INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2003; 18: 795–802. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.922 The role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers Elsie Chau-wai Yan and Catherine So-kum Tang* Department of Psychology, The Chinese University of Hong Kong SUMMARY Objective This study examined the role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers in Hong Kong. Methods A total of 295 elderly Chinese volunteers were individually interviewed on their demographic characteristics, voluntary service experience, physical health status, general self-efficacy, social support, satisfaction and perceived benefit from volunteer work, and burnout symptoms. Exploratory factor analysis was first performed to determine the underlying dimensions of burnout experience. Correlation analyses were then conducted to explore associations among major variables. Hierarchical regression analyses were also performed to unearth the relative contribution of various factors in predicting burnout among elderly volunteers. Results A two-factor structure of burnout, namely lack of personal accomplishment and emotional depletion, was found. Demographics, individual, interpersonal, and organizational factors were significant predictors of lack of personal accomplishment. In particular, personal accomplishment was best predicted by a long duration of voluntary work service and high levels of self-efficacy, work satisfaction, and perceived benefit. For emotional depletion, only demographics and individual factors were significant predictors. A low level of emotional depletion was best predicted by older age, a short duration of voluntary work experience, and good health. Conclusions Burnout experience was evident among elderly Chinese volunteers. There were different predictors of affective and cognitive components of burnout. Findings have significant implications to attenuate burnout symptoms among elderly volunteers. Copyright # 2003 John Wiley & Sons, Ltd. key words — elderly volunteer burnout; Chinese elderly volunteers; Chinese elderly burnout With improved nutrition and advancement in medical care, elderly people are now not only living longer but also remain healthy and capable. They thus constitute a substantial pool of voluntary workers for non-profit social service organizations. The rate of elderly volunteering is expected to continue to rise as a result of changing demographics alongside the active promotion of local and national governments (Chambre, 1993; Chong, 1993). Similar to paid workers, elderly volunteers are also vulnerable to work stress and burnout which may have adverse impacts on their mental health as well as disruption of service to their * Correspondence to: Professor C. S-K. Tang, Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. Tel: 852-26096503. Fax: 852-26035019. E-mail: email@example.com Copyright # 2003 John Wiley & Sons, Ltd. clients. With global aging, the role of elderly volunteers will become even more important. Thus, various negative aspects of volunteering are in need of attention to facilitate the contribution of elderly volunteers in ways that benefit themselves as well as those receiving their services. This study aimed to unearth various factors associated with burnout among elderly volunteers. Volunteerism and burnout Burnout is often defined as a syndrome of emotional exhaustion, a sense of lack of personal achievement, and being cynical and callous toward one’s work (Maslach et al., 1996). It is related to reduced physical and mental well-being among employed human service professionals (Burke and Greenglass, 1995; Received 16 January 2002 Accepted 20 May 2003 796 e. chau-wai yan and c. so-kum tang Tang et al., 2001), and is also the main reason why volunteers terminate their service (Cyr and Dowrick, 1991; Ross et al., 1999; Yiu et al., 2001). The following sections focus on aspects of individual, interpersonal, and organizational factors that are of particular relevance to burnout among elderly volunteers. For individual factors, symptoms such as dizziness, pain, and fatigue associated with various chronic medical conditions may affect elderly volunteers’ performance in the course of their voluntary work. They may be easily exhausted and perceive themselves as incompetent. Furthermore, elderly people tend to have a low level of self-efficacy as compared to other age cohorts (Wu et al., 2003). Studies have found that individuals with low self-efficacy often have pessimistic thoughts about accomplishment (Bandura, 1997) and are vulnerable to experiencing burnout at work (VanYpersen, 1998; Brouwers and Tomic, 2000; Tang et al., 2001). On the interpersonal level, benefits of social support against work stress and negative health outcomes have been well documented (Vismesvaran et al., 1999). Social support can either directly mitigate adverse effects of stress, or moderate effects of stress by enabling people to cope with stress more