Peer Support

What is it? Peer support and peer mentoring interventions bring students with shared experiences together to help each other emotionally or academically.

Evidence? Currently, the overall evidence base on the impact of peer support interventions in HE is weak. There are only a limited number of studies which can help us understand if these approaches are effective, and very few in a UK context.

What is the intervention?

The central tenet of a peer support intervention is that the facilitators and recipients share a certain set of experiences. These experiences may be based on a particular mental health difficulty or the experience of living in a certain social context. Most often this means that peer support interventions are delivered by students themselves. This category includes peer learning, peer support groups or peer mentoring interventions. Facilitators may have some prior training and most often are provided with some additional supervision. This can be an intervention appropriate for a wide range of experiences and does not have to be targeted in order to establish a model of shared experience. It is often seen as an accessible solution that balances out hierarchical imbalances in support groups led by professionals. These interventions require a significant amount of support to be run safely, as well as a safe space in which the intervention can be delivered. Delivery can be individual or in small groups and can be done either in person or online via video conferencing. This sort of intervention can also be delivered on specially designed platforms where peers can communicate anonymously online. The frequency of peer support sessions can also be adjusted to suit the needs of the recipients. The structure of peer support means that it can be delivered in varying levels of formality in terms of referral and monitoring.

How effective is it?

Evidence on peer support interventions roughly falls into three categories: peer-led support groups, peer mentoring and peer learning. Pointon-Haas et al. (2023) synthesise the current literature on the effectiveness of each of these approaches. They examine 28 studies on the impact of peer support interventions to improve mental health in student populations.

More detail on each of the three sorts of support is given below. In sum, there is mixed evidence on the impact of peer support which does not provide strong support for this approach at this stage. More research is needed to bolster the overall strength and coverage of the evidence base.

Peer-led support groups

On peer-led support groups, Pointon-Haas et al. (2023) find little evidence of impact on mental health outcomes. For example Moir et al. (2016) study an intervention in which medical students in New Zealand elected peer leaders who were trained to deliver a programme of support for students including mindfulness sessions and social events. Students were randomly allocated to either receive peer support or just standard support. Surveys run before the intervention and six months later didn’t find any impact of the peer support on a number of mental health outcomes, including depression and anxiety. Peterson (2013) also tested a multi-week programme of support groups, this time specifically with first-generation college students in the USA. They find mixed results, with some reductions in measures of distress and functional impairment, and improvements in perceived social support. However, there was no effect on other outcomes including stress or grade point average.

Frohn et al. (2013) test whether the providing two 90 minute training sessions, either on study skills or mindfulness, can help students manage stress. In a USA college setting they randomly allocated students to one of the two approaches and ran a survey immediately afterwards and one month later. They found a reduction in self-reported stress among the whole sample, but no difference between the two groups. However, the lack of a comparison to a group who didn’t receive any additional support makes it hard to assess whether this was due to the intervention or just a natural decline in stress scores which would have happened anyway over the course of the study. Fontana et al. (1999) also studied the effect of a series of stress reduction sessions on college students in the USA as part of a randomised study. They find some relatively large effects of this intervention on heart rate (although not on other physiological measures or perceived physical symptoms of stress) and on anxiety. However, this study has a comparatively smaller sample than some of the others discussed on this page which limits the strength of its findings.

In an example of digital support, Freeman et al. (2008) evaluated an online mutual support group for students at a UK university. Students were invited to join an online group for those feeling ‘stressed out or low.’ Those who expressed an interest were randomly allocated to either have access to a website containing information about common student problems, or the website plus an online support group, led by students. A survey run before the website launch and 10 weeks later found no evidence of any benefit of the support group on outcomes including wellbeing and satisfaction with life.

However, Mattanah et al. (2012) provides one example of a stronger positive finding. In a USA university, a sample of incoming students were randomly selected to participate in a nine week social support programme, during which they met in small groups with a peer facilitator during the first semester of college. Comparison of this group to a group who did not participate suggests the intervention does appear to have a small positive effect on both loneliness and grade point average.

There are some other studies with positive findings, albeit not for mental health outcomes per se. For example, Conley et al. (2020) studied a peer-led series of lessons all focused on reducing the stigma of mental illness designed to help participants make informed decisions about whether and how to disclose their mental health status. In a trial involving college students in the USA with existing mental health difficulties, they found this approach was effective at reducing perceived stigma, but not depression or anxiety. Similarly, Kilpela et al. (2016) test the impact of peer-led group sessions designed to improve body image. In study in the USA, students were allocated to either attend these sessions or to a ‘waitlist’ group who would attend later. Survey data collected after the first group took part suggest some positive effects on body satisfaction but not on other outcomes including negative affect. They find a small effect of attending this programme on loneliness and grade point average.

Peer-mentoring

On peer mentoring, Pointon-Haas et al. (2023) identify a small number of studies which generally examine the effect on stress among student populations. These have mixed findings, but overall do not currently provide strong evidence of impact for peer mentoring approaches.

