Volunteerism and Mortality among the Community-dwelling Elderly

Volunteering, religiosity, and quality of life in later life: evidence from Singapore

OBJECTIVES

We examine the association of the frequency of formal and informal volunteering with quality of life (QoL) among older adults in Singapore. We also assess if private (private prayer) or public (religious service attendance) aspects of personal religiosity moderate this association. In examining the moderating role of religiosity, we adjudicate between two competing theoretical views-the value-congruence and resource-compensation perspectives.

METHODS

Ordinary least squares regression models were estimated using cross-sectional data from a national survey of older Singaporeans, aged 60 and above, in 2016.

RESULTS

The frequency of both informal and formal volunteering was associated with better QoL. While private prayer did not moderate this association, religious attendance did-the positive association was stronger among those attending religious services less frequently.

CONCLUSION

Volunteering is beneficial for well-being in later life, especially so for older adults with less religious service attendance. These observations dovetail with the resource-compensation perspective, underscoring that the benefits of volunteering are amplified for older adults who are less integrated into their religious congregations. Hence, targeting those with lower levels of religious attendance might be useful in maximizing the benefits experienced by older volunteers.

How Effective Altruism Can Help Psychologists Maximize Their Impact

Although many psychologists are interested in making the world a better place through their work, they are often unable to have the impact that they would like. Here, we suggest that both individuals and psychology as a field can better improve human welfare by incorporating ideas from effective altruism, a growing movement whose members aim to do the most good by using science and reason to inform their efforts. In this article, we first briefly introduce effective altruism and review important principles that can be applied to how psychologists approach their work, such as the importance, tractability, and neglectedness framework. We then review how effective altruism can inform individual psychologists' choices. Finally, we close with a discussion of ideas for how psychology, as a field, can increase its positive impact. By applying insights from effective altruism to psychological science, we aim to integrate a new theoretical framework into psychological science, stimulate new areas of research, start a discussion on how psychology can maximize its impact, and inspire the psychology community to do the most good.

Role of personality traits in determining the association between social participation and mental health: A cross-sectional study in Japan

The role of personality in determining the association between social participation and mental health was examined by a cross-sectional study. We analyzed data from 4981 older adults aged 65-84 years who were recruited via a mail survey in one region of Japan. We defined poor mental health using a score ≤12 points on the World Health Organization-Five Well-Being Index-Japanese. Personality traits were measured by 10 Item Personality Inventory-Japanese. In women, higher openness positively moderated the association between private group participation (volunteering, sports, hobby, and learning) and mental health, while higher neuroticism negatively moderated it. This study contributes to knowledge about mental health, personality, and participation. The findings provide provisional evidence about recommending private group participation for women with high openness but not those with high neuroticism.

"I'm aging faster": social participation as experienced by individuals aging with a traumatic brain injury

OBJECTIVES

1) To get an insight into the experience of aging with traumatic brain injury (TBI), and 2) explore intervention avenues perceived as promising for the social participation of this population.

METHOD

Through an exploratory descriptive study, in-depth semi-structured interviews were conducted with aging TBI survivors recruited in a nonprofit community organization whose mission is to support the social participation of people living with TBI. Thematic analysis was done on qualitative data, using a hybrid approach of deductive and inductive analysis.

RESULTS

Ten aging TBI survivors with an average age of 64.9 years were interviewed. Participants expressed the perception of declining faster and with greater limitations than their fellow seniors unchallenged by TBI but also of having social participation opportunities due to their condition. A list of ten facilitators (e.g., doing activities in synch with life story) and five barriers (e.g., unequal levels of disability) to their social participation emerged.

CONCLUSION

Social participation is crucial to TBI-affected individuals' healthy aging. Nonprofit community organizations should offer opportunities for participation, mobilize environmental resources, foster self-confidence, and support the achievement of meaningful personal projects to enable the social participation of people aging with TBI.

Identifying pathways to increased volunteering in older US adults

While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t₀; 2006/2008 and t₁; 2010/2012) were associated with volunteer activity four years later (t₂; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.

Healing in Health Care: Mental Health Promotion, Advocacy, and Voluntarism in Response to COVID-19

The COVID-19 pandemic increased many known risk factors for mental health problems. In the context of overwhelmed health systems and resource and staffing shortages, the mental health needs of frontline health care workers (HCWs) gained attention as a major public health concern and a threat to high-quality care delivery. In response, mental health promotion initiatives were quickly developed to meet the demands of the public health crisis. Two years later, the context for psychotherapy has changed, especially as it pertains to the health care workforce. Particularly salient experiences-grief, burnout, moral injury, compassion fatigue, and racial trauma-have become routinely discussed as part of everyday clinical practice. Service programs have become more responsive to the needs, schedules, and identities of HCWs. In addition, mental health and other HCWs have contributed to advocacy and volunteer initiatives promoting health equity, culturally responsive care, and access to care across a range of settings. In this article, the authors review the benefits of these activities to individuals, organizations, and communities and summarize example programs. Many of these initiatives began in response to the acute public health crisis; however, engaging in these ways and spaces holds promise for increasing connection and prioritizing equity and structural change over the long term.

In the Shadow of the Casinos: The Relationship between Religion and Health in Macau

Considerable research has shown that religion operates as a protective factor for one's health. However, there is still a lack of understanding of the mechanisms by which religion is linked to individual health and wellbeing, especially in predominantly secular societies. This study tried to address this gap by developing a theoretical model to examine how religiosity is related to life satisfaction and health perception in a non-Western culture. Macau, a Portuguese colony until 1999, remains a diversified culture because of its intermixed historical background from the East and the West. Through structural equation modeling, the analysis of data collected from a representative sample of Macau residents, using a multistage stratified sampling procedure, indicated a positive link between religiosity and health. Moreover, altruism and prejudice mediated a portion of the relationship between religiosity and health. Additionally, our results demonstrated that Macau residents who were more religious had a higher level of altruism and a lower level of prejudice. The link between religion and prejudice in Macau differs from that of many other cultures, indicating that the effect of religion on prejudice varies by cultural context. In sum, our study showed that even in the shadow of glittering casinos, religion is positively related to health.

