Research paper · RP34

Peer versus Professional

Outside the clinic, working adults carry stress that never reaches a hospital door. An exploratory random-effects pool of five waitlist- or usual-care-controlled trials gave Hedges g = −0.48 (95% CI −0.64 to −0.33; I² = 0%; 95% prediction interval −0.70 to −0.27) on distress. That pool uses converted effects from mixed adult samples and is GRADE low. Head-to-head with professionally led programmes the published difference remains g = 0.10 (95% CI −0.20 to 0.39) in Pfeiffer and colleagues (2011) and d = 0.08 (95% CI −0.15 to 0.32) in Bryan and Arkowitz (2015); a 2025 Indian campus trial against supportive counselling was also null. Pfeiffer’s older usual-care pool was g = −0.59. Yeo and colleagues (2025) found digital peer support in people without a clinical condition improved mental health by SMD 0.53. No eligible trial reported cost per outcome. In Indian private markets a professional session typically costs five to fifteen times a peer or listener session. India still has no published randomised trial of structured peer support for subclinical workplace distress in working professionals. Peer programmes are a high-volume first line, not a substitute when risk is high. Train the peer. Count the reps. Hand off when the score is no longer subclinical.