Peer-Led Models Focussed on Emotional Distress and Suicide Prevention: A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This scoping review addresses an important and under-explored area in suicide prevention by examining peer models of support for individuals experiencing suicidal crisis and/or emotional distress. The focus on peer-led approaches is timely and valuable, particularly given the growing interest in lived-experience informed interventions. The volume of data gathered appears extensive and has the potential to make a meaningful contribution to the field.

However, there are several substantive issues that limit the manuscript’s suitability for publication in its current form. First, the rationale for the review lacks clarity, particularly in relation to the inclusion of both suicidal distress and general emotional distress, despite the clearly stated primary interest in suicidal distress. Second, the methods section is insufficiently described, with some processes appearing unconventional and inadequately justified. Third, the conclusions drawn from the findings appear to overstate what can reasonably be inferred, given the identified gaps in the literature. The implications of the review are not clearly or critically articulated. Finally, the manuscript would benefit from significant language editing, as issues related to colloquial phrasing, sentence structure, grammar, and syntax detract from its academic rigor and clarity.

Addressing these concerns would substantially strengthen the manuscript. Please see specific section-wise comments below. 

Abstract

• The summary of findings would benefit from greater specificity. For example, the statement that “peer-led programs were widely accepted and achieved positive results” is quite broad. Clarifying what is meant by “positive results” (e.g., improvements in specific outcomes or participant experiences).

Introduction

• Greater conceptual clarity is needed regarding the grouping of emotional distress and suicidal crisis. While the title uses “and/or,” some statements in the text appear to conflate the two. Clarifying how emotional distress relates to suicidal crisis, and when these are treated as distinct versus overlapping constructs, would improve coherence and consistency.

Methods

• Table 1: The presentation of inclusion and exclusion criteria is somewhat unconventional and not self-explanatory. Reformatting may improve clarity.

• The rationale for excluding grey literature requires clearer justification. While time and resource constraints are understandable, the subsequent statement referencing another review is confusing. It is unclear whether this implies that grey literature is sufficiently covered elsewhere or that this review intentionally defers to prior work. 

• It may be clearer to identify, at the outset, who comprised the pilot team and the review team, and then refer only to the initials of the person involved rather than listing all team members repeatedly.

• The description of the screening process is difficult to follow. The explanation of the title and abstract screening process is unclear. It appears that two searches (original and updated) were conducted, each followed by multiple rounds of screening. Conducting multiple rounds of title and abstract screening is not conventional, and the rationale for this approach should be clearly explained.

• The need for an updated search is not explicitly justified and would benefit from a brief rationale.

• Minor but important corrections are needed for consistency and accuracy: for example, “title and abstract screening” (rather than “titles and abstract screening”), and appropriate naming of figures (e.g., “PRISMA Flow Diagram” rather than “This is a figure”).

• As with earlier sections, researcher initials alone should be used when describing full-text screening and data extraction, and the roles of different reviewers should be clearly delineated.

• Covidence is mentioned only at the data extraction stage; it would be helpful to clarify at the outset whether this software was used throughout the review process and to provide an appropriate reference.

• Colloquial phrasing should be avoided, and grammar and syntax reviewed throughout (e.g., phrases such as “Basic article identifiers…”).

Results

• Unclear what this means: “Due to the large number of papers reviewed, individual studies are only cited in the text when we refer to four or fewer papers”.

• Descriptions of tables and supplementary materials are somewhat redundant, as the information is already evident from the tables themselves.

• The clarification regarding the authors’ primary interest in suicide-related peer models appears late in the manuscript and would be more appropriate in the methods section. This also raises a broader issue: if the primary focus was suicidal crisis, the rationale for including studies on general emotional distress is unclear.

• Grammar, syntax, and tone should be reviewed to avoid speculative language in the results section (for example - "“We split the findings by group as they could potentially yield relevant information to add to or contrast with the findings from the articles which were primarily about suicidal crisis, ideation and distress”). The results should focus on presenting findings rather than interpreting potential relevance.

• Meaning of "mixed" is unclear in this statement: “The information provided on the characteristics of the peer worker, training and components of the peer models was mixed in both groups of articles, with one of the suicide-related articles not reporting on any of these aspects”

• Table formatting is inconsistent (e.g., alignment and capitalisation), which affects readability and should be standardised.

• In several instances (e.g., Table 2), findings are presented in abbreviated or fragmented sentences that limit comprehensibility. Expanding these into clearer, complete statements would improve clarity.

• Where possible, it may be more informative to highlight what was reported rather than emphasising what was not reported (e.g., "Over half (53%) of the papers did not mention how they involved people with lived experience").

• Sections such as “How peers and co-design processes informed the models” appear to focus primarily on counts rather than addressing how these processes shaped intervention design or delivery. If limited information was available, this could be acknowledged explicitly as a key finding.