effectively. Support from coworkers and supervisors can help manage or prevent burnout among volunteers (Lafer, 1991; Capner and Caltabiano, 1993). However, elderly people have been identified as a population with a high need for support but a lack of opportunity to obtain it (Dunkel-Schetter and Wortman, 1981). Thus, elderly volunteers may not have adequate support to buffer against burnout experience in their voluntary work. Two of the most frequently cited organizational factors in relation to burnout are dissatisfaction and lack of reward from work. Research on paid workers has shown that those who perceive low satisfaction and few rewards from work tend to report mental and burnout symptoms (Deckard et al., 1994; Schmoldt et al., 1994; Lee and Ashforth, 1996; Demerouti et al., 2001; Freeborn, 2001; Van der Hulst and Geurts, 2001). As voluntary work does not have explicit extrinsic rewards such as salary or fringe benefits, volunteers have to rely on more intrinsic rewards or motives for becoming and continuing to act as voluntary workers (Black and DiNitto, 1994; Omoto and Synder, 1995). Benefits that are of particular relevance to elderly volunteers include opportunities to learn new things, filling the vocational void left by retirement, becoming a useful member of the society, Copyright # 2003 John Wiley & Sons, Ltd. and finding a peer group (Barlow and Hainsworth, 2001). There is not yet any study examining the association between burnout and work satisfaction among volunteers. However, Bennett et al. (1996) found that a lack of perceived reward from work is related to feelings of depersonalization and lack of personal accomplishment among AIDS voluntary helpers. Similar to other countries, elderly Chinese provide an invaluable pool of voluntary workers. A majority of elderly Chinese are healthy and functionally independent, and still enjoy the prestige, power, and care in the family as prescribed by the Confucian principles of filial piety. Recently, there has been an increasing interest in recruiting elderly Chinese to local voluntary service to enable them to continue to play an active and productive role in the community (Chong, 1993). In fact, traditional Chinese values have always placed great emphasis on collectivism, advocating that effort and contributions should be directed toward collective good rather than toward individual benefit (Triandis et al., 1998). Chinese cultural beliefs also espouse that individuals helping less fortunate persons will be promised a good life after death and the blessings of the next generation. A recent study on young Chinese voluntary workers has shown that satisfaction with voluntary work, integration into the voluntary organization, and absence of burnout symptoms were all related to the expected duration of voluntary service (Yiu et al., 2001). Purposes of the present study This study aimed to examine the role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers in Hong Kong. On the individual level, it was hypothesized that few burnout symptoms would be related to good physical health and a sense of general self-efficacy. On the interpersonal level, it was hypothesized that few burnout symptoms would be related to a high level of social support from family members and other voluntary workers. On the organizational level, it was hypothesized that few burnout symptoms would be related to satisfaction and perceived benefit from voluntary work. As various factors did not exist alone, it was important that their shared variances should be taken into consideration when determining their respective contribution in understanding burnout experience. It was further hypothesized that individual, interpersonal, and organizational factors would remain salient factors even after controlling for their shared variances. Int J Geriatr Psychiatry 2003; 18: 795–802. chinese elderly volunteer burnout METHOD Recruitment of participants and sampling procedure Twenty-three community centers in Hong Kong were randomly selected from the local social service directory for elderly people. Invitation letters were sent to administrators of these centers to invite them to refer their elderly members to participate in a study about the life style and health status of elderly people. Eighteen of the 23 contacted centers replied and referred their elderly members to the study. Trained research assistants individually interviewed the elderly people in rooms provided by the community centers. The purposes of the present study were first explained and informed consent was obtained prior to the interview. These elderly people participated in the study voluntarily and without monetary reward. A souvenir was given to each participant as a token of appreciation. Approximately one in every ten of the referred elderly people refused to participate in the study, with the main reasons either being too tired or not having time. A total of 518 elderly people completed the interviews. For this