There is sufficient evidence that peer-led interventions have a positive impact on social outcomes for adolescents at risk for depression, with impacts extending to the family and/or caregiving context.
Impact Assessment
The findings below synthesize the results of the studies on peer-led interventions in adolescents at risk for depression across three domains of measurement:
Symptoms of depression often include feelings of sadness, inability to feel happiness, self-criticism, fatigue, loss of appetite and inability to sleep[1]. Symptoms can fall on a spectrum from mild to severe. Major depression signifies an impairment that interferes with an individual’s ability to conduct activities in daily life[2].
There has been an increase in adolescent stress, anxiety, depression, self-harm, and suicidality. Adolescent depression increased from 8.1% in 2009 to 15.8% in 2019 with higher rates of depression among people who identify as female than male[3]. Suicide is the third leading cause of death among adolescents with depression being a leading risk factor[4]. About five million adolescents experienced a major depressive episode in 2021, with the prevalence being higher among females, 29.2% of whom experienced an episode compared to 11.5% of males[5]. The group that demonstrated the highest prevalence of experiencing a major depressive episode were adolescents who identify as two or more races (27.2%).
A growing body of evidence suggests that positive parenting practices, such as parental warmth and granting adolescents autonomy coupled with age-appropriate levels of activity monitoring, are associated with lower rates of adolescent depression. Conversely, psychological control, punishment-focus, inappropriate levels of activity restriction/monitoring for developmental age, and inter-parental conflict within the household are negative risk factors[6].
Depression can lead to substance misuse, eating disorders, obesity, challenges with social functioning, and adult depression[7],[8]. Among adolescents in particular, depression is often underdiagnosed and remains untreated, as symptoms can be attributed to the mood swings and affectation typically associated with adolescence[9]. The U.S. Preventive Services Task Force recommends that all adolescents between the ages of 12 and 18 be screened for depression[10].
Treatment for depression spans a myriad of interventions including evidence-based talk therapy, medication, and sleep and exercise[11]. Among U.S. adolescents who experienced a major depressive episode in 2021, only 40.6% received treatment[12]. Lower rates of treatment and medication use were found among racial/ethnic minorities and adolescents without any medical insurance[13].
Adolescents of color are more likely to be underdiagnosed, treated less frequently, and, when services are rendered, are less likely to have a clinically meaningful impact compared to their White counterparts. Between 2005 and 2012, data collected from the National Health and Nutrition Examination Survey indicated that Hispanic and Black people were significantly more likely to experience serious depression than White people[14]. In a 2011 RAND report entitled, The Teen Depression Awareness Project, the majority of White teens from a diverse sample reported readiness to receive therapy for depression, while Black and Hispanic teens reported treatment readiness at lower rates[15]. Provider-mediated factors contributing to differences in treatment readiness include practice location and accessibility, referral bias, and culturally uninformed provider communication[16].
According to the Center for Disease Control and Prevention (CDC), treatment for depression is most effective if it is tailored to the needs of the child and family[17]. The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes that treatment for depression should be ‘person-centered’ meaning that it is responsive to the individual’s cultural, linguistic, and other social and environmental needs. ‘Family-centered’ care recognizes the important role of family members and caregivers in the design and implementation of individualized, person-centered services[18]. The National Alliance on Mental Illness (NAMI) provides peer-led training for Family Support Groups for any adult with a loved one who has experienced symptoms of a mental health condition. One advantage of the Family Support Group is that participating family members gain insight from the challenges and successes of others who have been through similar experiences[19]. Peer-to-peer mental health interventions focus on prevention and the development of social-emotional skills. Peer-to-peer intervention models can be helpful for youth who may be resistant to traditional treatment methods. Peer-to-peer programs have historically been implemented within schools as an important component of their mental health strategy[20]. Potential models include peer-designed/led groups, wellness ambassador programs, peer health educator models, and counseling programs.
Peer interventions may provide prevention and help youth overcome some barriers to seeking care. In the 2011 RAND report on teen depression, themes that emerged from focus groups and surveys included the following[21]:
Medicaid provides coverage for 27 million children 18 years of age and younger[22]. Medicaid and the Children’s Health Insurance Program (CHIP) together cover more than 41 million U.S. children[23]. These programs, in addition to other federal funding streams, can support behavioral health services for adolescents. Schools can combine insurance coverage and funding from federal, state, and local sources as well as grants and collaborate with mental health clinics to support school-based mental health programs[24]. Some states use mechanisms such as Medicaid 1915(b)(3) waivers to provide funding for peer services that are not Medicaid benefits. There are often significant limitations to these services, for example they may only be available to youth with severe and persistent mental illness rather than being available for preventive purposes[25].
