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Public transport policy, social engagement and mental health in older age: a quasi-experimental evaluation of free bus passes in England
  1. Erica Reinhard1,2,
  2. Emilie Courtin1,3,
  3. Frank J van Lenthe2,4,
  4. Mauricio Avendano1,5
  1. 1 Department of Global Health and Social Medicine, King’s College London, London, UK
  2. 2 Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
  4. 4 Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
  5. 5 Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Cambridge, Massachusetts, USA
  1. Correspondence to Erica Reinhard, Department of Global Health and Social Medicine, King’s College London, London WC2R 2LS, UK; erica.reinhard{at}


Background Social engagement and social isolation are key determinants of mental health in older age, yet there is limited evidence on how public policies may contribute to reducing isolation, promoting social engagement and improving mental health among older people. This study examines the impact of the introduction of an age-friendly transportation policy, free bus passes, on the mental health of older people in England.

Methods We use an instrumental variable (IV) approach that exploits eligibility criteria for free bus passes to estimate the impact of increased public transportation use on depressive symptoms, loneliness, social isolation and social engagement.

Results Eligibility for the free bus travel pass was associated with an 8% (95% CI 6.4% to 9.6%) increase in the use of public transportation among older people. The IV model suggests that using public transport reduces depressive symptoms by 0.952 points (95% CI −1.712 to −0.192) on the Center for Epidemiologic Studies Depression Scale. IV models also suggest that using public transport reduces feelings of loneliness (β −0.794, 95% CI −1.528 to −0.061), increases volunteering at least monthly (β 0.237, 95% CI 0.059 to 0.414) and increases having regular contact with children (β 0.480, 95% CI 0.208 to 0.752) and friends (β 0.311, 95% CI 0.109 to 0.513).

Conclusion Free bus travel is associated with reductions in depressive symptoms and feelings of loneliness among older people. Transportation policies may increase older people’s social engagement and consequently deliver significant benefits to mental health.

  • mental health
  • depression
  • loneliness
  • ageing
  • transportation
  • policy

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  • Contributors ER conceptualised and designed the study, carried out the analyses and drafted the manuscript. MA conceptualised and designed the study, critically reviewed the results of analyses, and reviewed and revised the manuscript. EC and FJvL critically reviewed the results of analyses and reviewed and revised the manuscript. ER is guarantor.

  • Funding This study was supported by the European Commission Horizon 2020 Programme under grant agreement no. 667661 (Promoting mental well-being in the ageing population, MINDMAP).

  • Disclaimer The study does not necessarily reflect the commission’s views and in no way anticipates the Commission’s future policy in this area. The funding source did not have a role in the design and conduct of the study, the collection, management, analysis and interpretation of the data or the preparation, review, approval or decision to submit the manuscript.

  • Competing interests None declared.

  • Ethics approval This study is a secondary data analysis of the English Longitudinal Study of Ageing (ELSA). No additional ethics approval was required. Ethical approval for ELSA was obtained from the London Multi-Centre Research Ethics Committee in England. International Review Board (IRB) number for the ethics approval of the ELSA study is IRB 00002308. Reference number for the last Medical Research Ethics Committee (MREC) approval for ELSA is MREC/04/006.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The English Longitudinal Study of Ageing datasets are available to users registered with the Economic and Social Data Service, available at