The Future of Peer Support in Digital Psychiatry: Promise, Progress, and Opportunities
This selective review highlights promising findings and future opportunities relevant to digital peer support services. This review considered literature published in peer-reviewed scholarly journals within the past 36 months.
Digital peer support spans multiple technology modalities: peer-delivered and smartphone-supported interventions, peer-supported asynchronous technology, artificial peer support, informal peer-to-peer support via social media, video games, and virtual worlds. Digital peer support is an emerging area of research that shows promise in improving mental health symptoms, medical and psychiatric self-management skill development, social functioning, hope, and empowerment.
As the science of peer support in digital psychiatry advances, peer support specialists will likely have an increasingly important role in the mental health workforce—from providing evidence-based, fidelity-adherent interventions to expanding their reach to vulnerable populations and communities.
KeywordsPeer support Digital health technology Patient-facilitated networks Mental health care
Compliance with Ethical Standards
Conflict of Interest
Karen L. Fortuna, Maria Venegas, Emre Umucu, George Mois, Robert Walker, and Jessica M. Brooks declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.World Health Organization. (2017). Promoting recovery in mental health and related services: handbook for personal use and teaching: WHO QualityRights training to act, unite and empower for mental health (pilot version). World Health Organization. http://www.who.int/iris/handle/10665/254811. License: CC BYNC-SA 3.0 IGO.
- 2.Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilation Journal J. 2004;27(4):392–401.Google Scholar
- 3.Mead S, MacNeil C. Peer support: what makes it unique. Int J Psychosoc Rehabil. 2006;10(2):29–37.Google Scholar
- 4.Wexler B, Davidson L, Styron T, Strauss J. Severe and persistent mental illness. Hoboken, NJ: John Wiley & Sons; 2007.Google Scholar
- 5.Chinman M, George P, Dougherty R, et al. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv. 2014;65(4):429–41.Google Scholar
- 6.Druss B, Singh M, von Esenwein S, et al. Peer-led self-management of general medical conditions for patients with serious mental illnesses: a randomized trial. Psychiatr Serv. 2018;69(5):529–35.Google Scholar
- 7.Davidson L, Bellamy C, Guy K, Miller R. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry. 2012;11(2):123–8.Google Scholar
- 8.Naslund J, Grande S, Aschbrenner K, Elwyn G. Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube. PLoS One. 2014;9(10):e110171.Google Scholar
- 9.Naslund J, Aschbrenner K, Marsch L, McHugo G, Bartels S. Facebook for supporting a lifestyle intervention for people with major depressive disorder, bipolar disorder, and schizophrenia: an exploratory study. Psychiatry Q. 2018;89(1):81–94.Google Scholar
- 10.Colder Carras M, Van Rooij A, Spruijt-Metz D, et al. Commercial video games as therapy: a new research agenda to unlock the potential of a global pastime. Front Psych. 2017;8:300.Google Scholar
- 11.Campbell S, Holter M, Manthey T, Rapp C. The effect of CommonGround software and decision support center. Am J Psychiatr Rehabil. 2014;17(2):166–80.Google Scholar
- 12.Salyers M, Fukui S, Bonfils K, et al. Consumer outcomes after implementing CommonGround as an approach to shared decision making. Psychiatr Serv. 2016;68(3):299–302.Google Scholar
- 13.Fortuna K, DiMilia PR, Lohman MC, Bruce ML, Zubritsky CD, Halaby MR, et al. Feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported self-management intervention for older adults with serious mental illness. Psychiatry Q. 2018;89(2):293–305.Google Scholar
- 14.Rehm I, Foenander E, Wallace K, Abbott J, Kyrios M, Thomas N. What role can avatars play in e-mental health interventions? Exploring new models of client-therapist interaction. Front Psych. 2016;7(186).Google Scholar
- 15.Medeiros L, Bosse T. An empathic agent that alleviates stress by providing support via social media paper presented at. In: AAMAS ’17 Proceedings of the 16th Conference on Autonomous Agents and MultiAgent Systems Pages; 2017.Google Scholar
- 16.• Fortuna K, Barr P, Goldstein C, et al. Application of community-engaged research to inform the development and implementation of a peer-delivered mobile health intervention for adults with serious mental illness. JMIR: J Participatory Med. 2019;11(1):e12380 The authors, researchers at Dartmouth College, Brown University, Massachusetts Department of Mental Health, Mayo Clinic College of Medicine, Dartmouth-Hitchcock Medical Center, and Massachusetts General Hospital, used a peer-researcher equal partnership approach to create and describe a guiding framework for the development, testing, and implementation of peer-delivered mobile health interventions in community settings. The framework highlights principles and methods essential to best practices in community-based, multidisciplinary health intervention research in digital psychiatry.Google Scholar
- 17.• Fortuna KL, Brooks JM, Umucu E, Walker R, Chow P. Peer support:a human factor to enhance engagement in digital health behavior change interventions. Journal of Technology and Behavioral Science. 2019. https://doi.org/10.1007/s41347-019-00105-x. The authors, researchers and peer support specialists from Dartmouth College, Portland State University, University of Texas at El Paso, Massachusetts Department of Mental Health, and University of Virginia, conducted a theoretical and empirical literature review and developed one of the first models based on peer support factors associated with engagement in digital health interventions. It was proposed that a theoretical model tailored to peer-specific components of digital health services might improve behavioral change outcomes within peer-led programs and collaborations.
