Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers

In the paper

“Eleven papers reported RCTs (n = 7) [30,33,35,37,54,58,62] and non-RCTs (n = 4) [27,29,34,57].”

What the sources say

• Not checked yetcites [27] Belgrave M: The effect of a music therapy intergenerational program on children and older adults’ intergenerational interactions, cross-age attitudes, and older adults’ psychosocial well-being. J Music Ther. 2011, 48: 486-508. source
• Not checked yetcites [29] Carlson MC, Erickson KI, Kramer AF, Voss MW, Bolea N, Mielke M, McGill S, Rebok GW, Seeman T, Fried LP: Evidence for neurocognitive plasticity in at-risk older adults: the experience corps program. J Gerontol A Biol Sci Med Sci. 2009, 64: 1275-1282. source
• Not checked yetcites [34] Dabelko-Schoeny H, Anderson KA, Spinks K: Civic engagement for older adults with functional limitations: piloting an intervention for adult day health participants. Gerontologist. 2010, 50: 694-701. 10.1093/geront/gnq019. source
• Not checked yetcites [57] Tan EJ, Rebok GW, Yu QL, Frangakis CE, Carlson MC, Wang T, Ricks M, Tanner EK, McGill S, Fried LP: The long-term relationship between high-intensity volunteering and physical activity in older African American women. J Gerontol B Psychol Sci Soc Sci. 2009, 64: 304-311. source

In the paper

“Forty papers were selected: five randomised controlled trials (RCTs, seven papers); four non-RCTs; and 17 cohort studies (29 papers).”

• Also stated in: § Results · plain

  “Forty papers were included in the review [9,25-63].”

What the sources say

• Not checked yetcites [9,25-63]

In the paper

“Twenty-nine papers reported longitudinal analysis of cohort studies; 13 papers reported unique cohorts.”

In the paper

“Volunteering status was significantly associated with improved wellbeing in three cohorts [25,28,31,51,52] (10–29 year follow-ups) but findings regarding volunteering intensity were inconsistent.”

What the sources say

• Not checked yetcites [25] Son J, Wilson J: Volunteer work and hedonic, eudemonic, and social well-being. Sociological Forum. 2012, 27: 658-681. 10.1111/j.1573-7861.2012.01340.x. source
• Not checked yetcites [28] Bowman N, Brandenberger J, Lapsley D, Hill P, Quaranto J: Serving in college, flourishing in adulthood: does community engagement during the college years predict adult well-being?. Appl Psychol Health Wellbeing. 2010, 2: 14-34. 10.1111/j.1758-0854.2009.01020.x. source
• Not checked yetcites [31] Choi NG, Kim J: The effect of time volunteering and charitable donations in later life on psychological wellbeing. Ageing Soc. 2011, 31: 590-610. 10.1017/S0144686X10001224. source
• Not checked yetcites [51] Piliavin JA: Feeling good by doing good: health consequences of social service. Processes of community change and social action. 2005, Mahwah, New Jersey, USA: Lawrence Erlbaum Associates Publishers, 29-50.
• Not checked yetcites [52] Piliavin JA, Siegl E: Health benefits of volunteering in the Wisconsin longitudinal study. J Health Soc Behav. 2007, 48: 450-464. 10.1177/002214650704800408. source

In the paper

“Irrespective of how it was measured, volunteering was associated with reduced levels of depression in four cohorts [32,40-42,46,48,51,63], with two cohorts reporting no benefits [36,53].”

