title: Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers.
abstract: BACKGROUND
  Volunteering has been advocated by the United Nations, and American and European governments as a way to engage people in their local communities and improve social capital, with the potential for public health benefits such as improving wellbeing and decreasing health inequalities. Furthermore, the US Corporation for National and Community Service Strategic Plan for 2011-2015 focused on increasing the impact of national service on community needs, supporting volunteers' wellbeing, and prioritising recruitment and engagement of underrepresented populations. The aims of this review were to examine the effect of formal volunteering on volunteers' physical and mental health and survival, and to explore the influence of volunteering type and intensity on health outcomes.
  
  
  METHODS
  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. No language, country or date restrictions were applied. Data synthesis was based on vote counting and random effects meta-analysis of mortality risk ratios.
  
  
  RESULTS
  Forty papers were selected: five randomised controlled trials (RCTs, seven papers); four non-RCTs; and 17 cohort studies (29 papers). Cohort studies showed volunteering had favourable effects on depression, life satisfaction, wellbeing but not on physical health. These findings were not confirmed by experimental studies. Meta-analysis of five cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78; 95% CI: 0.66, 0.90). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes.
  
  
  CONCLUSIONS
  Observational evidence suggested that volunteering may benefit mental health and survival although the causal mechanisms remain unclear. Consequently, there was limited robustly designed research to guide the development of volunteering as a public health promotion intervention. Future studies should explicitly map intervention design to clear health outcomes as well as use pragmatic RCT methodology to test effects.
authors: Primary Care, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK. s.h.richards@exeter.ac.uk.
authors: Caroline E
authors: CE
authors: Jenkinson
authors: Andy P
authors: AP
authors: Dickens
authors: Kerry
authors: K
authors: Jones
authors: Jo
authors: J
authors: Thompson-Coon
authors: Rod S
authors: RS
authors: Taylor
authors: Morwenna
authors: M
authors: Rogers
authors: Clare L
authors: CL
authors: Bambra
authors: Iain
authors: I
authors: Lang
authors: Suzanne H
authors: SH
authors: Richards
mesh_terms: D006801:Humans; D008603:Mental Health; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D066270:Social Capital; D014838:Volunteers / Q000523:psychology*
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