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Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis

  • Nicola Mead (a1), Helen Lester (a1), Carolyn Chew-Graham (a1), Linda Gask (a1) and Peter Bower (a2)...

High rates of emotional distress and depressive symptoms in the community can reflect difficult life events and social circumstances. There is a need for appropriate, low-cost, non-medical interventions for many individuals. Befriending is an emotional support intervention commonly offered by the voluntary sector.


To examine the effectiveness of befriending in the treatment of emotional distress and depressive symptoms.


Systematic review of randomised trials of interventions focused on providing emotional support to individuals in the community.


Compared with usual care or no treatment, befriending had a modest but significant effect on depressive symptoms in the short term (standardised mean difference SMD=−0.27, 95% CI −0.48 to −0.06, nine studies) and long term (SMD = −0.18, 95% CI −0.32 to −0.05, five studies).


Befriending has a modest effect on depressive symptoms and emotional distress in varied patient groups. Further exploration of active ingredients, appropriate target populations and optimal methods of delivery is required.

Corresponding author
Nicola Mead, Research Fellow, NIHR School for Primary Care Research, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email:
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1 Singleton, N, Bumpstead, R, O'Brien, M, Lee, A, Meltzer, H. Psychiatric Morbidity among Adults Living in Private Households, 2000. TSO (The Stationery Office), 2001 (
2 National Institute for Health and Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care. NICE, 2007 (
3 Middleton, H, Shaw, I, Hull, S, Feder, G. NICE guidelines for the management of depression. BMJ 2005; 330: 267–8.
4 Pincus, H, Davis, W, McQueen, L. ‘Subthreshold’ mental disorders. A review and synthesis of studies on minor depression and other ‘brand names’. Br J Psychiatry 1999; 174: 288–96.
5 Middleton, H, Shaw, I. Distinguishing mental illness in primary care. BMJ 2000; 320: 1420–1.
6 Brown, G, Harris, T. The Social Origins of Depression. Tavistock, 1978.
7 Lester, H, Freemantle, N, Wilson, S, Sorohan, H, England, E, Griffin, C, et al. Cluster randomised controlled trial of the effectiveness of primary care mental health workers. Br J Gen Pract 2007; 57: 196203.
8 Dean, J, Goodlad, R. Supporting Community Participation; the Role and Impact of Befriending. Pavilion Publishing & Joseph Rowntree Foundation, 1998.
9 Langford, C, Bowsher, J, Maloney, J, Lillis, P. Social support: a conceptual analysis. J Adv Nurs 1997; 25: 95100.
10 Faulkner, M, Davies, S. Social support in the healthcare setting: the role of volunteers. Health Soc Care Community 2005; 13: 3845.
11 Higgins, J, Green, S, (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration, 2009 (
12 Lipsey, M, Wilson, D. Practical Meta-Analysis. Sage, 2001.
13 Higgins, J, Thompson, S, Deeks, J, Altman, D. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60.
14 Egger, M, Davey Smith, G, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
15 Sterne, J, Egger, M, Davey Smith, G. Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323: 101–5.
16 Barnett, B, Parker, G. Professional and non-professional intervention for highly anxious primiparous mothers. Br J Psychiatry 1985; 146: 287–93.
17 Berkman, P, Heinik, J, Rosenthal, M, Burke, M. Supportive telephone outreach as an interventional strategy for elderly patients in a period of crisis. Soc Work Health Care 1999; 28: 6376.