Caregivers of children with mental health concerns.
NAMI's peer-led family support program for caregivers of children with mental health concerns. Caregivers participated in a six-class NAMI course led by peer parents.
Randomized control trial. 111 families were randomly assigned to the NAMI course (n=52) or an eight-week waitlist (n=59).
Social: Compared with caregivers on the waitlist, program participants reported significant increases in parent engagement, activation, and intentions to engage with mental health services (p<0.001). NAMI participants also reported significant decreases in their child’s intrapersonal (p=0.02) and interpersonal distress (p=0.003). No differences were observed on measures of parental stress, attitudes toward mental health services, or stigma.
Parents in the United Kingdom (UK), specifically those living in areas of greater social deprivation and experiencing significant social disadvantage.
Empowering Parents Empowering Communities’ (EPEC) Being a Parent (BAP) program, a peer-led, community-based parenting program. EPEC is a task sharing, peer-led parenting approach. Its group-based parenting course format is consistent with policy recommendations and intended to build social support between participants, optimize impact, and lower unit cost. EPEC is delivered in local, community locations and the program uses high visibility, pro-active local outreach campaigns to engage parents.
Quasi-experimental study with an embedded randomized control trial used for benchmarking purposes (n=930).
Social: Parent participants reported significant improvements in child concerns, parenting skills, parenting goals, and overall parental wellbeing.
Families of children and adults with mental health conditions.
Peer-facilitated services focused on coping and parenting skills, mental health knowledge, and emotional support.
Systematic review of 6 randomized studies.
Social: Significant improvements in family-centered skills such as overall functioning, parenting skills related to the intervention, knowledge about mental illness, parental concerns about their child, and general parenting skills.
Individuals with mental health conditions, including adolescents, college students, people who are unemployed, as well as family members of adults experiencing mental health challenges.
Peer-led interventions targeting self-stigma, clinical symptoms, recovery-related outcomes, and disclosure-related outcomes in individuals with mental health conditions.
Systematic review. Meta-analysis of 8 RCTs evaluating peer-led interventions targeting self-stigma, clinical symptoms, recovery-related outcomes, and disclosure-related outcomes in individuals with mental health conditions.
Health: There was no significant influence on clinical symptoms such as depression, anxiety and hopelessness.
Social: The peer-led intervention had a positive effect on reducing self-stigma and stigma pressure. The intervention also showed a positive effect on rehabilitation and empowerment, though without statistical significance. It also significantly improved self-efficacy and the willingness to seek professional help. Additionally, the intervention had a statistically significant effect on confidentiality and disclosure-related distress in the Honest Open Proud (HOP) subgroup, but no significant influence in the non-HOP subgroup.
[1] Huang, X., Hu, N., Yao, Z., & Peng, B. (2022). Family functioning and adolescent depression: A moderated mediation model of self-esteem and peer relationships. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.962147
[2] U.S. Department of Health and Human Services. (n.d.). Major depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
[3] Wilson, S., & Dumornay, N. M. (2022). Rising Rates of Adolescent Depression in the United States: Challenges and Opportunities in the 2020s. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 70(3), 354–355. https://doi.org/10.1016/j.jadohealth.2021.12.003
[4] Lu W. Adolescent Depression: National Trends, Risk Factors, and Healthcare Disparities. Am J Health Behav. 2019; 43(1):181-194.
[5] U.S. Department of Health and Human Services. (n.d.). Major depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
[6] Sim WH, Jorm AF, Yap MBH. The Role of Parent Engagement in a Web-Based Preventive Parenting Intervention for Child Mental Health in Predicting Parenting, Parent and Child Outcomes. Int J Environ Res Public Health. 2022; 19(4):2191.
