Volunteering is an intentional, proactive helping behavior aimed at enhancing social capital, strengthening the community, and delivering services that otherwise would have costs or be underprovided [1
In the last three decades, many volunteers have approached the clown activity in healthcare settings since it was found to humanize healthcare and promote patients’ good health [3
]. Clowns are colloquially called “clown doctors” as they are identified as part of the hospital medical staff, although they are not necessarily medically qualified [5
The central aspect of volunteering is the free will to help others [1
]. However, research has shown that people are motivated to volunteer also to grow and satisfy personal psychological needs [6
]. Evidence exists that volunteering may promote the volunteers’ benefits in terms of physical, social, and psychological health [9
]. Most studies have focused only on the beneficial effects of engaging in volunteering, whereas individual characteristics that may contribute to volunteers’ psychological health have not been thoroughly investigated. We committed to filling this gap in the literature by examining whether some factors associated with positive mental functioning of other populations may also play the same role in healthcare volunteers like clown doctors.
Multiple factors have shown to contribute to individual psychological health; among them, we were interested in self-efficacy, optimism, and empathy.
Psychological health has been referred to as a variety of different constructs. Positive psychology researchers differentiated between eudaimonia and hedonia [16
], which are referred to and assessed as psychological well-being and subjective well-being. Psychological well-being is the realization of one’s authentic self and positive functioning in several domains: self-acceptance, positive social relations, autonomy in thought and action, meaning and purpose in life, and continuous growth as a person [17
]. Subjective well-being is a person’s positive cognitive and affective evaluations of her or his life, including satisfaction with life and the experience of positive emotions and mood states [18
]. Since psychological and subjective well-being refer to different constructs, it was worth considering both as outcomes.
Self-efficacy and optimism are relatively stable cognitive traits that are distinct yet similar in some respects [20
]. They are both related to positive expectations in life and help people better address the difficulties [21
]. Self-efficacy refers to the individuals’ beliefs about their capability to produce given attainments and perform specific tasks [25
]. People high in self-efficacy tend to deal effectively with a variety of stressful situations to achieve their goals [26
]. Optimism refers to the generalized expectation of positive vs. adverse outcomes in essential domains of life [29
]. As a consequence of their positive view of the future, people with optimistic traits, compared to those with pessimistic traits, are more likely to use active coping strategies, achieve high goals, and engage in social activities [31
]. Extensive research has documented the link of self-efficacy and optimism with positive psychological health. Self-efficacy was positively associated with subjective well-being [34
] and its components like positive affect [35
] and life satisfaction [36
]. It was also positively related to subjective well-being in nurses [37
] and psychological well-being in nursing home residents [38
]. Optimism was a significant predictor of volunteerism, which positively influenced life satisfaction and psychological well-being [39
]. A recent study found a direct positive effect of optimism on subjective well-being [40
]. A meta-analysis found that optimism had moderated to strong associations with the three aspects of subjective well-being: it was associated positively with positive affect and satisfaction with life and negatively with negative affect [41
Empathy is an individual’s tendency to empathize with others, which develops first in childhood and remains relatively stable throughout the lifespan [42
]. However, whereas personality traits are relatively fixed, there is evidence that empathy may be influenced by education and training [45
]. Davis [42
] identified an affective and a cognitive component of empathy. The affective component includes empathic concern, which involves feelings of sorrow for others’ misfortune, and personal distress, which involves feelings of suffering for others’ difficulties. The cognitive component refers to perspective taking as the ability to accurately imagine and adopt others’ point of view. Globally, both empathic concern and perspective taking components have been linked to psychological health [46
]. A study of older adults’ informal caregivers showed that those with greater cognitive empathy appraised the caregiving situation as less stressful and threatening; in contrast, caregivers with lower empathy had reduced well-being and more depressive symptoms [48
]. In the healthcare setting, greater empathic concern and perspective-taking were associated with higher healthcare professionals’ psychosocial well-being. In contrast, higher personal distress in the presence of another’s suffering was linked to greater emotional exhaustion and risk for burnout [49
According to the empathy-altruism model [52
], empathy may lead to engaging in prosocial behavior by evoking empathic feelings, which elicit altruistic motivation and interest in others’ well-being. Therefore, it is a crucial component in the decision to volunteer [6
], and greater empathy was positively associated with the amount of time spent on volunteering and the duration of the voluntary service [53
]. Although the direct link between volunteers’ empathy and their psychological health has not been investigated yet, we could expect that empathy cognitive and affective components were associated with volunteer clown doctors’ psychological health in the same direction as healthcare professionals [49
]. Given the crucial role of empathy in volunteering, we also expected that empathy adds to the explanation of psychological health, over and above that accounted for by self-efficacy and optimism.