18 Brent, DA, Holder, D, Kolko, D, Birmaher, B, Baugher, M, Roth, C, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive therapy. Arch Gen Psychiatry 1997; 54: 885.
19 Bullock, LF, Wells, JE, Duff, GB, Hornblow, AR. Telephone support for pregnant women: outcome in late pregnancy. N Z Med J 1995; 108: 476–8.
20 Carroll, DL, Rankin, SH. Comparing interventions in older unpartnered adults after myocardial infarction. Eur J Cardiovasc Nurs 2006; 5: 83–9.
21 Chang, B. Cognitive-behavioral intervention for homebound caregivers of persons with dementia. Nurs Res 1999; 48: 173–82.
22 Charlesworth, G, Shepstone, L, Wilson, E, Thalanany, M, Mugford, M, Poland, F. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Health Technol Assess 2008; 12; 192.
23 Charlesworth, G, Shepstone, L, Wilson, E, Reynolds, S, Mugford, M, Price, D, et al. Befriending carers of people with dementia: randomised controlled trial. BMJ 2008; 336: 1295–7.
24 Dennis, CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry 2003; 48: 115–24.
25 Harris, T, Brown, GW, Robinson, R. Befriending as an intervention for chronic depression among women in an inner city. I: Randomised controlled trial. Br J Psychiatry 1999; 174: 219–24.
26 Harris, T, Brown, GW, Robinson, R. Befriending as an intervention for chronic depression among women in an inner city. 2: Role of fresh start experiences and baseline psychosocial factors in remission from depression. Br J Psychiatry 1999; 174: 225–32.
27 Heller, K, Thompson, MG, Trueba, PE, Hogg, JR, Vlachos-Weber, I. Peer support telephone dyads for elderly women: was this the wrong intervention? Am J Community Psychol 1991; 19: 5374.
28 Hunkeler, EM, Meresman, JF, Hargreaves, WA, Fireman, B, Berman, WH, Kirsch, AJ, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000; 9: 700–8.
29 Jackson, HJ, McGorry, PD, Killackey, E, Bendall, S, Allott, K, Dudgeon, P, et al. Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project. Psychol Med 2008; 38: 725–35.
30 McMillan, SC, Small, BJ, Weitzner, M, Schonwetter, R, Tittle, M, Moody, L, et al. Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial. Cancer 2006; 106: 214–22.
31 McNeil, JK, LeBlanc, E, Joyner, M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 1991; 6: 487–8.
32 Oakley, A, Rajan, L, Grant, A. Social support and pregnancy outcome. Br J Obstet Gyn 1990; 97: 155–62.
33 Oakley, A. Social support in pregnancy: methodology and findings of a 1-year follow-up study. J Reprod Infant Psychol 1992; 10: 219–31.
34 Onrust, S, Smit, F, Willemse, G, van den Bout, J, Cuijpers, P. Cost-utility of a visting service for older widowed individuals: randomised trial. BMC Health Serv Res 2008; 8: 128.
35 Pillemer, K, Jill, SJ. Peer support for Alzheimer's caregivers: is it enough to make a difference? Res Aging 2002; 24: 171–92.
36 Reinke, BJ, Holmes, DS, Denney, NW. Influence of a ‘friendly visitor’ program on the cognitive functioning and morale of elderly persons. Am J Community Psychol 1981; 9: 491504.
37 Roberts, J, Browne, GB, Streiner, D, Gafni, A, Pallister, R, Hoxby, H, et al. Problem-solving counselling or phone-call support for outpatients with chronic illness: effective for whom? Can J Nurs Res 1995; 27: 111–37.
38 Schwartz, CE. Teaching coping skills enhances quality of life more than peer support: results of a randomized trial with multiple sclerosis patients. Health Psychol 1999; 18: 211–20.
39 Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry 2000; 57: 165–72.