A holistic approach to campus well-being: Steps to Leaps at Purdue University

In response to the increasing demand of mental health solutions, Purdue University launched the Steps to Leaps initiative in 2019 to promote student well-being. It provided the tools and resources to build students’ resilience skills and establish lifelong habits to help them realize their personal definitions of success. Working collaboratively with students, faculty, and front- line staff, the initiative identified five pillars, to address these concerns: well-being, leadership/professional development, impact, networks and grit. This article briefly outlined the program implementation and provides relevant theoretical frameworks in a case study format. It then summarized twelve key lessons learned from the two years of practice and concluded with a community perspective.

Benefits of volunteerism for middle-aged and older adults: comparisons between types of volunteering activities

Volunteering is a popular activity among middle-aged and older adults as means to contribute to the society and to maintain personal health and wellbeing. While the benefits of volunteering have been well-documented in the current literature, it does not tend to distinguish between various types of volunteering activities. This cross-sectional study aims to compare the effects of instrumental (e.g. food preparation, fundraising) and cognitively demanding volunteering activities (e.g. befriending, mentoring) in a sample of 487 middle-aged and older Hong Kong Chinese adults. Participation in instrumental and cognitively demanding volunteering, life satisfaction, depressive symptoms, cognitive functioning and hand-grip strength were measured. The results of two-way between-subject robust analyses of variance demonstrated significant main effects of volunteering type and their interaction effect with age on life satisfaction and depressive symptoms. Comparisons among four volunteering groups (no volunteering, instrumental volunteering, cognitively demanding volunteering and both types) revealed that individuals engaging in instrumental volunteering exhibited lower life satisfaction and more depressive symptoms compared to those who engaged in cognitively demanding volunteering and those who did not volunteer at all. This detrimental pattern of instrumental volunteering was only seen in middle-aged adults, but not in older adults. Findings of this study revealed distinctive effects of two volunteering types, and provide valuable directions for designing future volunteering programmes.

Volunteering as an Equalizer: A Quasi-Experimental Study Using Propensity Score Analysis

INTRODUCTION

Formal volunteering in later life is beneficial for both physical and psychological well-being. However, research points to potential selection bias because older adults with key advantages, such as wealth, are more likely to volunteer and reap its benefits. Accordingly, this study addresses this selection bias by considering the characteristics of volunteers and nonvolunteers using the inverse probability of treatment weighting. It also examines whether volunteering has differential impacts between the highest and lowest wealth quintiles using inverse probability of treatment weighting.

METHODS

Data were analyzed from the 2004-2016 waves of the Health and Retirement Study (N=90,881). The weights, created using a machine learning method, were incorporated in the analysis to estimate the treatment effects along with relevant covariates. Analyses were conducted in 2020.

RESULTS

Volunteering enhanced self-reported health and reduced depressive symptoms in the full sample. Furthermore, those in the lowest wealth quintile experienced significantly better self-reported health from volunteering than their wealthy counterparts. Volunteering was associated with fewer depressive symptoms regardless of wealth status.

CONCLUSIONS

The study enhances the understanding of formal volunteering and health while suggesting that volunteers with low wealth may benefit more from volunteering in terms of their health. Hindrances to volunteering among the least wealthy, such as financial distress, discrimination, or lack of organizational support, may attenuate the benefits of voluntary activity.

Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV

While programs and interventions intended to increase positive affect among people living with HIV (PLWH) and other chronic diseases have been associated with improved health outcomes, including decreased depression, programs have not been tailored specifically for Black women. We tailored a program designed to increase positive affect and to decrease depressive symptoms in PLWH to a group format for Black WLWH. We also added skills to increase gender empowerment. We then tested the acceptability and feasibility of this program with 8 Black WLWH. The program was acceptable and relatively feasible, as assessed by women’s participation and feedback about program clarity and helpfulness, which women rated above 9 on a 10-point scale. A few women suggested that optimal delivery point for some skills taught would be shortly after HIV diagnosis. A proof-of-concept program intended to bolster positive emotions and gender empowerment and decrease depression can be tailored for Black WLWH and is relatively feasible and acceptable. A randomized controlled trial is needed to assess the preliminary efficacy of this program on positive affect, depression, and other health outcomes for WLWH.

Incorporating Volunteering Into Treatment for Depression Among Adolescents: Developmental and Clinical Considerations

Volunteering, or taking part in unpaid work for the benefit of others, can be a powerful positive experience with returns to both individual well-being and community projects. Volunteering is positively associated with mental health in observational studies with community samples but has not been systematically examined as a potential part of treatment interventions with clinical adolescent samples. In this manuscript, we review the empirical evidence base connecting volunteerism to mental health and well-being, outline potential mechanisms based in the theoretical literature from developmental science, and discuss the existing clinical approaches that support community volunteering as a part of treatment. Drawing on this review, we propose that including volunteering as a component of clinical treatment approaches for adolescent depression can be a powerful intervention for adolescents.

Benefits of volunteering on psychological well-being in older adulthood: evidence from a randomized controlled trial

Objectives: Long-term volunteering has been associated with better physical, mental, and cognitive health in correlational studies. Few studies, however, have examined the longitudinal benefits of volunteering with randomized experimental designs (e.g., intervention studies). Even fewer studies have examined whether such benefits can be shown after short-term volunteering. To fill this gap, we conducted four 1-hour volunteering intervention sessions to promote volunteering among a group of older adults with limited volunteering experience and examined the impact of volunteering on depressive symptoms, meaning in life, general self-efficacy, and perceived autonomy.Methods: A total of 384 participants aged 50-96 years were assigned at random to either an intervention group to promote volunteering behaviors or an active control group to promote physical activity. The participants' monthly volunteering minutes, depressive symptoms, meaning in life, general self-efficacy and perceived autonomy were measured at baseline and six weeks, three months, and six months after the intervention.Results: Being in the volunteering intervention condition was not directly associated with depressive symptoms, meaning in life, general self-efficacy, or perceived autonomy at the 6-week, 3-month, or 6-month follow-ups after the intervention. However, there was an indirect effect of the intervention on depressive symptoms: participants in the intervention group, who had increased their volunteering at the 3-month follow-up, reported fewer depressive symptoms at the 6-month follow-up.Discussion: Our randomized controlled trial suggests that short-term volunteering does not reliably lead to short-term changes in psychosocial health measures as correlational studies would suggest. Efforts need to be made to encourage older adults to maintain long-term volunteering.

