RESEARCH NOTE

Volunteers and the Risk of

Posttraumatic Stress Disorder
Eli Jaffe,1 Uzi Sasson,2 Haim Knobler,2
Einat Aviel,3 Avishy Goldberg2
1Magen David Adom,
2Ben-Gurion University of the Negev, 3Bar-Ilan University

Symptoms of posttraumatic stress disorder (PTSD) result from

exposure to a traumatic event and influence a person’s ability to
cope psychologically. Recent documentation from emergency
rooms shows that medical personnel, including volunteers who
treated severely injured people, can develop symptoms of PTSD
even though the volunteers themselves were not personally sub-
jected to the stressful event. This article finds similar results
among adolescents who volunteered with Magen David Adom
(MDA), Israel’s national emergency medical, disaster, ambulance,
and blood bank service. Because of the security threats Israel has
faced, these adolescents are likely to be exposed to traumatic
events during their volunteer service, and some may develop
PTSD. This article explores who is most susceptible to develop-
ing PTSD and the underlying theories of why that may be the
case. Since the adolescents’ motives to volunteer vary, the article
proposes that volunteers with certain motives retain their enthu-
siasm for volunteering despite the danger of developing PTSD
symptoms. It also finds that some of the motives to volunteer cor-
related with a reduction in the level of PTSD symptoms. Under-
standing the adolescents’ motivations to volunteer will help
nonprofit leaders and managers allocate volunteers according to
their motivations and the levels of threat a particular job entails.
Keywords: volunteers, nonprofit management, third sector,
health, motivation

Correspondence to: Uzi Sasson, 33 Chad Ness St., Ramat-Gan 52331, Israel.
E-mail: Uzi.Sasson@gmail.com

NONPROFIT MANAGEMENT & LEADERSHIP, vol. 22, no. 3, Spring 2012 © 2012 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/nml.20059
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368 J A F F E , S A S S O N , K N O B L E R , AV I E L , G O L D B E R G

T his article addresses adolescent volunteers who serve with

emergency medical services (EMS) professionals. It also ex-
amines adolescents’ motivations for volunteering and re-
maining in their positions for long periods of active service. We
hypothesize that the effect of the experience of traumatic events
on volunteer attrition is moderated by the adolescents’ motivation
for volunteering.
Posttraumatic stress disorder (PTSD) can influence an individ-
ual’s daily activities through symptoms that include obsessiveness,
anxiety, hostility, phobia, paranoia, depression, and a tendency
toward psychosis. For example, a traumatic event can cause a per-
son to experience difficulty sleeping, dreams that occur in relation
to the traumatic event, excessive nervousness, flashbacks from the
event, and even major changes in normal behavior (Beaton and
Murphy, 1995; Horowitz, Wilner, and Alvarez, 1979).
By examining the motivations to volunteer, a manager of vol-
unteers will be able to better determine assignment allocations and
diminish the possibility of a volunteer developing PTSD. Volunteer
managers are encouraged to perform an assessment during the
Emergency recruitment process, with the objective of discovering the applicant’s
motivations to volunteer. In this process, and according to the results
service providers of this study, the manager will be able to best assign missions to
have higher levels those volunteers who are less likely than others to develop PTSD.
of PTSD Although we conducted the study on Israeli adolescent EMS vol-
unteers, we believe our conclusions may be relevant to a wider array
symptoms than of leaders and managers of volunteers outside the Israeli context,
does the general outside the EMS context, and even outside the adolescent context.
population.
Literature Review
For the past several decades, there has been increasing evidence
for the risk of developing mental symptoms, including symptoms
of PTSD, among workers and adult volunteers in rescue and first-
aid teams (Beaton and others, 1999; Corneil, 1995; Durham,
McCammon, and Allison, 1985; O’Rear, 1992). Research has
shown that among EMS professionals there is a connection be-
tween experiencing trauma and developing PTSD (Fullerton,
McCarroll, Ursano, and Wright, 1992). For example, emergency
service providers have higher levels of PTSD symptoms than does
the general population (McCarroll, Ursano, Fullerton, Liu, and
Lundy, 2002). The psychological stressors that might account for
this higher prevalence of PTSD come in part from the work envi-
ronment of the emergency service personnel—an environment
that frequently exposes the workers to safety threats, hazardous
materials, disturbing injuries and deaths, and mass casualty inci-
dents (Beaton and Murphy, 1995; Corneil, 1995). This work envi-
ronment has been described as a continuous state of helplessness,
panic, and behavioral transformations (Raphael, 1986).