What the sources say

• Not checked yetcites [32] Choi NG, Bohman TM: Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?. J Aging Health. 2007, 19: 152-177. 10.1177/0898264306297602. source
• Not checked yetcites [40] Kim J, Pai M: Volunteering and trajectories of depression. J Aging Health. 2010, 22: 84-105. 10.1177/0898264309351310. source
• Not checked yetcites [41] Li Y, Ferraro KF: Volunteering and depression in later life: social benefit or selection processes?. J Health Soc Behav. 2005, 46: 68-84. 10.1177/002214650504600106. source
• Not checked yetcites [42] Li Y, Ferraro KF: Volunteering in middle and later life: is health a benefit, barrier or both?. Soc Forces. 2006, 85: 497-519. 10.1353/sof.2006.0132. source
• Not checked yetcites [46] Morrow-Howell N, Hinterlong J, Rozario PA, Tang F: Effects of volunteering on the well-being of older adults. J Gerontol B Psychol Sci Soc Sci. 2003, 58: S137-S145. 10.1093/geronb/58.3.S137. source
• Not checked yetcites [48] Musick MA, Wilson J: Volunteering and depression: the role of psychological and social resources in different age groups. Soc Sci Med. 2003, 56: 259-269. 10.1016/S0277-9536(02)00025-4. source
• Not checked yetcites [51] Piliavin JA: Feeling good by doing good: health consequences of social service. Processes of community change and social action. 2005, Mahwah, New Jersey, USA: Lawrence Erlbaum Associates Publishers, 29-50.
• Not checked yetcites [63] Nazroo J, Matthews K: The impact of volunteering on well-being in later life. A report to WRVS. 2012, Cardiff, UK: WRVS
• Not checked yetcites [36] Fujiwara T, Kawachi I: A prospective study of individual-level social capital and major depression in the United States. J Epidemiol Community Health. 2008, 62: 627-633. 10.1136/jech.2007.064261. source
• Not checked yetcites [53] Pillemer K, Fuller-Rowell TE, Reid MC, Wells NM: Environmental volunteering and health outcomes over a 20-year period. Gerontologist. 2010, 50: 594-602. 10.1093/geront/gnq007. source

In the paper

“Improved quality of life was associated with volunteering status in two cohorts [56,61,63] (2–5 year follow-ups) but only if the activity was reciprocal, i.e. the volunteer felt their actions to be appreciated [56,63].”

What the sources say

• Not checked yetcites [56] Siegrist J, Wahrendorf M: Participation in socially productive activities and quality of life in early old age: findings from SHARE. J Eur Soc Pol. 2009, 19: 317-326. 10.1177/1350506809341513. source
• Not checked yetcites [61] Wahrendorf M, Siegrist J: Are changes in productive activities of older people associated with changes in their well-being? Results of a longitudinal European study. Eur J Ageing. 2010, 7: 59-68. 10.1007/s10433-010-0154-4. source
• Not checked yetcites [63] Nazroo J, Matthews K: The impact of volunteering on well-being in later life. A report to WRVS. 2012, Cardiff, UK: WRVS

In the paper

“In contrast, most papers reporting cohort studies (see Additional file 4: Table S4) were large and well designed (25/29 low risk, 4/29 moderate risk).”

In the paper

“Quality appraisal of non-RCTs (see Additional file 4: Table S4) found three non-RCTs were at moderate risk of bias, and one non-RCT at low risk.”

In the paper

“Volunteering was associated with improved self-efficacy for activities of daily living (one year follow-up) [55] but not with ‘happiness’ (25 year follow-up) [44].”

What the sources say

• Not checked yetcites [55] Shimanuki H, Honda H, Ito T, Kasai T, Takato J, Sakamoto Y, Inuzuka G, Ito Y, Arayama N, Ueki S, Haga H: Relationships between volunteerism and social-physical health and QOL with community-dwelling elderly participating in a long-term care prevention programme. [Japanese]. Nippon Koshu Eisei Zasshi. 2007, 54: 749-759.
• Not checked yetcites [44] Menec VH: The relation between everyday activities and successful aging: a 6 year longitudinal study. J Gerontol B Psychol Sci Soc Sci. 2003, 58B: S74-S82. source

In the paper

“Heterogeneous findings were observed in the five trials [30,35,37,54,58,62] investigating the health effects of intergenerational volunteering among older adults, with benefits reported for some elements of physical activity and cognitive function.”

What the sources say

• Not checked yetcites [30] Carlson MC, Saczynski JS, Rebok GW, Seeman T, Glass TA, McGill S, Tielsch J, Frick KD, Hill J, Fried LP: Exploring the effects of an “everyday” activity program on executive function and memory in older adults: experience corps. Gerontologist. 2008, 48: 793-801. 10.1093/geront/48.6.793. source
• Not checked yetcites [35] Fried LP, Carlson MC, Freedman M, Frick KD, Glass TA, Hill J, McGill S, Rebok GW, Seeman T, Tielsch J, Wasik BA, Zeger S: A social model for health promotion for an aging population: initial evidence on the experience corps model. J Urban Health Bull N Y Acad Med. 2004, 81: 64-78. source
• Not checked yetcites [37] George DR, Singer ME: Intergenerational volunteering and quality of life for persons with mild to moderate dementia: results from a 5-month intervention study in the United States. Am J Geriatr Psychiatry. 2011, 19: 392-396. 10.1097/JGP.0b013e3181f17f20. source
• Not checked yetcites [54] Rook KS, Sorkin DH: Fostering social ties through a volunteer role: Implications for older-adults’ psychological health. Int J Aging Hum Dev. 2003, 57: 313-337. 10.2190/NBBN-EU3H-4Q1N-UXHR. source
• Not checked yetcites [58] Tan EJ, Xue QL, Li T, Carlson MC, Fried LP: Volunteering: a physical activity intervention for older adults - the experience corps program in Baltimore. J Urban Health. 2006, 83: 954-969. 10.1007/s11524-006-9060-7. source
• Not checked yetcites [62] Yuen HK, Huang P, Burik JK, Smith TG: Impact of participation in volunteer activities for residents living in long-term-care facilities. Am J Occup Ther. 2008, 62: 71-76. 10.5014/ajot.62.1.71. source