Pfister (2004) provides evidence from one of the largest studies. In a USA college, student-athletes were randomly assigned to either a peer mentor or a faculty mentor. Stress and social support were measured three times during a 16-week semester. No significant differences were found in the perceived stress levels of student athletes mentored by faculty versus peers; however, the faculty-mentored student athletes consistently reported higher levels of social support from their mentors than the peer-mentored group. The lack of a group who received no mentoring means we cannot know what the overall effect of the intervention was compared to no additional support.

Some studies provide mixed or positive results, but the smaller sample sizes limit their strength. Kim et al. (2013) tested the effect of graduate-to-undergraduate student mentoring for student nurses in a USA college. They find significant positive effects on some but not all measures of anxiety, satisfaction with nursing as a career and on attainment. There was no evidence of an effect on self-efficacy. Nowanz et al. (2019) also find a short-term positive effect of two week peer counselling intervention for third year university students in Japan on mental health outcomes. However, the sample size of just 34 and 27 participants for these studies respectively means we should not over rely on these results.

Peer learning

There are few studies which we can use to confidently determine the impact of peer learning. One study which provides some reasonable evidence is Kocak (2008). This research tested the effect of cooperative learning versus individual learning among university students in Turkey. Students randomly allocated to the cooperative learning group were required to spend some elements of their lectures working together in groups, and told that their final grades would be the average of the grades among that whole group. Analysis of surveys issued pre- and post- the intervention to both those who took part in cooperative and individual learning suggest small positive effects of the peer-based intervention on loneliness, social anxiety, and happiness, although no effect on self-monitoring skills or ability to identify their emotions.

How secure is the evidence?

The current evidence base for peer support interventions is weak. It should be noted that there are a sizeable number of medium/high-quality randomised controlled trials (RCTs) that have been conducted on a student population which provide causal evidence on these interventions, through comparison of a treatment group that receives the intervention and a control group that does not (or does so only after a set time period – a waitlist control). However, the majority of studies have been developed in North America. There is limited evidence on peer support activities in the UK. More research is needed in a UK context to draw reliable conclusions that are accurate for UK HE providers.

It should also be noted that the evidence is split between the various approaches outlined above so there is not a sufficiently large evidence base to start drawing conclusions about the efficacy of different peer support approaches, even in a global context.

Some of the evidence captures mental health outcomes immediately or soon after the intervention has been received, and therefore further research is needed to ascertain whether effects can be sustained in the long-term.

In contrast to some of the other intervention types included in this Toolkit, some of the causal studies focus on student outcomes, namely attainment, as well as mental health outcomes. This is welcome, as it is important to understand whether interventions improve student mental health but also that they contribute to success on-course.

Again, in contrast to some of the other intervention types included in this Toolkit, the causal studies reviewed above are less likely to have been tested with self-selecting samples of students. Some of these peer support interventions have been tested in more typically representative populations of undergraduate students, which may make them more generalisable to other similar contexts.

The use of self-report measures is a limitation of much of the evidence cited above, particularly as for many interventions here students may have been aware of the approach being tested, leading to a strong risk of students reporting better mental health outcomes because they think they are expected to. It should also be noted that some of the studies have small samples and/or there is insufficient detail in the paper to understand if the sample is big enough for the purpose of the analysis.

How do I evaluate this intervention?

RCTs are one of the most robust ways to measure interventions as they allow comparison of two groups that have either received or haven’t received the intervention, whilst controlling for observable and unobservable differences between the two groups. Kim et al. (2013) outline why it is so important to include a randomised control group in this sort of analysis. They state “Without the control group, a misleading negative conclusion would have been made regarding trait anxiety, since the within-group trait anxiety score improvement in the experimental group was minimal and not statistically significant. The positive effect of mentoring became detectable only through comparison with the control group, which showed a markedly worsening of the trait anxiety score.”

These trials should take place outside of lab settings to test whether, and how, interventions translate and perform in the ‘real world’. There are many examples of RCT designs in the literature cited above, including waitlist designs (see for example Conley et al., 2012); the key benefit of this design is that the control group is still able to receive the intervention, just at a later date once outcomes have been measured in both groups. However, this approach is less appropriate if we expect that the effect of an intervention will materialise in the longer term.

Outcomes should be measured in both treatment and control groups using validated scales before and after the intervention has been received. Measuring outcomes at multiple time points (e.g. three-, six- and twelve-month follow-ups) is important, rather than only immediately after.

It is important to measure the impact of peer support interventions on student outcomes such as attainment, retention and progression and HE providers should seek to embed these into evaluation plans.

See our evaluation guidance for more support.

Where can I find more information and guidance?

For guidance from the Mental Health Charter, please follow the links below:

Most peer support interventions fall under the following themes:

• Social integration and belonging
• Inclusivity and intersectional mental health
• Transition into university

Where does the evidence come from?

The evidence in the Toolkit was gathered via an evidence review undertaken as part of the Student Mental Health Project. For full details of this review, please see our Methodology document.