This study aimed to test whether self-efficacy and optimism were positively associated with volunteer clown doctors’ psychological health and whether empathy explained some incremental variance of this outcome. Specifically, we expected that empathic concern and perspective taking were positively associated, while empathic personal distress was negatively associated with the volunteers’ psychological health. Our general intent was to add to how healthcare volunteers can benefit from their volunteering activities, also considering their characteristics.
This study aimed to test whether self-efficacy and optimism were associated with psychological and subjective well-being among volunteer clown doctors since they were found to be related to other populations’ psychological health [34
]. This study also aimed to test whether empathy explained an incremental variability of psychological health, over and above self-efficacy and optimism since it is a crucial dimension in the decision to volunteer [6
]. We chose clown doctor volunteers as they are required to be exceptionally able to empathically listen and respond to the emotional state of people, mostly children, in the hospital [5
]. This was the first study investigating whether psychological characteristics of these volunteers can contribute to their positive psychological functioning.
This study’s findings indicated that self-efficacy and optimism explained part of the variability of the participants’ psychological and subjective well-being and that empathy explained an incremental variability. Self-efficacy and optimism jointly explained a moderate-to-large portion of the variability in positive psychological functioning, in line with previous evidence of such a positive role in other populations [27
As for the contribution of empathy, the cognitive ability to imagine other people’s points of view explained an incremental 2% in the variance of psychological well-being and an additional 5% in the variance of subjective well-being. These findings were in line with evidence showing an association of the cognitive component of empathy with increased emotional adjustment in the general population and healthcare staff [46
]. Perspective-taking involves a shift in the understanding of another’s situation as separate from one’s own; thus, it requires a self-other distinction that differentiates it from emotional contagion and is likely responsible for its positive association with psychological health. Notably, when empathic perspective taking was entered in the regression model with subjective well-being as the outcome, the contribution of optimism was suppressed, becoming nonsignificant. This result is coherent with experimental evidence that taking on others’ points of view can reduce individuals’ unrealistic optimism about the likelihood of specific life outcomes [62
]. The affective component of empathy represented by personal distress also explained an incremental 2% of the variability in psychological well-being, over and above that explained by self-efficacy and optimism. In contrast, its association with subjective well-being did not reach statistical significance. In both models, more considerable empathic distress was linked to worse psychological and subjective well-being. It was consistent with previous research on healthcare professionals pointing to the potentially adverse implications of an individual’s tendency to experience negative affect involving vicarious arousal when exposed to another person’s plight [49
Notably, in this study, only two of the four empathic dimensions considered contributed to explaining the variability of psychological health. Fantasy as the tendency to become immersed in the feelings and actions of fictional characters was unrelated to participants’ psychological health, consistent with previous studies [42
]. Moreover, some researchers do not see fantasy as a core element of the empathic experience [44
]. Instead, the nonsignificant association found in this study between empathic concern and psychological health is inconsistent with the majority of previous studies, which reported significant positive associations [46
]. Such a result might be partly attributable to the peculiarity of our sample. Some researchers proposed an association between feelings of sympathy for the others’ misfortune and the willingness to get involved in volunteer work [42
]. It is possible that for individuals with great empathic concern for others like volunteers involved in helping people, this component of empathy is not relevant to their mental health. However, further studies are needed to interpret these findings better.
As a final consideration, we should point out that although our regression models explained a large and medium proportion of the variability of psychological and subjective well-being, respectively, they did not fully explain the considered outcomes. Other studies of volunteers found other predictors of their psychological health, such as supportive work climate and autonomous motivation [64
]. Other personality traits that characterize the Italian clown doctors, such as high agreeableness, conscientiousness, openness, extraversion, and low neuroticism [65
], might also contribute to their psychological health. Therefore, further studies are needed to determine what could explain the remaining variance of psychological and subjective well-being.
Limitations and Future Directions
The principal limitation of the present study was its cross-sectional design that did not allow conclusions about the causal effects of the participants’ characteristics on their psychological health. Further longitudinal studies are thus warranted to replicate our findings. It would also be desirable to replicate the study with professional clown doctors to investigate whether the associations found in this study can be extended. Another limitation is that we did not use measures of patients’ or hospital staff’s perspective on the clown doctors’ empathic skills. Future studies using multiple informants are thus encouraged. Also, among the independent variables, only self-efficacy referred explicitly to the volunteer activity; therefore, future studies might use measures of both optimistic and empathic tendencies related to volunteering. Finally, the findings of the present study cannot be generalized as the sample was self-selected. Thus, it was not representative of the Italian volunteer clown doctors, although the sample size included almost 3% of that population.