In the paper

“While such adjustments strongly mediated survival, a significant effect remained.”

In the paper

“No significant effects were observed for depression, self-rated health or self-esteem.”

In the paper

“For mental health, volunteering had a favourable effect on depression, life satisfaction and wellbeing.”

In the paper

“Vote counting failed to identify any consistent beneficial effects of volunteering on either physical functional ability or self-rated health.”

In the paper

“The small number of observational studies that stratified analysis by age found that older people may be more likely to experience reduced functional dependency and fewer depressive symptoms through volunteering compared with their younger counterparts [40,42,48], although one study found no such benefit [45].”

What the sources say

• Not checked yetcites [40] Kim J, Pai M: Volunteering and trajectories of depression. J Aging Health. 2010, 22: 84-105. 10.1177/0898264309351310. source
• Not checked yetcites [42] Li Y, Ferraro KF: Volunteering in middle and later life: is health a benefit, barrier or both?. Soc Forces. 2006, 85: 497-519. 10.1353/sof.2006.0132. source
• Not checked yetcites [48] Musick MA, Wilson J: Volunteering and depression: the role of psychological and social resources in different age groups. Soc Sci Med. 2003, 56: 259-269. 10.1016/S0277-9536(02)00025-4. source
• Not checked yetcites [45] Moen P, Dempstermcclain D, Williams RM: Successful aging - a life-course perspective on women’s multiple roles and health. Am J Sociol. 1992, 97: 1612-1638. 10.1086/229941. source

In the paper

“Reassuringly, the estimates of the prevalence of volunteering from observational studies is consistent with other sources [3,5], which found the prevalence of volunteering is generally higher in the USA compared with European cohorts, and that older people may be less likely to volunteer than their younger counterparts [64].”

What the sources say

• Not checked yetcites [3] Bureau of Labor Statistics - US Department of Labor: Volunteering in the United States - 2011. 2012, USA: Department of Labor
• Not checked yetcites [5] Mathou C: Volunteering in the European Union - final report. Educational, Audiovisual & Culture Executive Agency - Directorate General Education and Culture. 2010, London, UK: GHK

In the paper

“For example, it is unclear what type or dose of volunteering activity is associated with the greatest health improvement, for which outcomes and for whom.”

In the paper

“No language, country or date restrictions were applied.”

• Also stated in: § Search strategy · plain

  “Studies were identified without language, country or date restrictions, by searching electronic databases and scanning reference lists.”

In the paper

“Observational evidence suggested that volunteering may benefit mental health and survival although the causal mechanisms remain unclear.”

In the paper

“To avoid double counting, where multiple papers from the same population cohort reported the same outcome, only one vote per cohort was counted.”

In the paper

“The Cochrane risk of bias tool [19] was used to assess the quality of RCTs. Non-representative samples and high loss to follow-up rates were considered major threats to the external validity of community-based studies. Thus, two domains, random sequence generation and incomplete outcome data, were prioritised out of a possible seven domains.”

What the sources say

• Not checked yetcites [19] The Cochrane Collaboration: The Cochrane handbook for systematic reviews of interventions (version 5.1.0). Edited by: Higgins JPT, Green S. 2011, http://www.cochrane-handbook.org/,

In the paper

“One reviewer (CJ) screened all titles and abstracts for eligibility. Uncertainties were checked by a second reviewer (AD) with discrepancies resolved by discussion (CJ, AD and SR). The full text of potentially relevant articles was screened independently by two reviewers (CJ and SR or KJ); discrepancies were resolved by discussion with a third reviewer (SR or KJ).”