It is important to note that our review, and therefore this Toolkit, only relates to student mental health. The review did not cover other populations (e.g. school children, other adult populations) or non-HE settings. The review was also subject to other inclusion/exclusion criteria, outlined in the Methodology document.

Please also note that this Toolkit page only includes Type 3 (causal) studies which have been rated as providing medium/high-quality evidence according to our evidence strength ratings. These studies are outlined in the page above and referenced below. A full list of studies collated via our evidence review, including Type 1/Type 2 studies, and those rated as providing weak/emerging evidence, can be found in our Evidence Review Spreadsheet. A breakdown of these studies by type and strength of evidence is available to download.

Main references

Reviews

Pointon-Haas, J., Waqar, L., Upsher, R., Foster, J., Byrom, N., Oates, J. (2023). A systematic review of peer support interventions for student mental health and wellbeing in higher education. BJPsych Open [Preprint]

Causal studies

Conley, C.S., Hundert, C.G., Charles, J.L.K., Huguenel, B.M., Al-khouja, M., Qin, S., Paniagua, D. & Corrigan, P.W. (2020) Honest, Open, Proud–College: Effectiveness of a Peer-Led Small-Group Intervention for Reducing the Stigma of Mental Illness. Stigma and Health. 5 (2), 168. doi: 10.1037/sah0000185

Fontana, A.M., Hyra, D., Godfrey, L. & Cermak, L. (1999) Impact of a Peer-Led Stress Inoculation Training Intervention on State Anxiety and Heart Rate in College Students. Journal of Applied Biobehavioral Research. 4 (1), 45–63. doi:10.1111/j.1751-9861.1999.tb00054.x

Freeman, E., Barker, C. & Pistrang, N. (2008) Outcome of an Online Mutual Support Group for College Students with Psychological Problems. CyberPsychology & Behavior. 11 (5), 591–593. doi:10.1089/cpb.2007.0133

Frohn, A.F., Turecka, S. & Katz, J. (2013) Can informal peer education help college students manage stress? Effects of two brief skills-based programs on student stress, rumination, and self-criticism. In: Psychology of Wellbeing: Theory, Perspectives and Practice,. pp. 19–31.  Available at: https://www.researchgate.net/publication/287324178_Can_informal_peer_education_help_college_students_manage_stress_Effect_of_two_brief_skills-based_programs_on_student_stress_rumination_and_self-criticism

Kilpela, L.S., Blomquist, K., Verzijl, C., Wilfred, S., Beyl, R. & Becker, C.B. (2016) The body project 4 all: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program: THE BODY PROJECT 4 ALL. International Journal of Eating Disorders. 49 (6), 591–602. doi:10.1002/eat.22562.

Kim, S.C., Oliveri, D., Riingen, M., Taylor, B. & Rankin, L. (2013) Randomized Controlled Trial of Graduate-to-Undergraduate Student Mentoring Program. Journal of Professional Nursing. 29 (6), e43–e49. doi:10.1016/j.profnurs.2013.04.003.

Kocak, R. (2008) The effects of cooperative learning on psychological and social traits among undergraduate students. Social Behavior and Personality: an International Journal. 36 (6), 771–782. doi:10.2224/sbp.2008.36.6.771

Mattanah, J.F., Brooks, L.J., Brand, B.L., Quimby, J.L. & Ayers, J.F. (2012) A Social Support Intervention and Academic Achievement in College: Does Perceived Loneliness Mediate the Relationship? Journal of College Counseling. 15 (1), 22–36. doi:10.1002/j.2161-1882.2012.00003.x

McNulty, K. (2018) The Effects of Peer Mentoring on the Stress Levels of Nursing Students. College of Saint Mary.

Moir, F., Henning, M., Hassed, C., Moyes, S.A. & Elley, C.R. (2016) A Peer-Support and Mindfulness Program to Improve the Mental Health of Medical Students. Teaching and Learning in Medicine. 28 (3), 293–302. doi:10.1080/10401334.2016.1153475.

Nozawa, H., Ikegami, K., Michii, S., Sugano, R., Ando, H., Kitamura, H. & Ogami, A. (2019) Peer counseling for mental health in young people – Randomized clinical trial –. Mental Health & Prevention. 14, 200164. doi:10.1016/j.mph.2019.200164.

Petersen, T.J. (2013) Evaluation of a Stress Management Program for Newly Matriculated First-Generation College Students: A Randomized Controlled Trial. College of Arts and Sciences of Ohio University. Available at: https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=ohiou1375377440&disposition=inline 

Pfister, V.R. (2004) Effects of Faculty and Peer Mentoring on Perceived Stress and Social Support of College Student Athletes. University of South Florida. Available at: https://digitalcommons.usf.edu/etd/1195

Other Studies

Pointon-Haas, J., Byrom, N., Foster, J., Hayes, C. and Oates, J., 2023. Staff Perspectives: Defining the Types, Challenges and Lessons Learnt of University Peer Support for Student Mental Health and Wellbeing. Education Sciences, 13(9), p.962. doi:10.3390/educsci13090962