[7] Petito, A., Pop, T. L., Namazova-Baranova, L., Mestrovic, J., Nigri, L., Vural, M., Sacco, M., Giardino, I., Ferrara, P., & Pettoello-Mantovani, M. (2020). The burden of depression in adolescents and the importance of early recognition. The Journal of Pediatrics, 218. https://doi.org/10.1016/j.jpeds.2019.12.003
[8] Rinke, Michael L. MD, PhD*; Bundy, David G. MD, MPH†; Stein, Ruth E.K. MD*; O’Donnell, Heather C. MD, MS‡; Heo, Moonseong PhD§; Sangvai, Shilpa MD, MPH¶; Lilienfeld, Harris MD‖; Singh, Hardeep MD, MPH**. Increasing Recognition and Diagnosis of Adolescent Depression: Project RedDE: A Cluster Randomized Trial. Pediatric Quality and Safety 4(5):p e217, September/October 2019. | DOI: 10.1097/pq9.0000000000000217
[9] Petito, A., Pop, T. L., Namazova-Baranova, L., Mestrovic, J., Nigri, L., Vural, M., Sacco, M., Giardino, I., Ferrara, P., & Pettoello-Mantovani, M. (2020). The burden of depression in adolescents and the importance of early recognition. The Journal of Pediatrics, 218. https://doi.org/10.1016/j.jpeds.2019.12.003
[10] Siu AL; US Preventive Services Task Force. Screening for depression in children and adolescents: US preventive services task force recommendation statement. Pediatrics. 2016;137:e20154467.
[11] Radovic A, Moreno MA. Treatment Options for Adolescent Depression. JAMA Pediatr. 2019;173(3):300. doi:10.1001/jamapediatrics.2018.5017
[12] U.S. Department of Health and Human Services. (n.d.). Major depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
[13] Lu W. Adolescent Depression: National Trends, Risk Factors, and Healthcare Disparities. Am J Health Behav. 2019; 43(1):181-194.
[14] Pabayo R, Benny C, Liu SY, et al. Financial Barriers to Mental Healthcare Services and Depressive Symptoms among Residents of Washington Heights, New York City. Hisp Health Care Int. 2022; 20(3):184-194.
[15] Jaycox L, Burnam A, Meredith L, et al. The Teen Depression Awareness Project: Building an Evidence Base for Improving Teen Depression Care. Santa Monica, CA: RAND Corporation, 2010. https://www.rand.org/pubs/research_briefs/RB9495.html.
[16] Stewart SM, Simmons A, Habibpour E. Treatment of culturally diverse children and adolescents with depression. J Child Adolesc Psychopharmacol. 2012; 22(1):72-79.
[17] Centers for Disease Control and Prevention. Treating Children’s Mental Health with Therapy. 2024. Available at: https://www.cdc.gov/children-mental-health/treatment/index.html. Accessed on March 19, 2025.
[18] Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: current applications and future directions in pediatric health care. Maternal and child health journal, 16(2), 297–305. https://doi.org/10.1007/s10995-011-0751-7
[19] National Alliance on Mental Illness (NAMI). NAMI Family Support Group. 2022. Available at: https://nami.org/Support-Education/Support-Groups/NAMI-Family-Support-Group. Accessed on September 19, 2022.
[20] Peer-to-peer mental health support: California school-based health alliance. California School-Based Health Alliance | Bringing Health Care to Kids in School. (2024, June 3). https://www.schoolhealthcenters.org/resources/student-impact/peer-support/
[21] Jaycox L, Burnam A, Meredith L, et al. The Teen Depression Awareness Project: Building an Evidence Base for Improving Teen Depression Care. Santa Monica, CA: RAND Corporation, 2010. https://www.rand.org/pubs/research_briefs/RB9495.html.
[22] Children and youth. Medicaid.gov. (n.d.). https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/children-and-youth/index.html
[23] Conrad, L., Lee, M., & Okolo, Z. (2024, April 10). Using medicaid to address young people’s mental health needs in school settings | commonwealth fund. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2024/using-medicaid-address-young-peoples-mental-health-needs-school-settings
[24] Conrad, L., Lee, M., & Okolo, Z. (2024, April 10). Using medicaid to address young people’s mental health needs in school settings | commonwealth fund. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2024/using-medicaid-address-young-peoples-mental-health-needs-school-settings
[25] Frequently asked questions on Medicaid and chip ... Medicaid.gov. (2024, June 5). https://www.medicaid.gov/federal-policy-guidance/downloads/faq06052024.pdf