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 VOLUNTEERS AND THE RISK OF P O S T T R A U M AT I C S T R E S S D I S O R D E R 369

There seems to be a correlation between age and the onset of

PTSD. Young EMS workers are more likely than their older col-
leagues to develop acute stress disorder (Fullerton, Ursano, and
Leming Wang, 2004). For example, in a study that examined symp-
toms of PTSD among paramedics working after the road collapse fol-
lowing the 1989 Loma Prieta earthquake in northern California,
Marmar, Weiss, Metzler, Ronfeldt, and Foreman (1996) found that
younger paramedics reported more symptoms of PTSD than did their
senior colleagues.
Despite the fact that volunteers who treat victims during disas-
ters and wars are available and are easily accessible for research, very
few studies have examined symptoms of PTSD among volunteers.
In addition, even though volunteers are not forced to perform their
jobs, those who serve in medical and first-aid teams are not immune
from developing PTSD symptoms (Bryant and Harvey, 1995). There Clary and others
has been some speculation that the connection between experiencing
trauma and developing PTSD is true of volunteers who give emer-
(1998) have listed
gency aid. Bryant and Harvey (1995) found that one-fourth of vol- six basic
unteer firefighters reported significant PTSD symptoms. Most of the motivations that
volunteers attributed their symptoms to personal experiences and
the large number of critical incidents they had recently witnessed.
explain
Most of the research on symptoms of PTSD has focused on pro- volunteers’
fessional EMS workers, and a smaller number of studies screened commitment for
volunteers. We could not find studies on adolescent EMS volunteers
and their links to PTSD. We believe that research is needed to bet-
their assigned
ter understand the link between adolescents volunteering in EMS work: (1) values,
and PTSD, which has a significant psychological dysfunction. We (2) understanding,
assumed in our study that the adolescents’ reasons for volunteering
may have influenced the likelihood that they would experience a
(3) social,
reduced level of PTSD. We asked what motivations to volunteer (4) career,
might increase or decrease the number of PTSD symptoms of ado- (5) protective
lescent EMS volunteers.
A number of psychologists and researchers have developed the
functions, and
motivational theory of volunteering (Chinman and Wandersman, (6) enhancement.
1999; Clary, Snyder, and Stukas, 1996; Clary and others, 1998;
Cnaan and Goldberg-Glen, 1991; Omoto and Snyder, 1993; Sasson
and Sasson, 2009; Yeung, 2004). Clary and others (1998) provide a
sufficient basis from which to outline volunteers’ recruitment and
retention with respect to their motivations and satisfaction. More
specifically, Clary and others’ (1996, 1998) list of motivations cor-
relate with the psychological tools that ease PTSD.
Clary and others (1998) have listed six basic motivations that
explain volunteers’ commitment for their assigned work: (1) values,
(2) understanding, (3) social, (4) career, (5) protective functions,
and (6) enhancement. Values are defined as “the opportunities to
express altruistic and humanitarian concerns for others” (p. 1517).
The researchers claim that the volunteer’s values as a motivation are
measured according to the volunteer’s concern for other groups or