• While detailed descriptions of peer worker characteristics are provided, there is limited synthesis across studies. Greater integration of findings would strengthen this section.

• Given the extent of missing or limited reporting across studies, it may be helpful to comment on study quality and consider a risk-of-bias or quality appraisal assessment.

Discussion

• Statements suggesting that peer-led programs were “widely accepted” and achieved “positive outcomes” may overstate the findings, particularly given the substantial gaps in reporting identified earlier. This is immediately contradicted in the next statement – “Whist the information on peer models was varied with a third of the articles have no information or only stating that peer worker facilitated the intervention…”. Moderating the tone of these conclusions and framing incomplete reporting as a key finding may provide a more balanced interpretation.

• The term “positive outcomes” should be clearly defined, both here and in the abstract.

• Long and complex sentences would benefit from being broken down for clarity.

• It would be helpful to clarify whether cited findings relate specifically to suicide-related peer work or to peer models addressing general emotional distress.

• “This study corroborates the challenges peer workers face in navigating the complex and sometimes competing sets of expectations and needs of consumers and health professionals [89].” – How so? This is unclear. Examples need to be discussed here to substantiate this.

• The implications for practice, policy, and future research could be expanded, particularly in relation to reporting standards, implementation processes, and the role of peer workers in suicide prevention contexts.

• Sentence construction in the limitations section should be revised for clarity and readability.

Conclusion

• Conclusions regarding the acceptability and effectiveness of peer-led programs should be drawn with greater caution, given the variability and incompleteness of the data presented. 

Author Response

please see attached document

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this manuscript. While the study addresses an important topic, the concerns raised above must be adequately addressed before the manuscript is suitable for publication.

 

Introduction

- It would be useful to clarify early on how peer-led or peer-informed models differ from general community support or volunteer-based services.

- Briefly explaining how emotional distress is conceptually and practically linked to suicidal crisis, and why including both enhances the relevance of the review rather than broadening it excessively.

- Clarify how their focus on peer-led, peer-informed, co-designed, or co-facilitated models differs methodologically and conceptually from existing reviews of peer support or suicide prevention.

 

Methods

- Please explicitly clarify which JBI stages were followed (e.g., identifying the research question, identifying relevant studies, study selection, charting the data, collating/summarizing results) and how PRISMA-ScR informed reporting rather than methodology.

- Question 1 is very broad. Consider clarifying whether the focus is on types, structures, settings, or mechanisms of peer models.

- Please explain why additional exclusion criteria were introduced only at the second screening stage and how this may have affected consistency.

- Clarify whether these additional criteria were pre-specified or developed inductively in response to screening challenges.

- Define the definition of “peer” more clearly in the main text (not only in Table 1).

- Consider briefly explaining why database searching was limited to health and social science databases and whether relevant interdisciplinary sources may have been missed.

- Clarify whether a pilot extraction was conducted to ensure consistency, and how disagreements during extraction were resolved in practice.

 

Results

- Brief summary comparison highlighting key similarities and differences between these two groups, rather than presenting them largely in parallel descriptive form.

- the meaning of the symbols should be clearly explained in the text (not only implied through Table 2) to ensure interpretability for readers.

- Given that over half of the included studies did not report lived-experience involvement, this finding warrants stronger emphasis as a critical gap in the literature rather than being presented primarily as a descriptive statistic.

- Consider synthesizing these findings into a small number of descriptive categories (e.g., “explicit lived-experience peers,” “paraprofessional/consumer staff,” “ambiguous or undefined peer roles”) rather than listing multiple examples.

- Explicitly linking these findings back to peer work principles (e.g., mutuality, non-clinical orientation), especially given the later observation of discordance between training and peer values.

- Consider summarizing peer model components into a small number of overarching functional domains (e.g., emotional support, safety planning, navigation/referral, advocacy, environmental safety) to improve synthesis.

 

Discussion

- Clearly restating how this review advances understanding beyond existing reviews.

- The observation that peer roles were often poorly specified is an important finding. However, the Discussion could go further by explicitly addressing the implications of this ambiguity.

- More clearly distinguish between training for peer work versus training to deliver an intervention, and supportive supervision versus professional oversight.

- Given the emphasis on co-design as best practice, the Discussion would benefit from a more explicit consideration of the ethical implications of excluding lived-experience perspectives—particularly in suicide prevention research.

- The authors may wish to briefly reflect on how the dominance of studies from the USA and UK may shape prevailing models of peer work and limit transferability to other cultural or health system contexts.

 

Conclusion

- More clearly distinguishing empirical gaps (e.g., reporting, design, outcomes) from practice gaps (e.g., training, supervision, co-design).

- Offering more specific directions for future research, such as minimum reporting standards for peer roles or evaluation frameworks grounded in peer work principles.

Author Response

Please see attached document

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

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