The Contribution of Agreeableness and Self-efficacy Beliefs to Prosociality

The present study examined how agreeableness and self-efficacy beliefs about responding empathically to others' needs predict individuals' prosociality across time. Participants were 377 adolescents (66% males) aged 16 at Time 1 and 18 at Time 2 who took part at this study. Measures of agreeableness, empathic self-efficacy and prosociality were collected at two time points. The findings corroborated the posited paths of relations to assigning agreeableness a major role in predicting the level of individuals' prosociality. Empathic self-efficacy beliefs partially mediated the relation of agreeableness to prosociality. The posited conceptual model accounted for a significant portion of variance in prosociality and provides guidance with respect to interventions aimed at promoting prosociality.

Voluntary work for the physical and mental health of older volunteers: A systematic review

Background

The increasing imbalance between the number of older adults not working and the number of adults in the age range of labour force participation (age range 20-64) has long been a fundamental public policy challenge in the Organization for Economic Co-operation and Development member countries. At a societal level, this growing imbalance raises serious concerns about the viability and funding of social security, pensions and health programmes. At an individual level, the concern is probably more that of aging well with the prospect of many years in retirement. Some research suggests that retiring for some carries the risk of a fast decline in health. Volunteering can play a significant role in people's lives as they transition from work to retirement, as it offers a "structured" means of making a meaningful contribution in society once the opportunity to do so through work has been cut off. Some older people consider voluntary work as a way to replicate aspects of paid work lost upon retirement, such as organisational structure and time discipline. In many countries, volunteering of the older adults is increasing and programmes designed specifically for this subpopulation are emerging. Volunteering may contribute to both individuals aging well and society aging well, as volunteering by the older adults at the same time relieves the societal burden if it helps maintain health and functionality for those who volunteer. It thus remains to be established to what extent volunteering impacts on the physical and mental health of those who volunteer.

Objectives

The main objective of this review is to answer the following research question: what are the effects of volunteering on the physical and mental health of people aged 65 years or older?

Search Strategy

Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and internet search engines. The database searches were carried out to December 2018 and other resources were searched in September 2019 and October 2019. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies and relevant reviews were also searched.

Selection Criteria

The intervention of interest was formal volunteering which can be described as voluntary, on-going, planned, helping behaviour that intend to increase the well-being of strangers, offers no monetary compensation and typically occurs within an organisational context. We included older people aged 65 or over who are engaged in formal voluntary work. The primary focus was on measures of physical and mental health. All study designs that used a well-defined control group were eligible for inclusion. Studies that utilised qualitative approaches were not included.

Data Collection and Analysis

The total number of potential relevant studies constituted 17,046 hits. A total of 90 studies, met the inclusion criteria and were critically appraised by the review authors. The 90 studies analysed 47 different populations. Only 26 studies (analysing 19 different populations) could be used in the data synthesis. Forty-six studies could not be used in the data synthesis as they were judged to have too high risk of bias and, in accordance with the protocol, were excluded from the meta-analysis on the basis that they would be more likely to mislead than inform. Eighteen studies did not provide enough information enabling us to calculate an effects size and standard error or did not provide results in a form enabling us to use it in the data synthesis. Finally, of the 26 studies that could be used in the data synthesis, two pairs of studies used the same two data sets and reported on the same outcome(s), thus in addition two studies were not used in the data synthesis.Meta-analysis of both physical health outcomes and mental health outcomes were conducted on each metric separately. All analyses were inverse variance weighted using random effects statistical models that incorporate both the sampling variance and between study variance components into the study level weights. Random effects weighted mean effect sizes were calculated using 95% confidence intervals (CIs).Sensitivity analysis was carried out by restricting the meta-analysis to a subset of all studies included in the original meta-analysis and was used to evaluate whether the pooled effect sizes were robust across components of risk of bias.

Results

The 24 studies (analysing 19 different populations), used for meta analysis were from Australia, Ireland, Israel, Japan, Korea and United States, three were a randomised controlled trial and 21 were NRS. The baseline time period (the year the voluntary work that was analysed was measured) spanned by the included studies is 30 years, from 1984 to 2014 and on average the baseline year was 2001. On average the number of follow up years was 5, although with great variation from 0 to 25 years. The average number of volunteers analysed (not reported in four studies) was 2,369, ranging from 15 to 27,131 and the average number of controls was 13,581, ranging from 13 to 217.297. In total the average number of participants analysed was 14,566, ranging from 28 to 244.428.Ten studies analysed the effect of voluntary work on mortality, however, eight studies reported a hazard ratio and two studies reported an odds ratio. We analysed these two types of effect sizes separately. A hazard ratio <1 indicates that the treated, the volunteers is favoured. That is, the conditional mortality rate is lower for volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.91. The random effects weighted mean hazard ratio was 0.76 (95% CI, 0.72-0.80) and statistically significant. The two studies that reported odds ratios of mortality supported this result. There was no heterogeneity between the studies in either of the meta analyses.Three studies analysed the effect of voluntary work on incident functional disability, using a hazard ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.70-0.99. The random effects weighted mean hazard ratio was 0.83 (95% CI, 0.72-0.97) and statistically significant. There was a small amount of heterogeneity between the studies.Two studies analysed the effect of voluntary work on decline in instrumental activities of daily living, using an odds ratio as effect measure. Both reported results indicated an effect favouring the volunteers (0.63 and 0.83). The random effects weighted mean odds ratio was 0.73 (95% CI, 0.53-1.01) and not statistically significant. There is no heterogeneity between the two studies.Three studies analysed the effect of voluntary work on maintenance of functional competence, using an odds ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.83. The random effects weighted mean odds ratio was 0.81 (95% CI, 0.70-0.94) and statistically significant. There is no heterogeneity between the studies.In addition a number of other physical outcomes were reported in a single study only.Three studies analysed the effect of voluntary work on depression, and reported results that enabled the calculation of standardised mean difference (SMD) and variance. The effect sizes are measured such that a positive effect size favours the volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.05-0.66. The random effects weighted SMD was 0.12 (95% CI, 0.00-0.23) and statistically significant. There is a very small amount of heterogeneity between the studies.In addition, a number of other mental health outcomes were reported in a single study only.We did not find any adverse effects.There were no appreciable changes in the results across components of risk of bias as indicated by the sensitivity analysis.