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370 J A F F E , S A S S O N , K N O B L E R , AV I E L , G O L D B E R G

individuals to whom the volunteer feels compassion and has an urge

to help. Thus, volunteering becomes a cause rather than a goal.
Understanding expresses the need of volunteers to increase
knowledge and/or practice skills that otherwise would not be exer-
cised (Clary and others, 1998). The researchers measure this moti-
vation with the perception that the volunteers’ expectations are that
they will learn more about the volunteering subject matter, gain new
perspective on the work, or have hands-on experience.
Social motivation realizes rewards from one’s acquaintances and
friends (Clary and others, 1998). The researchers emphasize the
influence of the volunteer’s social circles as the motivation to vol-
unteer. They argue that once a group of friends reaches a critical
mass, it causes its members to take action and to start volunteering.
Clary and others (1998) claim that the degree to which friends vol-
unteer or want their groups to volunteer and feel that volunteering is
important indicates the extent to which social motivation is impor-
tant in considering a volunteering job.
Career is concerned with career-related benefits (Clary and others,
1998). The researchers state that volunteering influenced by this
motivation is a means to leverage one’s professional success. Volun-
teering can be the first step to a paying job, can be mentioned as an
experience on the volunteer’s curriculum vitae, and can also serve
as a network for future job applications. This motivation provides
the greatest influence on volunteering and is congruent with volun-
teer retention (Clary and others, 1996, 1998).
The motivation to offer protective functions is related to ego and
personal perception and serves as a remedy to negative feelings
(Clary and others, 1998). The researchers emphasize the psycho-
logical benefits of volunteering: it is an effective means to forget bad
feelings, loneliness, guilt over one’s good fortune, and other personal
problems and difficulties.
The final volunteer motivation is enhancement of one’s positive
feelings and confidence (Clary and others, 1998). The researchers
acknowledge the strengthening of positive feelings such as enhance-
ment, self-importance, and admiration by others as a result of vol-
unteering.
Our study asks what might buffer volunteers from the ill effects
of trauma, specifically which motivations might be of greater signif-
icance than others. An adequate analysis of adolescent volunteers
will expand our knowledge of the factors that affect the best use of
this unique population of volunteers in challenging settings.

Study Population
We conducted the study with Magen David Adom (MDA) in Israel.
MDA, Israel’s national first-aid and EMS organization, employs vol-
unteers ages fifteen to eighteen as part of its ambulance teams.
Using a convenient sampling method, we examined 620 ambulance

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 VOLUNTEERS AND THE RISK OF P O S T T R A U M AT I C S T R E S S D I S O R D E R 371

volunteers out of thousands who volunteer for MDA. The volun-

teers who participated in the study were adolescents with an aver-
age age of 16.4 years old. These adolescents trained for sixty hours
to administer first-aid care to injured people using CPR (car-
diopulmonary resuscitation), bandaging methods, and evacuation
and stabilization of the person before he or she was admitted to a
hospital emergency room. These adolescent ambulance volunteers
provided first aid in road accidents, work accidents, and other
emergencies during the years 2003–2005.
The participants in this study volunteered for a week-long semi-
nar after volunteering actively for six months. The seminar attracted
volunteers from all regions of the country; it was open to all MDA vol-
unteers ages fifteen to eighteen. Males made up 45.6 percent of the
participants in the study, while 54.4 percent were females. Most
of the participants were Jewish (98.8 percent), though about half of
them (49.4 percent) did not practice Judaism; the rest, 50.6 percent,
practiced Judaism on various degrees. The exact parameters of the
volunteers’ population in MDA are not available, yet by talking to
professionals in this organization we sensed that the numbers are Participants in
somewhat the same for the entire adolescence volunteer population this study were
in MDA. Therefore, the transferability to MDA volunteers’ popula- screened for
tion is possible. However, the specificity of the context in which this
research was conducted does not enable a comparison with the PTSD during the
entire adolescence volunteer population in Israel. application
Participants in this study were screened for PTSD during the process to ensure
application process to ensure that their starting levels of PTSD were
not elevated. The application forms queried about PTSD levels, and that their starting
we determined whether an applicant was suitable for the job so as levels of PTSD
not to admit people who already had PTSD into the training. were not
elevated.
Methods
We composed a survey that included Clary and others’ (1998)
thirty-item questionnaire to investigate volunteers’ motives, and
Horowitz and others’ (1979) Impact of Events Scale (IES question-
naire) to detect the impact of traumatic events. The IES includes
sixteen items for the investigation of PTSD. In addition, we pro-
vided the SCL-90 scale, a questionnaire that includes ninety items
for examination of psychiatric symptoms for obsession, anxiety,
phobia, depression, and more (Derogatis, 1977). We used the same
categories as in the original surveys, with only one response possi-
ble. All parts of the questionnaire had been widely used in previ-
ous studies in the field of nonprofit administration and psychiatry.