In the paper

“This review followed a pre-defined protocol (http://clahrc-peninsula.nihr.ac.uk/includes/site/files/files/EST%20Docs/PenCLAHRC%20volunteering%20protocol%20(21_02_12).pdf), in accordance with the general principles published by the NHS Centre for Reviews and Dissemination [17] and PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) [18].”

What the sources say

• Not checked yetcites [17] Centre for Reviews and Dissemination: Systematic reviews. CRD’s guidance for undertaking reviews in health care. 2009, UK: Centre for Reviews and Dissemination, Univeristy of York
• Not checked yetcites [18] Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J. 2009, 339: 332-336. source

In the paper

“Data were extracted by one reviewer (CJ) and independently checked by a second (KJ or SR) using a standardised, piloted data extraction form.”

In the paper

“Given the statistical and methodological heterogeneity of studies, meta-analyses of health outcomes were not possible. Consistent with other published reviews [21,22], a more qualitative ‘vote counting’ [23] approach was undertaken.”

What the sources say

• Not checked yetcites [21] Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR: An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011, 7: CD009255
• Not checked yetcites [22] Dickens AP, Richards SH, Greaves CJ, Campbell JL: Interventions targeting social isolation in older people: a systematic review. BMC Publ Health. 2011, 11: 647-10.1186/1471-2458-11-647. source
• Not checked yetcites [23] Bushman BJ: Vote-counting procedures in meta-analysis. The Handbook of Research Synthesis. Edited by: Cooper H, Hedges LV. 1984, New York, USA: Russell Sage, 193-213.

In the paper

“The methodological quality of each paper was appraised to generate a risk of bias score. These numerical scores were used to aid interpretation only and not as a quality filter when synthesising results.”

In the paper

“Experimental and cohort studies comparing the physical and mental health outcomes and mortality of a volunteering group to a non-volunteering group were identified from twelve electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) and citation tracking in January 2013.”

In the paper

“The Newcastle-Ottawa Scale (NOS) for cohort studies [20] was used to assess the quality of non-RCTs and cohort studies.”

What the sources say

• Not checked yetcites [20] Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2012, http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp,

In the paper

“Although interpreting evidence of effectiveness from longitudinal analysis of cohort studies may be problematic, they were included due to the limited evidence from experimental studies.”

In the paper

“Health outcomes which included mortality, and physical or mental health measures could be self-reported or extracted from routine records; no quality filtering was applied although the validity of each measure was noted.”

In the paper

“Reassuringly, the estimates of the prevalence of volunteering from observational studies is consistent with other sources [3,5], which found the prevalence of volunteering is generally higher in the USA compared with European cohorts, and that older people may be less likely to volunteer than their younger counterparts [64].”

What the sources say

• Not checked yetcites [3] Bureau of Labor Statistics - US Department of Labor: Volunteering in the United States - 2011. 2012, USA: Department of Labor
• Not checked yetcites [5] Mathou C: Volunteering in the European Union - final report. Educational, Audiovisual & Culture Executive Agency - Directorate General Education and Culture. 2010, London, UK: GHK

In the paper

“Although people tend to volunteer for altruistic reasons [9], if reciprocity is not experienced, then the positive impact of volunteering on quality of life is negated [56,63].”

What the sources say

• Not checked yetcites [9] Konrath S, Fuhrel-Forbis A, Lou A, Brown S: Motives for volunteering are associated with mortality risk in older adults. Health Psychol. 2012, 31: 87-96. source

In the paper

“Reassuringly, the estimates of the prevalence of volunteering from observational studies is consistent with other sources [3,5], which found the prevalence of volunteering is generally higher in the USA compared with European cohorts, and that older people may be less likely to volunteer than their younger counterparts [64].”

What the sources say

• Not checked yetcites [64] Department for Communities and Local Government: Citizenship survey: 2009–10 (April 2009 - March 2010), England. 2010, London, UK: UK Government

In the paper

“The importance of reciprocity was highlighted in the cross sectional analysis of the English Longitudinal Study of Ageing (ELSA); retired people who engaged in either paid work or volunteering experienced greater levels of wellbeing compared to those retirees who engaged in caring [8].”

