title: Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder.
abstract: BACKGROUND
  The increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder.
  
  
  METHODS
  This qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study.
  
  
  RESULTS
  Qualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies.
  
  
  CONCLUSIONS
  Examples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.
authors.affiliation: Black Dog Institute and School of Psychiatry, University of New South Wales, Randwick, NSW, Australia. j.proudfoot@unsw.edu.au
authors.forename: Judith G
authors.initials: JG
authors.lastname: Proudfoot
authors.forename: Amisha
authors.initials: A
authors.lastname: Jayawant
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Whitton
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.forename: Vijaya
authors.initials: V
authors.lastname: Manicavasagar
authors.forename: Meg
authors.initials: M
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nicholas
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000451:nursing*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012944:Social Support