Results
To answer the questions that arose in this study, we used Pearson’s
correlation test. To understand which of the motivations correlated

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Table 1. Pearson’s Correlations Between Motivation to Volunteer

and Level of Psychiatric Variables
Protective
Values Understanding Social Career Function Enhancement

Psychiatric variables ⫺0.052 0.053 ⫺0.114(*) 0.074 0.183(*) 0.078

(based on the SCL–90)

*Correlation is significant at the 0.01 level (one-tailed).

Table 2. Pearson’s Correlations Between Motivation to Volunteer

and Specific Psychiatric Variables
Protective
Variable Values Understanding Social Career Function Enhancement

Obsessiveness ⫺0.009 0.069 ⫺0.079* 0.105** 0.188** 0.08*

Anxiety ⫺0.032 0.049 ⫺0.086* 0.091* 0.158** 0.086*
Hostility ⫺0.097* 0.016 ⫺0.132** 0.078 0.131** 0.044
Phobia ⫺0.058 0.017 ⫺0.075 0.024 0.08* 0.035
Paranoia ⫺0.059 0.079 ⫺0.136** 0.057 0.197** 0.088*
Tendency for psychosis ⫺0.098* 0.031 ⫺0.106** 0.055 0.145** 0.061
Sleep problems ⫺0.022 0.055 ⫺0.071 0.067 0.136** 0.047
Eating problems ⫺0.016 0.010 ⫺0.075 0.027 0.087* 0.038
Interpersonal problems ⫺0.052 0.048 ⫺0.118** 0.022 0.159** 0.075
Depression ⫺0.021 0.038 ⫺0.113** 0.066 0.171** 0.056

*Correlation is significant at the 0.05 level (one-tailed).

**Correlation is significant at the 0.01 level (one-tailed).

positively or negatively with the psychiatric variables, we used a

one-sided test. A significant negative correlation indicated a nega-
tive influence on PTSD and therefore was labeled as a motivation
that might help in reduction of the symptoms. Conversely, a signif-
icant positive correlation pointed out the motivations that might
increase the PTSD symptoms.
Table 1 shows the correlation between the different motivations
to volunteer and the scale of the psychiatric variables. The table
demonstrates a significant and negative association between the vari-
able social (⫺0.114) and PTSD. In addition, Table 1 indicates a sig-
nificant and positive correlation between protective function (0.183)
and PTSD. While social motivation to volunteer helped to reduce
PTSD, protective motivation to volunteer increased the symptoms.
The other four motivations to volunteer—values, understanding,
career, and enhancement—were not found to be significant. Hence,
Table 1 does not explain the power of the other volunteer motiva-
tions on the psychiatric variables.
Table 2 presents bivariate Pearson’s correlations among the psy-
chiatric variables and the motivations to volunteer. We show only

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 VOLUNTEERS AND THE RISK OF P O S T T R A U M AT I C S T R E S S D I S O R D E R 373

Table 3. Pearson’s Correlation Between Motivation to Volunteer

and Symptoms in the IES Questionnaire
Protective
Values Understanding Social Career Function Enhancement

Pearson’s correlation ⫺0.04 0.021 ⴚ0.094* 0.056 0.164** 0.064

*Correlation is significant at the 0.05 level (one-tailed).