Authors' Conclusions

The review aimed to examine effects on all types of physical and mental health outcomes. With the exception of mortality, there was insufficient evidence available. The available evidence, however, does suggest that there is an effect on the mortality of volunteers, although the effect is small. We found evidence that voluntary work reduces the mortality hazard of the volunteers aged 65 and above. The effect corresponds to a 43% chance of the volunteers dying first which should be compared to a fifty-fifty chance (50%) of dying first if the intervention had no effect. The evidence seems robust in the sense that we did not find any heterogeneity between the studies. As the intervention, unlike most other interventions in the social welfare area, is not costly, it could be prescribed to more older adults. In fact as the intervention in contrary to carrying a cost is a productive activity contributing directly to community well-being and has a positive effect on the volunteers it probably should be prescribed universally. However, due to the very nature of the intervention, it is voluntary and it cannot be prescribed. But more people could be encouraged to take up voluntary work if the opportunity was immediately available and visible.

Political connections and psychosocial wellbeing among Women's Development Army leaders in rural amhara, Ethiopia: Towards a holistic understanding of community health workers' socioeconomic status

Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n = 74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n = 422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.

Intergenerational resource sharing and mortality in a global perspective

Resource sharing has always been a central component of human sociality. Children require heavy investments in human capital; during working years, help is needed due to illness, disability, or bad luck. While hunter-gatherer elders assisted their descendants, more recently, elderly withdraw from work and require assistance as well. Willingness to share has been critically important for our past evolutionary success and our present daily lives. Here, we document a strong linear relationship between the public and private sharing generosity of a society and the average length of life of its members. Our findings from 34 countries on six continents suggest that survival is higher in societies that provide more support and care for one another. We suggest that this support reduces mortality by meeting urgent material needs, but also that sharing generosity may reflect the strength of social connectedness, which itself benefits human health and wellbeing and indirectly raises survival.

Volunteers' Felt Respect and Its Associations With Volunteering Retention, Daily Affect, Well-being, and Mortality

OBJECTIVES

Volunteering is associated with improved physical and psychological well-being; volunteers feeling more respect for their work may have better well-being than their counterparts.

METHODS

This study investigated the effects of felt respect for volunteer work on volunteering retention, daily affect, well-being (subjective, psychological, and social), and mortality. The study analyzed survey and mortality data from a national sample of 2,677 volunteers from the Midlife in the United States Study over a 20-year span. Daily affect data were obtained from a subsample of 1,032 volunteers.

RESULTS

Compared to volunteers feeling less respect from others, those feeling more respect (a) were more likely to continue volunteering 10 and 20 years later, (b) had higher levels of daily positive affect and lower levels of daily negative affect, and (c) had higher levels of well-being over a 20-year period. The effect of felt respect on mortality was not statistically significant.

DISCUSSION

Greater level of felt respect for volunteer work is positively related to volunteers' retention rates, daily affective experience, and well-being.

Aspects of the volunteering experience associated with well-being in older adults

ISSUES ADDRESSED

While the psychological health benefits of older people's engagement in formal volunteering are well-documented, there is limited research assessing how volunteering may produce these favourable outcomes. To guide the development of volunteer positions that optimise outcomes, this study examined (a) which aspects of the volunteering experience are most strongly associated with favourable psychological health among older adults and (b) whether relationships between these aspects and psychological outcomes are moderated by sociodemographic characteristics.

METHODS

A sample of 293 volunteers aged 60+ years (69% female, mean age = 73.33 years) completed measures assessing their engagement in volunteering, various aspects of their volunteer experience, and their psychological health.

RESULTS

Being adequately appreciated for one's contribution, perceived social and mental intensity of the volunteer role, and believing that others benefit from one's volunteering efforts were found to be associated with higher levels of psychological health.

CONCLUSIONS

Ensuring the contributions of volunteers are explicitly recognised, providing opportunities for engagement in social and cognitive activities, and informing volunteers of the benefits others experience constitute potential means of enhancing volunteer outcomes and may assist with volunteer retention. SO WHAT?: This study builds upon the limited research assessing which aspects of the volunteering experience are most strongly associated with favourable psychological health among older adults. The findings point to the potential importance of four specific aspects of the volunteer experience in enhancing psychological health outcomes.

Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach

INTRODUCTION

Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes.

METHODS

Data were from 12,998 participants in the Health and Retirement Study-a large, diverse, prospective, and nationally representative cohort of U.S. adults aged >50 years. Using multiple logistic, linear, and generalized linear regression models, this study evaluated if changes in volunteering (between t₀, 2006/2008 and t₁, 2010/2012) were associated with 34 indicators of physical health, health behaviors, and psychosocial well-being (in t₂, 2014/2016). Models adjusted for sociodemographics, physical health, health behaviors, psychosocial factors, and personality, as well as volunteering and all outcomes in the prebaseline wave (t₀, 2006/2008). Results accounted for multiple testing and data were analyzed in 2019.

RESULTS

During the 4-year follow-up period, participants who volunteered ≥100 hours/year (versus 0 hours/year) had a reduced risk of mortality and physical functioning limitations, higher physical activity, and better psychosocial outcomes (higher: positive affect, optimism, and purpose in life; lower: depressive symptoms, hopelessness, loneliness, and infrequent contact with friends). Volunteering was not associated with other physical health outcomes (diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, cognitive impairment, and chronic pain), health behaviors (binge drinking, smoking, and sleep problems), or psychosocial outcomes (life satisfaction, mastery, health/financial mastery, depression, negative affect, perceived constraints, and contact with other family/children).

CONCLUSIONS

With further research, volunteering is an activity that physicians might suggest to their willing and able patients as a way of simultaneously enhancing health and society.

A Web-Based, Positive Emotion Skills Intervention for Enhancing Posttreatment Psychological Well-Being in Young Adult Cancer Survivors (EMPOWER): Protocol for a Single-Arm Feasibility Trial

BACKGROUND

Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations but have not been routinely tested in AYAs.

OBJECTIVE

The aim of this protocol is to (1) test the feasibility and acceptability of a Web-based positive emotion skills intervention for posttreatment AYAs called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) and (2) examine proof of concept for reducing psychological distress and enhancing psychological well-being.