- 18.Sarason IG, Levine HM, Basham RB, Sarason BR. Assessing social support: the Social Support Questionnaire. J Pers Soc Psychol. 1983;44(1):127–39.Google Scholar
- 19.Borkman T. Experiential Knowledge. A new concept for the analysis of self-help groups. Soc Serv Rev. 1976;50(3):445–56.Google Scholar
- 20.Skovholt TM. The client as helper: a means to promote psychological growth. Couns Psychol. 1974;4(3):58–64.Google Scholar
- 21.Bandura A, Ramachaudran VS. Encyclopedia of human behavior, vol. 4. New York: Academic Press; 1994. p. 71–81.Google Scholar
- 22.Festinger L. A theory of social comparison processes. Hum Relat. 1954;7:117–40.Google Scholar
- 23.Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68.Google Scholar
- 24.Mueller NE, Panch T, Macias C, Cohen BM, Ongur D, Baker JT. Using smartphone apps to promote psychiatric rehabilitation in a peer-led community support program: pilot study. JMIR mental health. 2018;5(3):e10092.Google Scholar
- 25.Chan S, Li L, Torous J, Gratzer D, Yellowlees P. Review of use of asynchronous technologies incorporatedin mental health care. Curr Psychiatry Rep. 2018;20(10):85.Google Scholar
- 26.Deegan PE, Rapp C, Holter M, Riefer M. Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv. 2008;59(6):603–5.Google Scholar
- 27.• Deegan PE, Carpenter-Song E, Drake RE, Naslund JA, Luciano A, Hutchison SL. Enhancing clients’ communication regarding goals for using psychiatric medications. Psychiatr Serv. 2017;68(8):771–5 The authors, researchers from Pat Deegan Ph.D. & Associates, Dartmouth College, Duke University, and the Community Care Behavioral Health Organization, used a public mental health database query to determine that more than 17,000 consumer self-advocacy statements were made during web-based, peer co-facilitated shared decision making interventions at psychiatric medication visits. The authors also conducted a qualitative analysis of a random sample of 300 statements and found that service users most wanted psychiatric medications to assist with symptom control toward the pursuit of meaningful life goals and improved functioning.Google Scholar
- 28.Fortuna KL, Lohman MC, Batsis JA, et al. Patient experience with healthcare services among older adults with serious mental illness compared to the general older population. Int J Psychiatry Med. 2017;52(4–6):381–98.Google Scholar
- 29.Fortuna K, Naslund J, Aschbrenner K, et al. Text message exchanges between older adults with serious mental illness and older certified peer specialists in a smartphone-supported self-management intervention. Psychiatr Rehabil J. 2019;42(1):57–63.Google Scholar
- 30.O’Leary K, Schueller S, Wobbrock J, Pratt W. “Suddenly, we got to become therapists for each other”: designing peer support chats for mental health. Paper presented at: CHI ’18 Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems. 2018. Montreal QC, Canada. https://doi.org/10.1145/3173574.3173905.
- 31.Vance K, Howe W, Dellavalle RP. Social internet sites as a source of public health information. Dermatol Clin. 2009;27(2):133–6.Google Scholar
- 32.Aschbrenner KA, Naslund JA, Gorin AA, et al. Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: protocol for a randomized controlled trial. Contemp Clin Trials. 2018;74:97–106.Google Scholar
- 33.Castelein S, Bruggeman R, Van Busschbach JT, et al. The effectiveness of peer support groups in psychosis: a randomized controlled trial. Acta Psychiatr Scand. 2008;118(1):64–72.Google Scholar
- 34.Bracke P, Verhaeghe M. The balance of peer support among persons with chronic mental health problems: consequences and antecedents. Paper presented at: 11th International Congress of the European Society for Health and Medical Sociology. 2006.Google Scholar
- 35.Naslund J, Aschbrenner K. Risks to privacy with use of social media: understanding the views of social media users with serious mental illness. Psychiatr Serv. 2019. https://doi.org/10.1176/appi.ps.201800520.