**Correlation is significant at the 0.01 level (one-tailed).
Note: N ⫽ 587.

the psychiatric variables that significantly correlated with at least one

of the six motivations for volunteer service. Values was weakly and
negatively correlated with hostility and the tendency for psychosis.
Specifically, as the values for volunteering increased because of con-
cern for people in need of medical care that resulted from traumatic
situations, respondents reported lower levels of hostility (⫺0.097)
and had lower tendencies for psychosis (⫺0.098). Career was mod-
estly and positively correlated with levels of obsessiveness (0.105)
but weakly correlated with levels of anxiety (0.091). As the level of
the career motivation increased, the levels of obsessiveness and
of anxiety increased as well. Social motivation was modestly
and negatively correlated with hostility (⫺0.132), paranoia (⫺0.136),
tendency for psychosis (⫺0.106), interpersonal problems (⫺0.118),
and depression (⫺0.113). It was also weakly and negatively corre-
lated with obsessiveness (⫺0.079) and anxiety (⫺0.086). More
specifically, as the level of the social motivation increased, volunteers
reported that the levels of obsessiveness, anxiety, hostility, tendency
for psychosis, interpersonal problems, and depression decreased.
Enhancement as a motivation to volunteer was weakly and pos-
itively correlated with obsessiveness (0.08), anxiety (0.086), and
paranoia (0.088). As enhancement increased, posttraumatic symp-
toms such as obsessiveness, anxiety, and paranoia increased as well.
Finally, protective function was moderately and positively correlated
with obsessiveness (0.188), anxiety (0.158), hostility (0.131), para-
noia (0.197), tendency for psychosis (0.145), sleep problems (0.136),
interpersonal problems (0.159), and depression (0.171). In addition,
protective function was positively but weakly correlated with phobia
(0.08) and eating problems (0.087). When the level of protective
function was high, the volunteers were more likely to produce higher
levels of obsessiveness, anxiety, hostility, phobia, paranoia, tendency
for psychosis, sleep problems, eating problems, interpersonal prob-
lems, and depression.
To test the correlation between the motivation to volunteer and
PTSD symptoms for adolescents who gave medical care in a traumatic
event, we used Horowitz and others’ (1979) IES scale. Table 3 indi-
cates that social motivation was negatively and weakly correlated with
PTSD symptoms listed in the IES scale. This finding indicates, again,

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374 J A F F E , S A S S O N , K N O B L E R , AV I E L , G O L D B E R G

that when the level of social motivation was high, the level of PTSD
symptoms was low. The motivation protective function was found to
be moderately and positively correlated with PTSD as reflected in the
IES questionnaire. As the level of protective function motivation to
volunteer increased, the level of PTSD increased. Table 3 validates the
results shown in Table 2 for the motivations social and protective
function using the IES tool with the number of participants (N ⫽
587) who answered the various sections of the survey.

Discussion and Conclusion

The results exposed the association between motivations to volun-
teer and the level of PTSD symptoms such as obsessiveness, anxi-
ety, hostility, phobia, paranoia, depression, and the tendency of
psychosis. Among the sampled participants, volunteers who gave
medical care for traumatic events, such as accidents and severe in-
Volunteers who jury situations, have dealt better with PTSD when their initial mo-
tivation for volunteering was social. Being part of a larger social
gave medical care circle of committed volunteers mitigated the tendency toward
for traumatic PTSD. A casual volunteer who is less grounded in a strong social
events, such as group may be more susceptible to developing PTSD symptoms.
Relationships between and among volunteers support the volun-
accidents and teer experience and provide informal therapy after exposure to a
severe injury traumatic event. For example, friendly discussions after a trau-
situations, have matic event, when volunteers share the emotional challenges with
which they had to cope, may help the volunteers maintain a high
dealt better with motivation to volunteer despite the difficult situations they may
PTSD when their have encountered.
initial motivation Furthermore, engaging with friends and other volunteers who
may be compassionate people and who have experienced similar sit-
for volunteering uations may help the volunteer to reduce his or her psychiatric post-
was social. traumatic symptoms. The results indicate that those social circles
may reduce the domination of the volunteer’s persistent thoughts
and images from the traumatic event. The volunteer’s social rela-
tionships inside the organization may become a place of comfort that
may reduce the state of apprehension and psychic tension resulting
from the exposure to the event. In addition, hostility, paranoia, and
depression may be calmed by talking to a close friend or fellow vol-
unteer. Close social circles may help to improve the volunteer’s inter-
personal problems and delusions resulted from trauma.
We did not find that friends have any effect on symptoms such
as sleeping problems or eating problems caused by trauma. We can-
not conclude that volunteering motivated by close social friends is
a remedy for eating or sleeping disorders. We think that because
those actions are personal and are usually not social actions, close
friends and other volunteers cannot influence them. Volunteers who
have fears from a specific activity resulting from trauma tend to leave