METHODS

The intervention development and testing are taking place in 3 phases. In phase 1, we adapted the content of an existing, Web-based positive emotion intervention so that it would be suitable for AYAs. EMPOWER targets 8 skills (noticing positive events, capitalizing, gratitude, mindfulness, positive reappraisal, goal setting, personal strengths, and acts of kindness) and is delivered remotely as a 5-week, Web-based intervention. Phase 2 consisted of a pilot test of EMPOWER in a single-arm trial to evaluate feasibility, acceptability, retention, and adherence and to collect data on psychosocial outcomes for proof of concept. In phase 3, we are refining study procedures and conducting a second pilot test.

RESULTS

The project was part of a career development award. Pilot work began in June 2015, and data collection was completed in March 2019. The analysis is ongoing, and results will be submitted for publication by May 2020.

CONCLUSIONS

If this intervention proves feasible and acceptable, EMPOWER will be primed for a subsequent large, multisite randomized controlled trial. As a scalable intervention, it will be ideally suited for AYA survivors who would otherwise not have access to supportive care interventions to help manage posttreatment distress and enhance well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17078.

Socially Active Aging and Self-Reported Health: Building a Sustainable Solidarity Ecosystem

Senior volunteering is associated with improved welfare, in addition to contributing to social development. Thus, the involvement of seniors in non-profit organizations (NPO), the third sector, or the social economy is encouraged by European national governments. At the organizational level, the situation for older volunteers in the third sector has improved in recent years, mainly due to European legal regulations. Despite a certain degree of homogenization across European countries, significant national differences persist in the adoption and promotion of volunteering. The present study examines the link between self-reported health and participation in volunteering activities among European seniors, stratified by sex and generation (the Silent Generation and the Baby Boomer Generation). We focus our analysis on seniors living in Germany, Poland, Romania, Russia, Slovenia, Spain, Sweden, Turkey, and Ukraine. Analyses were conducted using empirical micro data from the World Values Survey (WVS; 1994/98, 2005/09 and 2010/14). Our results demonstrate the positive impact of volunteering on health status among the elderly, although we observed marked differences in the associated benefits between sexes, generational cohorts, and countries. Public policies should be developed with this important source of social capital in mind, but should also seek to address existing inequity.

Precision Medicine in Lifestyle Medicine: The Way of the Future?

Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.

Benefits of Older Volunteering on Wellbeing: An International Comparison

Healthier aging implies lower health service expenditure and the possibility for individuals to make a longer and more valuable contribution to society. Lifestyles, including volunteering, affect our health. The policy implications of the present study are that it aims to broaden the state of knowledge and be useful to public decision-makers: if voluntary activities enhance the integration of older people into society, their participation will help to generate economic resources and improve their own welfare; if, however, health and participation do not show positive synergies, then policymakers must act independently in each of these fields. In this work, we focus on the societies of Chile, Mexico, and Spain because they have significantly aging populations and share common traits but also exhibit important differences. The empirical study employs micro-data from the World Value Survey (1994-1998, 2005-2009, and 2010-2014) and macro-data from the statistics of the OECD (Organization for Economic Co-operation and Development). Micro- and macro-data are merged by national and temporal identifiers. Our main results provide empirical evidence that volunteering might improve every indicator of wellbeing except happiness. Different kinds of activities have different impacts on individual wellbeing. For example, volunteering in activities related to social awareness is positive for male life satisfaction, whereas volunteering in activities related to religious issues is positive for male life satisfaction but also female happiness. In general, voluntary activities have a stronger impact on male wellbeing than female wellbeing.

Early life stress moderates the relationship between age and prosocial behaviors

BACKGROUND

Several studies suggest that prosocial behaviors gradually increase with age, but others report that prosocial behaviors are fixed traits with only minor fluctuations throughout the lifespan. Early life stress may help explain these inconsistencies, as distinct types of stress have been negatively or positively associated with prosocial behaviors.

OBJECTIVE

This current investigation used two studies to test whether distinct types of early life stress moderated the association between age and prosocial behavior.

PARTICIPANTS AND SETTING

Study 1 recruited undergraduate students (n = 69) between the ages of 18-35, and Study 2 was conducted on Amazon Mechanical Turk responders (n = 499) whose ages ranged from 18-74.

METHODS

Study 1 employed behavioral economic tasks to measure cooperation and charitability, while Study 2 utilized an online survey to measure helping attitudes.

RESULTS

Moderation analyses revealed the association between age and cooperation was significantly weakened by a history of family violence (β=-0.37,p = 0.002), community violence (β=-0.30,p = 0.012), emotional abuse (β=-0.27,p = 0.026), and an overall summary score of early life stress (β=-0.33,p = 0.006). The relationship between age and charitability was only weakened by family violence (β=-0.24,p = 0.048). The association between age and helping attitudes was weakened by family violence (β=-0.10, p = 0.023), community violence (β=-0.13,p = 0.003), and physical neglect (β=-0.11,p = 0.018).

CONCLUSIONS

Collectively, these results suggest that some types of early life stress, especially exposure to violent environments, may reduce the likelihood of prosocial behaviors increasing throughout the lifespan. This study suggests that age-related effects on prosocial behaviors may not be universal, but rather depend on individual differences in childhood stress.

Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers

OBJECTIVE

To test the effects of Life Enhancing Activities for Family Caregivers (LEAF), a 6-week positive emotion regulation intervention, on outcomes of positive emotion, depression, anxiety, and physical health as measured by the Patient-Reported Outcomes Measurement Information System® (PROMIS®).

METHOD

A randomized controlled trial (N = 170) comparing LEAF (N = 86) to an emotion reporting/waitlist condition (N = 84) in dementia caregivers. LEAF was individually delivered online by trained facilitators. Participants in the control condition completed daily online emotion reports and then crossed over into the intervention condition after 6 weeks. The study was registered with Clinicaltrials.gov (NCT01825681) and funded by R01NR014435.

RESULTS

Analyses of difference in change from baseline to 6 weeks demonstrated significantly greater decreases in PROMIS® depression (d = -.25; p = .02) and Quality of Life in Neurological Disorders (NeuroQOL) anxiety (d = -.33; p < .01), as well as improvements in PROMIS® physical health (d = .24; p = .02) in the intervention condition compared to the emotion reporting/waitlist control. The intervention also showed greater improvements in positive emotion (d = .58; p < .01) and positive aspects of caregiving (d = .36; p < .01). Increases in positive emotion significantly mediated the effect of LEAF on depression over time.