What the sources say

• Not checked yetcites [8] McMunn A, Nazroo J, Wahrendorf M, Breeze E, Zaninotto P: Participation in socially-productive activities, reciprocity and wellbeing in later life: baseline results in England. Ageing Soc. 2009, 29: 765-782. 10.1017/S0144686X08008350. source

In the paper

“The State of the World’s Volunteerism Report 2011 [14], the Policy Agenda for Volunteering in Europe (PAVE) [13], the CNCS Strategic Plan 2011–2015 [7] and the UK government policy [15] advocate the uptake of volunteering as a method of improving civic engagement, with the added potential of improving participants’ health and wellbeing [16].”

What the sources say

• Not checked yetcites [14] United Nations Volunteers: State of the world’s volunteerism report 2011. Universal values for global well-being. 2011, Bonn, Germany: United Nations Volunteers source
• Not checked yetcites [13] European Year of Voluteering: Policy Agenda for Volunteering in Europe (PAVE). 2011, Brussels, Belgium: EYV 2011 Alliance Secretariat
• Not checked yetcites [7] Corporation for National and Community Service: The Corporation for National and Community Service Strategic Plan 2011–2015. 2011, http://www.nationalservice.gov/sites/default/files/documents/11_0203_cncs_strategic_plan.pdf,

In the paper

“Taken together, this review suggests that bio-social and cultural factors may influence both a willingness to engage in volunteering, as well as the benefits that might accrue.”

In the paper

“A hierarchy of evidence approach [17] was applied; only experimental (randomised and non-randomised controlled trials) and cohort studies were included.”

What the sources say

• Not checked yetcites [17] Centre for Reviews and Dissemination: Systematic reviews. CRD’s guidance for undertaking reviews in health care. 2009, UK: Centre for Reviews and Dissemination, Univeristy of York

In the paper

“Since people reporting stronger social relationships have a reduced risk of mortality [68], the social aspects of volunteering may contribute to the observed survival differences.”

What the sources say

• Not checked yetcites [68] Holt-Lunstad J, Smith TB, Layton JB: Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010, 7: 10.1371/journal.pmed.1000316.

In the paper

“Two recent systematic reviews reported narrative evidence of the potential health benefits from volunteering, but findings were restricted to older adults and evidence from only one trial [11,12].”

What the sources say

• Not checked yetcites [11] von Bonsdorff MB, Rantanen T: Benefits of formal voluntary work among older people. A review. Aging Clin Exp Res. 2011, 23: 162-169. source
• Not checked yetcites [12] Cattan M, Hogg E, Hardill I: Improving quality of life in ageing populations: what can volunteering do?. Maturitas. 2011, 70: 328-332. 10.1016/j.maturitas.2011.08.010. source

In the paper

“Alongside more traditional health promotion goals, such as reducing physical inactivity and excess weight in adults, the new Public Health Framework for England (2013–16) [69] includes self-reported wellbeing and improving health-related quality of life for older people as indicators.”

What the sources say

• Not checked yetcites [69] Department of Health: Improving outcomes and supporting transparency. Part 1: a public health outcomes framework for England, 2013–2016. 2012, London, UK: Department of Health

In the paper

“The relevance of the current findings on a nation where health inequalities and volunteering are less prevalent may be questionable.”

In the paper

“While meta-analysis of survival data was undertaken, analysis of the remaining physical and mental health outcomes was restricted to vote counting [23] due to heterogeneous trial interventions and study methods of both trial and observational studies.”

What the sources say

• Not checked yetcites [23] Bushman BJ: Vote-counting procedures in meta-analysis. The Handbook of Research Synthesis. Edited by: Cooper H, Hedges LV. 1984, New York, USA: Russell Sage, 193-213.

In the paper

“Many uncertainties remain that preclude clear recommendations for practice.”

In the paper

“The emerging science of evaluating the impact of complex health behavioural change is giving new insights into intervention mapping and development [70].”

What the sources say

• Not checked yetcites [70] Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME: Planning health promotion programs: an intervention mapping approach. 2011, San Francisco: Jossey-Bass, 3

In the paper

“However, ‘volunteering’ (as assessed in cohort studies) is rarely described and heterogeneous in nature suggesting that future evaluations must seek to better describe the intervention ‘tested’.”

In the paper

“While the underlying causal mechanisms cannot be explained due to the potential for reverse causation and selection bias, synthesis of observational data suggests that people who choose to volunteer are at a lower risk of mortality, and may experience some benefits in terms of physical and mental health.”

In the paper

“By adopting this approach, it may be more feasible over the long-term, to robustly design and adequately power, pragmatic RCTs.”