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 VOLUNTEERS AND THE RISK OF P O S T T R A U M AT I C S T R E S S D I S O R D E R 375

their organizations for a short period of time. During the break from
activities, these volunteers try to deal with their sleeping or eating
disorders but find themselves back at the organization because of
their friends, who help them lower the levels of other psychiatric
symptoms such as anxiety, hostility, and depression.
The results also indicate that volunteers who are motivated by
altruism and ideals to help others and the community and have been
exposed to trauma lowered their levels of hostile attitude and their ten-
dencies to develop psychosis. Values such as altruism not only move a
person to volunteer for the community but also reduce the volunteer’s
levels of general resistance, antagonism, and unfriendliness.
Motivations to volunteer for the sake of a future career or to
improve one’s self-esteem, and volunteering for the purpose of reliev-
ing guilt accelerate the psychiatric reactions resulted from a trauma.
For example, a person who may try to protect him- or herself and
reduce the guilt that comes from an already low psychiatric state of Volunteers who
mind by taking on a volunteer role. Volunteering that exposes that join an
individual to traumatic events tends to increase his or her already
existing mental disorders. Hence, that volunteer may become more organization
depressed and less confident about his or her environment and also because of social
may feel paranoid at higher levels than he or she initially felt. motivation deal
The conclusions of this study are very important during the crit-
ical stage of volunteer recruitment. Volunteers who join an organi- better with
zation because of social motivation deal better with traumatic events. traumatic events.
Therefore, an organization should select these volunteers and moti- Therefore, an
vate them to join in any way it can. An organization should dis-
criminate against volunteers who seek the position because they organization
hope it will enable them to deal with inner conflicts, feelings of should select
incompetence, uncertainties about social identity, and emotional these volunteers
needs, because these emotions and feelings are likely to increase
these and other mental disorders. and motivate
An organization engaged in handling traumatic events, such as them to join in
the police, the army, firefighters, first-aid medical caregivers, EMS any way it can.
providers, and emergency room personnel, are recommended to sur-
vey their volunteers’ motivational objectives so that they can better
assign them to jobs that hold the likelihood of participating in trau-
matic events. This will help the organizations and the volunteers to
deal with PTSD and may even help prevent the onset among volun-
teers of symptoms from PTSD.
In summary, through examination of a volunteer’s motivations,
a volunteer manager can better decide on the allocation of assign-
ments on a daily or weekly basis. Volunteer managers should be
encouraged to periodically perform an examination of volunteer
motivations. We recommend that volunteer managers assign mis-
sions that have high risk of involvement in a traumatic event only
to volunteers who are supported socially and who are prepared pos-
itively and emotionally to deal with trauma.

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ELI JAFFE is division director of Magen David Adom in Tel Aviv, Israel.

UZI SASSON is a researcher at the Israeli Center for Third-Sector

Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

HAIM KNOBLER is a professor in the Department of Health Systems Man-

agement, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

EINAT AVIEL is a professor in the Department of Life Sciences, Bar-Ilan

University, Ramat Gan, Israel.

AVISHY GOLDBERG is a professor in the Department of Health Systems

Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Nonprofit Management & Leadership DOI: 10.1002/nml