CONCLUSIONS

This randomized controlled trial of the online-facilitated positive emotion regulation intervention in dementia caregivers demonstrated small to medium effect sizes on caregiver well-being and shows promise for remotely delivered programs to improve psychological well-being in caregivers of people with dementia and other chronic illnesses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychosocial distress among unpaid community health workers in rural Ethiopia: Comparing leaders in Ethiopia's Women's Development Army to their peers

There is a growing critical social science literature on volunteering in health programs in non-western, low-income countries, yet few have mixed quantitative and qualitative methods to examine the psychological and social wellbeing of unpaid community health workers in such contexts. We address this issue with data from unpaid community health workers (CHWs) and other women who comprise Ethiopia's state-organized Women's Development Army. We draw on qualitative and cross-sectional survey data collected between 2013 and 2016 to test links between various aspects of psychosocial and economic wellbeing and volunteer status in a rural context. We surveyed 422 adult women in Amhara state, 73 of whom were unpaid CHWs in the "Army". We also conducted interviews and focus group discussions with health officials, salaried Health Extension Workers, volunteer CHWs, and other adult women. Analyses of our qualitative and quantitative datasets show that volunteer CHWs are actually worse off than their peers in various psychosocial and economic respects, and that CHW recruitment processes are the most likely explanation for this difference. Additionally, the unpaid CHW position adds work to already burdened shoulders, and makes women-especially unmarried women-vulnerable to negative gossip and high levels of psychological distress. To a limited extent, the volunteer CHW position also bolsters married women's subjective socioeconomic status and confidence in achieving future gains in status. By showing that unpaid CHWs do not necessarily enjoy psychosocial benefits, and may experience harm as a result of their work, these findings reinforce the recommendation that CHWs in contexts of poverty be paid and better supported.

Feasibility and Acceptability of an Online Positive Affect Intervention for Those Living with Comorbid HIV Depression

Positive affect has unique beneficial effects on psychological and physical health, independent of the effects of negative affect. Interventions that explicitly target positive affect show promise for improving health outcomes in a number of chronic illnesses. In this article, we present pilot data on the acceptability and feasibility of an online intervention to increase positive affect in those living with comorbid human immunodeficiency virus (HIV) and depression. The intervention was rated both acceptable and feasible by participants. Six of nine participants completed the intervention and the subsequent follow-up assessment and a post-intervention phone call. We also present outcomes of planned comparisons of intervention effects on emotion, which indicate that positive affect increased significantly in the intervention group. Based upon results of the current study, future research should continue the development of positive affect interventions for people living with comorbid HIV and depression.

Changes in health parameters in older lay volunteers who delivered a lifestyle-based program to frail older people at home

OBJECTIVE

To measure health effects in lay volunteers who made home visits consisting of social interaction, nutritional and physical exercise interventions to pre-frail and frail older people (trial registration ClinicalTrials.gov, NCT01991639).

METHODS

After baseline, participants were followed-up at 12 (V1) and 24 (V2) weeks. A one-repetition maximum (1-RPM) and handgrip were measured with the Concept2®DYNO and a dynamometer. The Physical Activity Scale for the Elderly was used to assess physical activity, and Food Frequency Questionnaire and the Mediterranean Diet Adherence Screener for nutrition. Additionally, quality of life (QoL) was measured with the World Health Organization (WHO) quality of life brief questionnaire and anthropometric measurements were performed using bioelectrical impedance analysis.

RESULTS

Handgrip values significantly increased from 32.14 ± 7.94 kg to 33.69 ± 6.72 kg at V1 and 34.36 ± 6.96 kg at V2. The 1‑RPM on the leg press showed a significant increase from 72.47 ± 25.37 kg to 78.12 ± 23.77 kg and 80.85 ± 27.99 kg, respectively. We observed a significant decrease of protein intake from 0.38 ± 0.26 g/kgBW/day to 0.32 ± 0.19 g/kgBW/day and 0.26 ± 0.16 g/kgBW/day, respectively. There were no changes in physical activity, QoL and anthropometric measurements.

CONCLUSION

The findings indicate that projects involving aging healthy volunteers may have additional limited health benefits.

Collective Well-Being to Improve Population Health Outcomes: An Actionable Conceptual Model and Review of the Literature

OBJECTIVES

To propose collective well-being as a holistic measure of the overall "health" of a community. To define collective well-being as a group-level construct measured across 5 domains (vitality, opportunity, connectedness, contribution, and inspiration) and introduce an actionable model that demonstrates how community characteristics affect collective well-being. To review the literature describing each domain's association with health outcomes and community characteristics' associations with collective well-being.

METHODS

We came to consensus on topics describing each component of our conceptual model. Because "well-being" is not indexed in MEDLINE, we performed topic-specific database searches and examined bibliographies of papers retrieved. We excluded articles that were limited to narrow subtopics or studies within small subpopulations. Preference was given to quasi-experimental or randomized studies, systematic reviews, or meta-analyses. Consensus was reached on inclusion or exclusion of all articles.

RESULTS

Reviewed literature supported each of the proposed domains as important aspects of collective well-being and as determinants of individual or community health. Evidence suggests a broad range of community characteristics support collective well-being.

CONCLUSIONS

The health and quality of life of a community may be improved by focusing efforts on community characteristics that support key aspects of well-being. Future work should develop a unified measure of collective well-being to evaluate the relative impact of specific efforts on the collective well-being of communities.

A Self-Paced, Web-Based, Positive Emotion Skills Intervention for Reducing Symptoms of Depression: Protocol for Development and Pilot Testing of MARIGOLD

BACKGROUND

Living with elevated symptoms of depression can have debilitating consequences for an individual's psychosocial and physical functioning, quality of life, and health care utilization. A growing body of evidence demonstrates that skills for increasing positive emotion can be helpful to individuals with depression. Although Web-based interventions to reduce negative emotion in individuals with depression are available, these interventions frequently suffer from poor retention and adherence and do not capitalize on the potential benefits of increasing positive emotion.

OBJECTIVE

The aim of this study was to develop and test a Web-based positive emotion skills intervention tailored for individuals living with elevated depressive symptoms, as well as to develop and test enhancement strategies for increasing retention and adherence to that intervention.