study, only elderly people with voluntary work experience were included (n ¼ 335). Among them, 36 had less than one year of experience and were excluded from subsequent analyses as they may not have had enough exposure to voluntary work. Furthermore, four elderly people had more than 50 years of voluntary work experience and they were also excluded to rule out the possibility that findings were due to their extremely long service duration. With these exclusion criteria, the present sample consisted of 295 participants (66 men and 229 women). Their age ranged from 56 to 91 years old (Mean ¼ 72.03, SD ¼ 6.91). The age distribution was as following: 2% aged below 60, 34% between 60–69 years, 50% between 70–79 years, and 14% aged 80 or above. Most of the participants had retired and about half of them were married at the time of the study. A majority of the participants lived with their family (68.1%) and approximately onethird of them lived alone (29%). Concerning education level, more than half of the participants had at least primary or secondary school education (71.5%). As compared to men, women were more likely to be widowed (2 ¼ 28.84, p < 0.001) and without employment (2 ¼ 38.15, p < 0.001). There was also no significant difference in demographic characteristics between the present sample and those who had less than one year or more than 50 years of voluntary service ( p > 0.01). Copyright # 2003 John Wiley & Sons, Ltd. 797 Voluntary work experience of the present sample ranged from one year to 32 years, with a mean of six and a half years. Among the participants, 55% had less than five years of voluntary experience, 28.5% had 6–10 years experience, 8.5% had 11–15 years experience, and 8% had 15–32 years experience. On average, participants provided four hours of voluntary service per week. Concerning the nature of their voluntary service, most of the participants assisted in organizing activities at community centers (50%) or paid visits to their service recipients on an irregular basis (57%). Recipients of their voluntary service were predominantly elderly people (96%). There was no gender difference regarding participants’ voluntary experience. Instruments Demographic variables. Participants were asked to provide information on their age, gender, marital status, and education level as well as past and current voluntary work experience. Physical health status. A self-constructed item was used to assess participants’ subjective physical health status. Participants were asked to rate their physical health on a five-point scale, with a higher score indicating poorer health. General self efficacy. Participants’ perceived self-efficacy was measured by the ten-item Generalized SelfEfficacy Scale (Schwarzer, 1993). This scale assesses the strength of people’s belief in their own abilities to respond to novel or difficult situations and to deal with any associated obstacles or setbacks. It demonstrates satisfactory internal consistency, test–retest reliability, and convergent and discriminant validity. The Chinese version of the scale is available and shows satisfactory internal consistency of 0.86 (Zhang and Schwarzer, 1995). Participants were asked to rate each item on a four-point scale, with high scores indicating high levels of self-efficacy. Social support. Social support was assessed by the 15item scale developed by Wills (1985). This scale consists of seven items measuring emotional support and eight items measuring instrumental support. The Chinese translation of the scale is available and shows satisfactory internal consistency with alpha values of 0.78 for emotional support and 0.74 for instrumental support (Tang et al., 2002). Participants were asked to indicate whether or not their family members Int J Geriatr Psychiatry 2003; 18: 795–802. 798 e. chau-wai yan and c. so-kum tang provided the depicted types of support on four-point scales, with higher scores indicating higher levels of various types of social support. A self-constructed item on the total number of close friends in the voluntary group was also used to assess the level of emotional support from other volunteer workers. Work satisfaction. Satisfaction with voluntary work was measured by a single item stating ‘Overall, how satisfied are you with the volunteer work?’ Participants rated their satisfaction level with a ten-point scale, with 1 as ‘extremely unsatisfied’ and 10 as ‘extremely satisfied’. Higher scores represent greater satisfaction with voluntary work. Perceived benefit from volunteer work. Perceived benefit from volunteer work was measured by the 12-item Expectation Fulfillment Index (EFI) adopted from a previous study on Chinese volunteers (Yiu et al., 2001). This index is positively associated with Chinese volunteers’ work satisfaction (Yiu et al., 2001). Examples of depicted benefits are contribution to the society and acquisition of new knowledge and skill. Participants rated each item on a four-point scale, with higher scores indicating greater perceived benefit. Burnout. Participants’ level of burnout was measured by the 22-item Maslach Burnout Inventory (Maslach et al., 1996). A high level of burnout is reflected by high levels of emotional exhaustion, depersonalization, and lack of personal accomplishment. A Chinese version of this scale is available and its internal consistency is satisfactory with alpha values ranging from 0.71 to 0.86 (Tang, 1998). Participants rated each item on a seven-point scale, with higher scores indicating greater burnout experiences. RESULTS There has been very little research studying burnout in elderly volunteers, an exploratory factor analysis with maximum likelihood estimation and direct oblimin rotation was conducted to explore the factor structure of the Maslach Burnout Inventory (Maslach et al., 1996) for the present sample. Results suggested a two-factor structure of burnout, namely emotional depletion (EP) and lack of personal achievement (LPA). The EP subscale contained all nine items from the original emotional exhaustion subscale and three items from the original depersonalization subscale, while the LPA subscale included all of the eight items from the original subscale. Both EP and LPA Copyright # 2003 John Wiley & Sons, Ltd. subscales had eigenvalues greater than one, and together they accounted for a total of 26% of the variance. Table 1 presents means, standard deviations, internal consistency, and results of Pearson correlation analyses of major variables. All measurement scales were internally consistent, with alpha values ranging from 0.69 to 0.93. A series of hierarchical regression analyses were performed to unearth the relative contribution of various factors in predicting burnout among elderly volunteers. Various factors were entered into the regression analysis from the micro level (demographic and individual factors) to more macro level (interpersonal and organizational factors). For subsequent analyses, demographic variables including participants’ age, gender, marital status, educational attainment, and years of voluntary work experience were entered as Block 1. As years of voluntary work experience were skewed toward the shorter duration, this variable was transformed into a logarithm with a base of 10. Individual factors of participants’ physical health and general self-efficacy were entered as Block 2. Interpersonal factors of emotional and instrumental support from family members as well as support from other volunteer workers were entered as Block 3. Organizational factors including satisfaction and perceived benefit from voluntary work were entered as Block 4. Regression analyses were performed separately for EP and LPA subscales. Detail results are summarized in Table 2. For the EP subscale, the four blocks of predictor variables accounted for a total of 12% of the variance. Only demographics and individual factors were significant predictors. The beta values of the final model showed that a low level of EP was best predicted by older age, short years of voluntary work experience, and good health. For the LPA subscale, the four blocks of predictor variables were all significant, and together accounted for a total of 39% of the variance. However, the significance of interpersonal variables was diminished after organizational factors were entered into the regression analysis. Beta values of the final model indicated that a high level of personal accomplishment was best predicted by a long voluntary work experience as well as high levels of general self-efficacy, work satisfaction, and perceived benefit from voluntary work. DISCUSSION This study examined the role of individual, interpersonal, and organization factors in mitigating burnout among elderly Chinese volunteers in Hong Kong. The Int J Geriatr Psychiatry 2003; 18: 795–802. Copyright # 2003 John Wiley & Sons, Ltd. 0.05 0.09 — — 0–1 — 0.06 0.11 72.03 6.91 56–91 — 0.00 0.04 0.18** 0.13* 0.18* 0.24** — — 6.53 — — 5.74 0–1 1–4 1–32 — — — 0.00 0.02 1.00 7 9 0.24** 0.27** 0.06 0.22** 1.00 0.56** 1.00 0.05 0.00 8 0.22** 0.06 1.00 10 1.00 0.21** 11 1.00 12 13 14 0.17** 0.07 0.01 0.01 0.08 0.03 0.04 1.00 0.10 0.30** 0.29** 0.17** 0.14* 0.36** 0.41** 0.10 1.00 2.84 28.18 21.50 23.13 4.57 7.58 38.42 16.03 14.78 0.90 4.77 3.43 4.06 5.47 1.89 3.88 3.97 3.39 1–5 4–40 7–28 8–32 0–40 1–10 12–48 12–84 8–56 — 0.93 0.84 0.82 — — 0.71 0.69 0.72 0.19** 0.11 0.09 0.32** 0.16** 0.15* 0.12* 0.03 1.00 0.33** 6 0.20** 0.05 0.20** 0.01 0.08 0.09 0.05 0.01 0.07 0.10 0.22** 0.08 0.03 0.02 0.02 0.09 0.08 0.03 0.00 0.11 0.05 0.00 0.02 0.04 0.03 1.00 5 0.01 0.10 0.26** 0.03 1.00 0.12 4 0.00 0.04 0.03 0.15** 0.16** 0.07 0.06 0.06 0.11 0.01 0.11 0.25** 3 0.29** 1.00 1.00 2 0.23** 1.00 0.13* Note: *p < 0.05 (two-tailed); **p < 0.01 (two-tailed). Demographics 1. Age 2. Gender (0 ¼ female, 1 ¼ male) 3. Marital status (0 ¼ single, 1 ¼ married) 4. Education level 5. Voluntary work experience (Years) Individual factors 6. Poor health status 7. General self efficacy Interpersonal factors 8. Emotional family support 9. Instrumental family support 10. Volunteer worker support Organizational factors 11. Satisfaction with volunteer work 12. Perceived benefit from volunteer work Burnout 13. Emotional depletion 14. Lack of personal achievement Means Standard deviation Possible range Internal reliability (Alpha) 1 Table 1. Descriptive statistics and correlation results among major variables chinese elderly volunteer burnout 799 Int J Geriatr Psychiatry 2003; 18: 795–802. 