Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review

Abstract

ObjectiveThis study aims to establish the effectiveness and active ingredients of UK-based social prescribing interventions targeting mental health and well-being outcomes.DesignSystematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysies guidelines and a published protocol.Data sourcesNine databases were systematically searched up to March 2022.Eligibility criteriaSocial prescribing interventions in the UK involving adults aged ≥18 years, which reported on mental health outcomes.Data extraction and synthesisTwo reviewers extracted data on study characteristics; outcomes; referral pathways; treatment fidelity strategies; person-centredness; intervention development processes and theory-linked behaviour change techniques (BCTs). Data were narratively synthesised.Results52 074 records were retrieved by the search, 13 interventions reported across 17 studies were included in this review (N=5036 participants at post-intervention). Fifteen studies were uncontrolled before-and-after designs, one a randomised controlled trial and one a matched groups design. The most frequently reported referral pathway was the link worker model (n=12), followed by direct referrals from community services (n=3). Participants were predominantly working age adults, and were referred for anxiety, depression, social isolation and loneliness. 16 out of 17 studies reported statistically significant improvements in outcomes (mental health, mental well-being, general health, or quality of life). Strategies to enhance treatment fidelity were suboptimal across studies. Only two studies used a specific theoretical framework. A few studies reported engaging service users in codesign (n=2) or usability and/or feasibility testing (n=4). Overall, 22 BCTs were coded across 13 interventions. The most frequently coded BCTs were social support-unspecified (n=11), credible source (n=7) and social support-practical (n=6).ConclusionsRobust conclusions on the effectiveness of social prescribing for mental health-related outcomes cannot be made. Future research would benefit from comprehensive intervention developmental processes, with reference to appropriate theory, alongside long-term follow-up outcome assessment, using treatment fidelity strategies and a focus on principle of person-centred care.PROSPERO registration numberCRD42020167887.

Effectiveness of social prescribing for chronic disease prevention in adults: a systematic review and meta-analysis of randomised controlled trials

“…Findings from the present review and numerous SP reviews of other health outcomes23 24 26 27 29 30 33 35 36 76 81 have clearly shown that the evidence was still insufficient and scientifically inconclusive to justify the recommendation reliably. Some immediate increases in physical activity and energy expenditure are noted in our study, but whether the benefits sustain post-trial is questionable.…”

“…A key strength of this systematic review is that it provides the first evidence of SP in addressing the determinants of chronic diseases by comprehensively synthesising the available data and applying the methodologically rigorous standards of conduct and reporting. It is recommended that this study should be interpreted together with other prior reviews to understand the impact of SP on the person (ie, physical, mental and social well-being), community groups and the healthcare system 23–36. A further strength was performing meta-analyses separately at two assessment points.…”

“…SP programmes are now progressively promoted as not only a scheme that can benefit patients but also a policy alternative that can alleviate the burden on the healthcare system 21 22. Previous systematic reviews have explored the impact of SP on a range of individual’s health outcomes including general health, quality of life, mental and social well-being 23–31. Several of these reviews have identified the benefits of SP such as improvement in self-reported health,24 26 well-being,24 26 health-related behaviours,26 30 quality of life,27 self-esteem,25 26 mental well-being,25 27 28 anxiety25 30 and depression 25 30.…”

“…Previous systematic reviews have explored the impact of SP on a range of individual’s health outcomes including general health, quality of life, mental and social well-being 23–31. Several of these reviews have identified the benefits of SP such as improvement in self-reported health,24 26 well-being,24 26 health-related behaviours,26 30 quality of life,27 self-esteem,25 26 mental well-being,25 27 28 anxiety25 30 and depression 25 30. A positive impact on social health including strengthening social contacts,24 26 28 and minimising isolation30 were also reported.…”

Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women: A Cross-Sectional Study

“…Social prescribing is being proposed as a solution to poor social health, as an innovative holistic community-centred approach [ 68 ]. There are systematic reviews demonstrating benefits of social prescribing to well-being [ 69 , 70 ] and quality of life [ 71 ]. A recent systematic review identified that while there was a lack of evidence on social prescribing for chronic disease risk factors, the few group-exercise programs that were identified had benefits for physical activity [ 68 ].…”