METHODS

This study protocol describes the development and testing for Mobile Affect Regulation Intervention with the Goal of Lowering Depression (MARIGOLD), a Web-based positive emotion skills intervention, adapted for individuals with elevated depressive symptomatology. The intervention development is taking place in three phases. In phase 1, we are tailoring an existing positive emotion skills intervention for individuals with elevated symptoms of depression and are pilot testing the tailored version of the intervention in a randomized controlled trial with two control conditions (N=60). In phase 2, we are developing and testing three enhancements aimed at boosting retention and adherence to the Web-based intervention (N=75): facilitator contact, an online discussion board, and virtual badges. In phase 3, we are conducting a multifactorial, nine-arm pilot trial (N=600) to systematically test these enhancement strategies, individually and in combination. The primary outcome is depressive symptom severity. Secondary outcomes include positive and negative emotion, psychological well-being, and coping resources.

RESULTS

The project was funded in August 2014, and data collection was completed in May 2018. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2018.

CONCLUSIONS

Findings from this investigation will enable us to develop an optimal package of intervention content and enhancement strategies for individuals with elevated symptoms of depression. If this intervention proves to be effective, it will provide a cost-effective, anonymous, appealing, and flexible approach for reducing symptoms of depression and improving psychological adjustment through increasing positive emotion.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01964820 (Phase 1); https://clinicaltrials.gov/ct2/show/NCT01964820 (Archived by WebCite at http://www.webcitation.org/6zpmKBcyX). ClinicalTrials.gov NCT02861755 (Phase 2); https://clinicaltrials.gov/ct2/show/NCT02861755 (Archived by WebCite at http://www.webcitation.org/6zpmLmy8k).

REGISTERED REPORT IDENTIFIER

RR1-10.2196/10494.

Life Enhancing Activities for Family Caregivers of people with dementia: protocol for a randomized controlled trial of a positive affect skills intervention

Given the increasing number of family caregivers of persons with dementia (PWD) and the associated burden and detriments to both physical and mental health, interventions that aim to improve such outcomes are important. Studies are increasingly demonstrating the unique importance of positive emotions in coping with stress, independent from the impact of negative emotions. However, none have examined the benefits of interventions that target positive emotions for caregivers of individuals with a chronic and debilitating disease such as dementia. This paper presents the design and methods for a randomized controlled trial (RCT) of a positive affect skills intervention for family caregivers of PWD. The RCT is of a skills-based intervention that seeks to increase the frequency and intensity of positive affect in order to improve outcomes such as well-being, coping, and physical and mental health. The skills are delivered by trained facilitators via five one-to-one Internet video sessions with family caregivers of persons diagnosed with dementia (eg, Alzheimer's disease, vascular dementia, unspecified). The control group is an emotion reporting/waitlist control. Follow-up assessments are conducted post-intervention and at 1, 3, and 6 months post-completion of the intervention. This study promises to be an important and needed step toward improving the lives of caregivers of PWD.

For how many days and what types of group activities should older Japanese adults be involved in to maintain health? A 4-year longitudinal study

OBJECTIVE

Studies have suggested that frequent participation in social groups contributes to the well-being of older people. The primary aim of this study was to identify the number of days older adults should participate in the activities of social groups to maintain their health for 4 years. This study also aimed to examine whether the effective frequency differs by the type of social group activity.

METHOD

We examined a prospective cohort of 1,320 community-dwelling older adults over 65 years of age, who responded to both a baseline and a follow-up mail survey, in a suburban city of Tokyo, Japan. The dependent variable was the change in functional competence during 4 years. Logistic regression analyses were conducted to examine the effects of participation in the activities of the 5 most common social groups among older Japanese on maintaining functional competence.

RESULTS

Nine hundred and ninety-four participants (76.5%) maintained their functional competence for 4 years. The results of the logistic regression analyses showed that participating in alumni groups less than once a month and being an inactive member were associated with higher odds of maintaining functional competence, after controlling for socioeconomic, demographic and baseline health status. Additionally, the odds of maintaining functional competence for 4 years increased upon participating in volunteer groups once a month or more. These results were also confirmed using logistic regression analysis, even after adjustment for the effects of participation in other social groups.

DISCUSSION

The results indicated the effectiveness of volunteer activities that fulfill a social role in maintaining health. Therefore, older adults should be encouraged to participate in activities of volunteer groups at least once a month. Additionally, older adults can obtain positive health outcomes through less frequent participation in alumni groups, compared with the activities of volunteer groups.

Volunteering and mortality risk: a partner-controlled quasi-experimental design

Background

The consensus that volunteering is associated with a lower mortality risk is derived from a body of observational studies and therefore vulnerable to uncontrolled or residual confounding. This potential limitation is likely to be particularly problematic for volunteers who, by definition, are self-selected and known to be significantly different from non-volunteers across a range of factors associated with better survival.

Methods

This is a census-based record-linkage study of 308 733 married couples aged 25 and over, including 100 571 volunteers, with mortality follow-up for 33 months. We used a standard Cox model to examine whether mortality risk in the partners of volunteers was influenced by partner volunteering status-something expected if the effects of volunteering on mortality risk were due to shared household or behavioural characteristics.

Results

Volunteers were general more affluent, better educated and more religious than their non-volunteering peers; they also had a lower mortality risk [hazard ratio (HR)adj = 0.78: 95% confidence interval (CI) = 0.71, 0.85 for males and HRadj = 0.77: 95% CI = 0.68, 0.88 for females]. However, amongst cohort members who were not volunteers, having a partner who was a volunteer was not associated with a mortality advantage (HRadj = 1.01: 95% CI = 0.92, 1.11 for men and HRadj = 1.00: 95% CI = 0.88, 1.13 women).

Conclusions

This study provides further evidence that the lower mortality associated with volunteering is unlikely to be due to health selection or to residual confounding arising from unmeasured selection effects within households. It therefore increases the plausibility of a direct causal effect.

Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV

OBJECTIVE

We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV.

METHOD

One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition.

RESULTS

For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes.