800 e. chau-wai yan and c. so-kum tang Table 2. Results of hierarchical multiple regression analyses Emotional depletion Block 1: Demographics Age Gender (0 ¼ female, 1 ¼ male) Marital status (0 ¼ single, 1 ¼ married) Education level Voluntary work experience (Years) Block 2: Individual factors Age Gender Marital status Education level Voluntary work experience (Years) Poor health status General self efficacy Block 3: Interpersonal factors Age Gender Marital status Education level Voluntary work experience (Years) Poor health status General self efficacy Emotional family support Instrumental family support Volunteer worker support Block 4: Organizational factors Age Gender Marital status Education level Voluntary work experience (Years) Poor health status General self efficacy Emotional family support Instrumental family support Voluntary worker support Satisfaction with volunteer work Perceived benefit from volunteer work Beta t-value 0.23 0.03 0.08 0.04 0.19 2.89** 0.42 0.98 0.57 2.56* 0.22 0.03 0.06 0.06 0.21 0.21 0.05 2.83** 0.43 0.78 0.75 2.82** 2.80** 0.66 0.22 0.04 0.06 0.05 0.21 0.22 0.07 0.06 0.04 0.02 2.82** 0.51 0.79 0.65 2.85** 2.85** 0.75 0.63 0.50 0.33 0.22 0.04 0.07 0.04 0.24 0.23 0.06 0.03 0.06 0.04 0.02 0.12 2.80** 0.51 0.88 0.57 3.06** 2.96** 0.68 0.36 0.67 0.47 0.19 1.55 2 Lack of personal achievement R F Change 0.07 2.53* 0.11 0.11 0.12 Beta t-value 0.17 0.03 0.07 0.09 0.37 2.34* 0.39 0.87 1.34 5.23*** 0.14 0.01 0.07 0.04 0.36 0.00 0.23 1.82 0.18 0.99 0.57 5.09*** 0.06 2.98** 0.12 0.03 0.08 0.01 0.32 0.01 0.18 0.21 0.01 0.13 1.59 0.42 1.13 0.20 4.68*** 0.18 2.32* 2.66** 0.10 1.99* 0.13 0.04 0.09 0.02 0.21 0.01 0.17 0.10 0.00 0.09 0.25 0.23 1.95 0.56 1.40 0.24 3.11** 0.13 2.33* 1.35 0.01 1.42 3.70*** 3.52*** 3.98* 0.20 1.20 R2 F Change 0.17 7.34*** 0.22 5.23** 0.28 4.74** 0.39 15.32*** Note: *p < 0.05 (two-tailed); **p < 0.01 (two-tailed); ***p < 0.001 (two-tailed). present results first showed that burnout experience of elderly voluntary workers also included affective (EP) and cognitive (LPA) components (Maslach et al., 1996). When compared to a previous study on Chinese teachers, nurses, and police officers (Tang and Lau, 1996), the present sample of elderly volunteers reported slightly lower levels of EP but much higher levels of LPA. It should be noted that personal achievement in paid employment would be measured against concrete outcomes such as pay increases and promotion. Participation in voluntary work often relies on intrinsic motives such as altruism, personal development, and social responsibility (Black and DiNitto, 1990; Omoto and Synder, 1995; Barlow Copyright # 2003 John Wiley & Sons, Ltd. and Hainsworth, 2001). However, the attainment of these intrinsic goals are often difficult to evaluate. Thus, it is understandable that volunteers may not easily experience a sense of personal accomplishment in the course of their voluntary service. In this study, a majority of the depicted benefits from voluntary work were related to contribution to the society and opportunities to acquire knowledge and skills, which are two important aspects of benefit/reward that elderly volunteers would like to obtain from their service (Barlow and Hainsworth, 2001). Indeed, results from hierarchical regression analyses showed that among all hypothesized factors, organizational factors of perceived benefit and satisfaction Int J Geriatr Psychiatry 2003; 18: 795–802. chinese elderly volunteer burnout from voluntary work emerged as the best predictors of the LPA dimension of burnout. These findings were in line with previous studies in that few burnout symptoms are related to job satisfaction and reward from work among employed human service professionals (Demerouti et al., 2001; Freeborn, 2001) and volunteers (Bennett et al., 1996; Yiu et al., 2001). Another salient predictor of LPA for elderly Chinese volunteers was a sense of self-efficacy. As hypothesized and similar to an earlier study on Chinese teachers (Tang et al., 2001), results of this study showed that a high level of self-efficacy was predictive of a low level of LPA even after interpersonal and organization factors were entered into the regression model. Research on self-efficacy (Bandura, 1997) also suggests that elderly volunteers with a low level of personal competency may avoid challenging tasks and take on monotonous and repetitious chores in their voluntary service. This may deprive themselves potential sources