40 Weber, BA, Roberts, BL, Resnick, M, Deimling, G, Zauszniewski, JA, Musil, C, et al. The effect of dyadic intervention on self-efficacy, social support, and depression for men with prostate cancer. Psychooncology 2004; 13: 4760.
41 Weber, BA, Roberts, BL, Yarandi, H, Mills, TL, Chumbler, NR, Algood, C. Dyadic support and quality-of-life after radical prostatectomy. J Mens Health Gend 2007; 4: 156–64.
42 Wiggins, M, Oakley, A, Roberts, I, Turner, H, Rajan, L, Austerberry, H, et al. The Social Support and Family Health Study: a randomized controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner city areas. Health Technol Assess 2004; 8; 1120.
43 Wiggins, M, Oakley, A, Roberts, I, Turner, H, Rajan, L, Austerberry, H, et al. Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial. J Epidemiol Community Health 2005; 59: 288–95.
44 Ioannidis, J, Patsopoulos, N, Rothstein, H. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ 2008; 336: 1413–5.
45 Rapaport, M, Judd, L, Schettler, P, Yonkers, KA, Thase, ME, Kupfer, DJ, et al. A descriptive analysis of minor depression. Am J Psychiatry 2002; 159: 637–43.
46 Compton, W, Conway, K, Stinson, F, Grant, B. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991–1992 and 2001–2002. Am J Psychiatry 2006; 163: 2141–7.
47 Henderson, M, Glozier, N, Holland-Elliott, K. Long term sickness absence. BMJ 2005; 330: 802–3.
48 Middleton, N, Gunnell, D, Whitely, E, Dorling, D, Frankel, S. Secular trends in antidepressant prescribing in the UK, 1975–1998. J Public Health Med 2001; 23: 262–7.
49 Raine, R, Haines, A, Sensky, T, Hutchings, A, Larkin, K, Black, N. Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care? BMJ 2002; 325: 1082.
50 Churchill, R, Hunot, V, Corney, R, Knapp, M, McGuire, H, Tylee, A, et al. A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technol Assess 2002; 5: 1183.
51 Gilbody, S, Bower, P, Fletcher, J, Richards, D, Sutton, A. Collaborative care for depression: a systematic review and cumulative meta-analysis. Arch Intern Med 2006; 166: 2314–21.
52 Bower, P, Rowland, N, Hardy, R. The clinical effectiveness of counselling in primary care: a systematic review and meta-analysis. Psychol Med 2003; 33: 203–15.
53 Bower, P, Gilbody, S. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. Br J Psychiatry 2005; 186: 11–7.
54 Department of Health. High Quality Care for All: NHS Next Stage Review Final Report. Department of Health, 2008.
55 Richards, D, Suckling, R. Improving access to psychological therapies: phase IV prospective cohort study. Br J Clin Psychol 2009; 48: 377–96.
56 World Health Organization. Mental Health: Facing the Challenges, Building Solutions. WHO, 2005 (
57 Department of Health. Support, Time and Recovery Workers. A Competence Framework. Department of Health, 2008.
58 Westen, D, Morrison, K. A multidimensional meta-analysis of treatments for depression, panic and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. J Consult Clin Psychol 2001; 69: 875–99.
59 Torgerson, D, Sibbald, B. What is a patient preference trial? BMJ 1998; 316: 360.
60 Brand, E, Lakey, B, Berman, S. A preventive, psychoeducational approach to increase perceived social support. Am J Community Psychol 1995; 23: 117–35.
61 Campbell, M, Fitzpatrick, R, Haines, A, Kinmonth, AL, Sandercock, P, Spiegelhalter, D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000; 321: 694–6.
62 Campbell, N, Murray, E, Darbyshire, J, Emery, J, Farmer, A, Griffiths, F, et al. Designing and evaluating complex interventions to improve health care. BMJ 2007; 334: 455–9.
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Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis

  • Nicola Mead (a1), Helen Lester (a1), Carolyn Chew-Graham (a1), Linda Gask (a1) and Peter Bower (a2)...
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Re: "Effects of Befriending on Depressive Symptoms: A Precautionary Note on Promising Findings"

Nicola Mead, Research fellow
16 June 2010

We should like to thank Dr El-Baalbaki and colleagues for their thoughtful comments on our recent paper. We agree with their cautious interpretation of the results of our meta-analysis.

We were interested in their suggestion that befriending serve as a comparator condition for more structured treatments such as collaborative care, to tease out the specific benefits of the latter over and above the general effects of increased attention and support, and to explore the cost-effectiveness of these complex organisational interventions. Althoughthis makes good sense in design terms, it does, however, relegate befriending to the status of comparator rather than active intervention. The recent Mental Health Foundation report 'The Lonely Society?'(1) highlights the impact of loneliness on health, and its findings are supported by the Royal College of Psychiatrists(2). We would therefore want to complement Dr El-Baalbaki and colleagues’ suggestion with further research specifically exploring the role of befriending as a potential alternative therapeutic intervention for certain groups, such as isolated older adults.




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"Effects of Befriending on Depressive Symptoms: A Precautionary Note on Promising Findings"

Ghassan El-Baalbaki, Postdoctoral Fellow
02 June 2010

Mead et al. (1) recently meta-analyzed data on the effectiveness of befriending interventions on reducing depressive symptoms. Befriending wasdefined as a non-professional intervention that provides clients with non-directive, emotionally-focused support by one or more individuals; was notpsychoeducational or mentoring in nature; and did not constitute formal psychotherapy. Mead et al. found that befriending interventions had a modest, statistically significant effect on depressive symptoms within 12 months of randomization (standardized mean difference = 0.27, 95% CI =0.06 to 0.48, 9 studies) and a slightly smaller effect on longer-term outcomes (standardized mean difference = 0.18, 95% CI = 0.05 to 0.32, 5 studies).

As the authors noted, the effect sizes for befriending were essentially equivalent to effect sizes from collaborative care depression interventions in primary care. In a 2006 meta-analysis, Gilbody et al. (2)reported a short-term (within 6 months) standardized mean difference effect size for symptom reduction from collaborative or enhanced depression care of 0.25 (95% CI = 0.18 to 0.32, 35 studies) and longer- term effect sizes of 0.15 at 2 years post-randomization (95% CI = -0.03 to0.32, 9 studies) and 0.15 at 5 years post-randomization (95% CI = 0.001 to0.30, 2 studies). As Mead and colleagues note, the implications of this are important. Befriending or social support interventions could provide aless expensive and potentially ?less medicalized? option of care for patients with mild to moderate symptoms of depression in primary care. Indeed, collaborative care is a complex, multifaceted, expensive organizational intervention that can be difficult to implement outside of research settings (3, 4).

There are caveats, however. As noted by Mead et al., only a small setof heterogeneous studies have examined the effects of befriending interventions on depressive symptoms. Furthermore, as noted by Mead et al., funnel plot asymmetry suggested that publication bias may have influenced the estimate of the degree to which befriending may affect depressive symptoms. Mead et al. did not assess the degree to which publication bias may have influenced the results of the meta-analysis. However, if only studies with statistical power of at least 0.70 among thestudies with short-term outcomes evaluated by Mead et al. are analyzed, the resulting synthesized effect estimate is 0.08 (95% CI = -0.06 to 0.21,4 studies), a substantially smaller estimate than that produced by all 9 studies (0.27, 95% CI = 0.06 to 0.48). Thus, as noted by Mead et al., morehigh-quality research is needed on befriending in order to determine the likely benefit to patients in clinical practice.

Meanwhile, the results of the meta-analysis by Mead et al. suggest that future research on collaborative care should use a befriending or attention control group. Up to now, collaborative care interventions have been compared to usual care, and it is not known to what degree the effects that have been reported are due to specific effects of the collaborative care intervention versus effects that may come from the substantially increased attention and support received by patients in collaborative care.


1.Mead N, Lester H, Chew-Graham C, Gask L, Bower P. Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. Br J Psychiatry 2010; 196: 96-101.

2.Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006; 166: 2314-2321.

3.Katon WJ, Seelig M. Population-based care of depression: team care

approaches to improving outcomes. J Occup Environ Med 2008; 50: 459-467.

4.Katon W, Un?tzer J, Wells K, Jones L. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. Gen Hosp Psychiatry 2010; in press.

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