CONCLUSIONS

This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record

"Working with COW": Social Work Supporting Older Women Living in the Community

Australia, like all developed Western countries, is experiencing a demographic shift resulting in an increasing proportion of the population being over the age of 65 years. Contrary to stereotypes, the vast majority of older people live independently in communities. This article explores the potential of social work practice informed by community development principles to enable socially disadvantaged older women to live in vibrant and supportive communities, in which they feel safe and are able to access the support services they need. It argues that participation in social action not only builds older women's well-being but also enables them to become (or continue to be) agents for social change in local communities. Adopting a community-based research methodology, this article draws on a decade of community development practice with the Concerned Older Women's (COW) Group. This data suggests that community development practice based on participation, empowerment, and social action founded on respectful relationships may accrue significant benefits to individuals and the broader community. This social work practice creates the social conditions to facilitate older women's capacity to work collectively to achieve social change, challenging ageist stereotypes.

A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer

BACKGROUND

We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in-person delivery.

METHODS

Women with metastatic breast cancer (N = 39) were randomized to an in-person intervention, online intervention, or in-person attention-matched control. Psychological well-being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer-specific quality of life [Multidimensional Quality of Life Scale-Cancer Version]), and positive coping (mindfulness, positive-affect skill use, and self-compassion [Self-Compassion Scale: Short-Form]) were assessed at baseline, 1 week post-intervention, and 1 month post-intervention follow-up.

RESULTS

The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between-group differences in change on preliminary efficacy outcomes, within-group comparisons revealed that LILAC participants (in-person and online combined) showed reductions in depression and negative affect by the 1 month follow-up (d = -0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow-up (t[17] = -2.22, P = .04, d = -0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14).

CONCLUSIONS

The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well-being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.

Perceived Neighborhood Safety Better Predicts Risk of Mortality for Whites than Blacks

AIM

The current study had two aims: (1) to investigate whether single-item measures of subjective evaluation of neighborhood (i.e., perceived neighborhood safety and quality) predict long-term risk of mortality and (2) to test whether these associations depend on race and gender.

METHODS

The data came from the Americans' Changing Lives Study (ACL), 1986-2011, a nationally representative longitudinal cohort of 3361 Black and White adults in the USA. The main predictors of interest were perceived neighborhood safety and perceived neighborhood quality, as measured in 1986 using single items and treated as dichotomous variables. Mortality due to all internal and external causes was the main outcome. Confounders included baseline age, socioeconomic status (education, income), health behaviors (smoking, drinking, and exercise), and health (chronic medical conditions, self-rated health, and depressive symptoms). Race and gender were focal effect modifiers. Cox proportional hazard models were ran in the pooled sample and stratified by race and gender.

RESULTS

In the pooled sample, low perceived neighborhood safety and quality predicted increased risk of mortality due to all causes as well as internal causes, net of all covariates. Significant interaction was found between race and perceived neighborhood safety on all-cause mortality, indicating a stronger association for Whites compared to Blacks. Race did not interact with perceived neighborhood quality on mortality. Gender also did not interact with perceived neighborhood safety or quality on mortality. Perceived neighborhood safety and quality were not associated with mortality due to external causes.

CONCLUSION

Findings suggest that single items are appropriate for the measurement of perceived neighborhood safety and quality. Our results also suggest that perceived neighborhood safety better predicts increased risk of mortality over the course of 25 years among Whites than Blacks.

Volunteerism as an Occupation and its Relationship to Health and Wellbeing

Occupational therapy philosophy asserts a positive relationship between occupation and health and aims to promote and restore health through enabling occupation. This study aimed to explore volunteerism as an occupation and its possible relationship to health and wellbeing from an occupational science perspective and to consider how this knowledge might be used to inform occupational therapy practice.

Qualitative and quantitative methods were used, with a sample of 109 volunteers. The qualitative data are presented here and comprise written responses to two open-ended questions. The first asked the volunteers about their motivations to volunteer (MTVs) and the second asked the volunteers to describe their personal experiences of volunteering (PEVs). These data were analysed to identify patterns of MTVs and themes relating to the costs and benefits of volunteering to health and wellbeing.

The findings revealed a range of MTVs, both altruistic and egoistic, as well as many and varied benefits of volunteering, providing some support for a positive relationship between volunteerism and health and wellbeing. Volunteering appeared to exert its positive effects predominantly on aspects of mental health by providing opportunities to increase confidence and self-esteem, gain social support, replace lost roles and feel included in community life. The pattern of benefits seemed to reflect the volunteers' motivations, suggesting that benefits to health may be mediated by the MTV; this was consistent with the occupational therapy philosophy that occupations need to be meaningful and purposeful to hold therapeutic value.

The article concludes that engaging in a volunteer role has many potential benefits to health and wellbeing, particularly to aspects of mental health. This may have implications for the occupational therapy profession. For occupational therapists working with clients experiencing mental health problems, there may be some therapeutic value in enabling their clients to engage in a volunteer role. Future research with occupational therapists working in this area could establish if volunteerism has been used as a therapeutic occupation and its outcomes, thereby informing occupational therapy practice.

Altruistic behavior: mapping responses in the brain

Altruism is an important social construct related to human relationships and the way many interpersonal and economic decisions are made. Recent progress in social neuroscience research shows that altruism is associated with a specific pattern of brain activity. The tendency to engage in altruistic behaviors is associated with greater activity within limbic regions such as the nucleus accumbens and anterior cingulate cortex in addition to cortical regions such as the medial prefrontal cortex and temporoparietal junction. Here, we review existing theoretical models of altruism as well as recent empirical neuroimaging research demonstrating how altruism is processed within the brain. This review not only highlights the progress in neuroscience research on altruism but also shows that there exist several open questions that remain unexplored.

Formal and Informal Volunteer Activity and Spousal Caregiving Among Older Adults

On the basis of data from the 1998 and 2000 waves of the Health and Retirement Study, this study tested two alternative hypotheses, role overload and role extension, about the relationship between volunteering and spousal caregiving among older married persons. Spousal caregiving was not significantly associated with the likelihood of formal or informal volunteering for men; however, female caregivers were found to be less likely than noncaregivers to have engaged in formal or informal volunteering to a certain extent, thus lending partial support to the role overload hypothesis. Functional health status and other human and cultural capital resources were significant predictors of both formal and informal volunteering for both men and women. Future studies need to examine in more depth the effect of spousal caregiving on volunteering, taking caregiving burden and stress into consideration, to more fully understand these two types of productive activity in later life.