the organisations where the activities are developed, which are not specified	Franke et al.⁹ (2010)
	– The majority of studies indicate a weekly periodicity	Moran et al.¹⁹ (2012)
	– The person in charge varies, and it may be a health care professional or a more experienced peer supporter	Repper and Watson²¹ (2012)
	– Overall this is considered an important procedure for the good performance of peer supporters	Chinman et al.³³ (2006)
		Lawn et al.⁴⁹ (2008)
		Gillard et al.⁵⁵ (2013)
		Nestor and Galletly⁵¹ (2008)
		Barber et al.⁵³ (2008)
		Chinman et al.⁶³ (2010)

Practices	Results	Authors
Models	The models most advocated are the following:	Kern et al.¹⁶ (2013)
	– Social support	Solomon²² (2004)
	– Experimental knowledge	Swarbrick²³ (2013)
	– “Helper-therapy” principle	Scott and Doughy²⁵ (2012)
	– Social learning theory	Brown et al.³² (2008)
	– Social comparison theory	Finn et al.⁴² (2009)
	– Empowerment theory	Lucock et al.⁴³ (2007)
	– Cognitive-behavioural therapy	Dennis⁵⁴ (2003)
	– Socio-ecological model	Rabenschlag et al.⁶⁰ (2012)
		MacDonald-Wilson et al.⁶⁴ (2013)

Local	Peer support can take place in several contexts:	Shahar et al.⁴⁵ (2006)
	– In outpatient and inpatient hospital treatments	Dennis⁵⁴ (2003) (2011)
	– In the community: at home, at school, in prisons and in primary care centres	Landers and Zhou⁶⁵
		Robinson et al.⁶¹ (2010)
		Delaney⁶⁶ (2010)
		Janzen et al.⁶⁷ (2007)

Contact Phase	This is a relatively unexplored topic, although the authors who have studied it argue that the first contact should occur early in the onset of the illness and still in inpatient treatment or immediately after discharge	Chinman et al.⁴¹ (2001)
		Lawn et al.⁴⁹ (2008)
		Nestor and Galletly⁵¹ (2008)
		Robinson et al.⁶¹ (2010)

Programmes	No consensus was found regarding the activities that should comprise each programme With regard to the number of participants, the maximum number was established at around 15 per programme In terms of duration there was a trend for weekly periodicity and no maximum overall duration	Davidson et al.² (2006)
		Fuku et al.³⁵ (2010)
		Burns-Lynch and Salzer³⁹ (2001)
		Finn et al.⁴² (2009)
		Lawn et al.⁴⁹ (2008)
		Nestor and Galletly⁵¹ (2008)
		Barber et al.⁵³ (2008)
		Cook et al.⁵⁷ (2010)
		Corrigan et al.⁶⁸ (2002)

Efficacy	Results	Authors
Users services	Reduction in hospitalisations and psychiatric symptoms; increased quality of life and self-esteem; increased social networking; reintegration into the community; improved coping strategies; management of the illness; improved functioning in daily activities; increased sense of empowerment; increased recovery potential; increased hope for recovery	Repper and Carter³ (2011)
		Moran et al.¹⁸ (2013)
		Moran et al.¹⁹ (2012)
		Moran et al.²⁰ (2012)

		Repper and Watson²¹ (2012)
Peer supporter	Greater personal growth; increased self-confidence; improved self-esteem; greater empowerment; improved sense of self-efficacy; improved quality of life; benefits for the personal recovery process; reduced hospitalisations; financial remuneration; opportunities for the development of vocational skills	Solomon²² (2004)
		Coniglio et al.²⁷ (2012)
		Rabenschlag et al.³⁰ (2012)
		Walker and Bryant³¹ (2013)
Mental health system	Lower costs for the mental health system; Improvement of the efficacy of mental health services; Increase of the satisfaction with mental health services	Chinman et al.³³ (2006)
		Corrigan et al.³⁴ (2013)
		Henderson and Kemp³⁶ (2013)
		Chinman et al.⁴¹ (2001)
		Lawn et al.⁴⁹ (2008)
		Moll et al.⁵⁰ (2009)
		Ahmed et al.⁵² (2013)
		Gillard et al.⁵⁵ (2013)
		Cook et al.⁵⁷ (2010)
		Rabenschlag et al.⁶⁰ (2012)
		Corrigan et al.⁶⁸ (2002)
		Biegel et al.⁶⁹ (2013)
		Jonikas et al.⁷⁰ (2010)
		Van Gestel-Timmermans et al.⁷¹ (2012)

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[1] Address correspondence to: António José Pereira da Silva Marques. Laboratório de Reabilitação Psicossocial da FPCEUP/ESTSPIPP, Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto. Rua Alfredo Allen, s/n – 4200-135 – Porto, Portugal. E-mail: ajmarques@estsp.ipp.pt