of accomplishment. Moreover, elderly volunteers with low self-efficacy may also have the tendency to have cynical and pessimistic views regarding their own achievements and attach little significance to their contribution. This study also indicated that distinct predictors were noted for the EP dimension of burnout. Unlike the LPA dimension, interpersonal and organizational factors were not predictive of EP, instead, health status emerged as the most salient predictor. It may be that the EP dimension tends to have overlapping associations with psychological and somatic strains (Firth et al., 1985). In fact, studies on western samples have also identified a strong relationship between emotional exhaustion and physical symptoms (Schaufeli and van Dierendonck, 1993). Furthermore, elderly people with poor health conditions may have already experienced a high level of emotional distress in relation to the aging process, limited abilities and time, and anxiety toward death and dying (Wu et al., 2002). Thus, they may be particularly vulnerable to emotional exhaustion in their voluntary work. Among the hypothesized variables, years of experience emerged as the only common predictor of EP and LPA dimensions of burnout, albeit in different directions. It was also noted that this variable remained a significant predictor even after considering effects of age. In particular, a long period of voluntary service was related to greater emotional exhaustion and sense of personal accomplishment. These findings were similar to a study on employed substance abuse treatment therapists (Barnett and Dowd, 1997). It is plausible that elderly volunteers may be emotionally drained from their long voluntary Copyright # 2003 John Wiley & Sons, Ltd. 801 service, but were reluctant to terminate their service. As a result of cognitive dissonance, they believed themselves as accomplishing various goals to reconcile the frustrations and emotional exhaustion arising from their voluntary service. However, it is also possible that a long duration of voluntary service may provide elderly volunteers additional opportunities to achieve the desired goals to enhance their sense of personal accomplishment. Limitations and implications This study has several limitations and caution should be taken in interpreting and generalizing the results. First, the present sample was recruited from elderly community centers. Elderly volunteers working in organizations serving different clients such as young children or people with special needs were not included in this study. Thus, it remains unclear to what extent the present sample represented the population of elderly Chinese volunteers. Second, this study did not examine the nature of the voluntary work which may have important implications for burnout experience. For example, voluntary work that involves intensive interpersonal interactions may be more emotionally taxing than voluntary work that requires clerical skills. Third, the present study relied solely on self-reports of elderly volunteers regarding their health status, social support, work satisfaction, and burnout symptoms; which were subject to recall and social desirability biases. Similar to most burnout studies, elderly volunteers who experienced a severe level of burnout may have already left the service, and participants in the present study may consist of those who experienced only a low to moderate level of burnout. This may obscure the pattern of relationship between burnout and various factors. Finally, this was a cross-sectional study and its results represented associations between variables only. No conclusive statement on causal effects could be inferred from the present findings. Despite the above limitations, this study has important practical implications in mitigating burnout among elderly volunteers. In particular, organizations should strive to enhance satisfaction and perceived benefit of voluntary work to enhance the sense of personal accomplishment. Organizations can provide work-related training programs on skills acquisition and enhancement of personal competency, with frequent reassurance and feedback of their performance. Work assignments should receive social applause and fulfil community obligations rather than comprise repetitious and monotonous chores. The contribution Int J Geriatr Psychiatry 2003; 18: 795–802. 802 e. chau-wai yan and c. so-kum tang and accomplishment of volunteers should be recognized by issuing letters of appreciation and presenting awards to outstanding and long service volunteers. As good health is an important predictor of few emotional symptoms of burnout, regular check ups and health promotion programs that aim at improving the overall health conditions of elderly people are also recommended. Finally, elderly people’s level of emotional distress should also be periodically evaluated with referral to relevant intervention if necessary. 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