- 36.Leutwyler H, Hubbard E, Vinogradov S, Dowling G. Videogames to promote physical activity in older adults with schizophrenia. Games Health J. 2012;1(5):381–3.Google Scholar
- 37.Han D, Renshaw P, Sim M, Kim J, Arenella L, Lyoo I. The effect of Internet video game play on clinical and extrapyramidal symptoms in patients with schizophrenia. Schizophr Res. 2008;103(1–3):338–40.Google Scholar
- 38.Morie JF, Chance E. Extending the reach of health care for obesity and diabetes using virtual worlds. J Diabetes Sci Technol. 2011;5(2):272–6.Google Scholar
- 39.Yee N, Bailenson J. The Proteus effect: the effect of transformed self-representation on behavior. Hum Commun Res. 2007;33(3):271–90.Google Scholar
- 40.Rus-Calafell M, Gutiérrez-Maldonado J, Ribas-Sabaté J. A virtual reality-integrated program for improving social skills in patients with schizophrenia: a pilot study. J Behav Ther Exp Psychiatry. 2014;45(1):81–9.Google Scholar
- 41.Kim S, Ku J, Han K, Lee H, Park J, Kim J. Virtual reality applications for patients with schizophrenia. J Cyber Ther Rehabil. 2008;1:101–12.Google Scholar
- 42.Bell M, Weinstein A. Simulated job interview skill training for people with psychiatric disability: feasibility and tolerability of virtual reality training. Schizophr Bull. 2011;37(2):S91–7.Google Scholar
- 43.Sohn B, Hwang J, Park S, et al. Developing a virtual reality-based vocational rehabilitation training program for patients with schizophrenia. Cyberpsychol Behav Soc Netw. 2016;19(11):686–91.Google Scholar
- 44.Coeckelbergh M. health care, capabilities, and AI assistive technologies. Ethical Theory Moral Pract. 2010;13(2):181–90.Google Scholar
- 45.Coeckelbergh M. Artificial agents, good care, and modernity. Theor Med Bioeth. 2015;36(4):285.Google Scholar
- 46.Feil-Seifer D, Skinner K, Matarić M. Benchmarks for evaluating socially assistive robotics. Interact Stud. 2007;8(3):423–39.Google Scholar
- 47.Miller E, Polson D. Apps, avatars, and robots: the future of mental healthcare. Issues in Ment Health Nurs. 2019;40(3):208–14.Google Scholar
- 48.Zwijsen S, Niemeijer A, Hertogh C. Ethics of using assistive technology in the care for community-dwelling elderly people: an overview of the literature. J Ageing Ment Health. 2011;15(4):419–27.Google Scholar
- 49.Brittain K, Corner L, Robison L, Bond J. Ageing in place and technologies of place: the lived experience of people with dementia in changing social, physical, and technological environments. Hoboken: Blackwell Publishing Ltd; 2010. p. 97–111.Google Scholar
- 50.Broekens J, Heerink M, Rosendal H. Assistive social robots in elderly care: a review. Gerontechnology. 2009;8:94–103.Google Scholar
- 51.Burton A. Dolphins, dogs, and robot seals for the treatment of neurological disease. Lancet Neurol. 2013;12:851–2.Google Scholar
- 52.Diehl J, Schmitt L, Villano M, Crowell C. The clinical use of robots for individuals with autism spectrum disorders: a critical review. Res Autism Spectr Disord. 2012;6:249–62.Google Scholar
- 53.Fasola J, Matarić M. A socially assistive robot exercise coach for the elderly. J Hum–Robot Interact. 2013;2(2):3–32.Google Scholar
- 54.Rabbit S, Kazdin A, Scassellati B. Integrating socially assistive robotics into mental healthcare interventions: applications and recommendations for expanded use. Clin Psychol Rev. 2015;35:35–46.Google Scholar
- 55.Khan R, Das A. Introduction to chatbots. Berkeley, CA: Apress; 2018.Google Scholar
- 56.Fortuna K, Naslund J, Brooks J, Deegan P. Systematic review of peer support interventions in digital psychiatry (unpublished study).Google Scholar
- 57.Larsen M, Huckvale K, Nicholas J, et al. Using science to sell apps: evaluation of mental health app store quality claims. npj Digital Medicine, vol. 2; 2019. p. 18.Google Scholar
- 58.Smikowski J, Dewane S, Johnson ME, Brems C, Bruss C, Roberts LW. Community-based participatory research for improved mental health. Ethics Behav. 2009;19(6):461–78.Google Scholar
- 59.Forsythe L, Carman K, Szydlowski V, et al. Patient engagement in research: early findings from the Patient-Centered Outcomes Research Institute. Health Aff. 2019;38(3). https://doi.org/10.1377/hlthaff.2018.05067.
- 60.Salzer M, Schwenk E, Brusilovskiy E. Certified peer specialists roles and activities: results from a national survey. Psychiatr Serv. 2010;61(5):520–3Google Scholar
- 61.Bartels S, DiMilia P, Fortuna KL, Naslund J. Integrated care for older adults with serious mental illness and medical comorbidity: evidence-based models and future research directions. Psychiatr Clin N Am. 2018;41(1):153–64.Google Scholar
- 62.Kumar S, Shah N. False Information on web and social media: a survey. 2018;1(1):35.Google Scholar
- 63.Bode L, Vraga E. See something, say something: correction of global health misinformation on social media. Health Commun. 2017;33(9):1131–40.Google Scholar
- 64.Kaye H, Yeager P, Reed M. Disparities in usage of assistive technology among people with disabilities. Assist Technol. 2008;20(4):194–203.Google Scholar
- 65.Nicholson J, Wright S, Carlisle A. Pre-post, mixed-methods feasibility study of the WorkingWell mobile support tool for individuals with serious mental illness in the USA: a pilot study protocol. BMJ Open. 2018;8:e019936.Google Scholar
- 66.Pols J. Care at a distance: on the closeness of technology. Amsterdam: University Press; 2012.Google Scholar