Relationships in the 21st century: the forgotten foundation of mental health and wellbeing
Relationships are one of the most important aspects of our lives, yet we can often forget just how crucial our connections with other people are for our physical and mental health and wellbeing.
People who are more socially connected to family, friends, or their community are happier, physically healthier and live longer, with fewer mental health problems than people who are less well connected.
It’s not just the number of friends you have, and it’s not whether or not you’re in a committed relationship, but it’s the quality of your close relationships that matters. Living in conflict or within a toxic relationship is more damaging than being alone.
As a society and as individuals, we must urgently prioritise investing in building and maintaining good relationships and tackling the barriers to forming them. Failing to do so is equivalent to turning a blind eye to the impact of smoking and obesity on our health and wellbeing.
The Mental Health Foundation defines relationships as ‘the way in which two or more people are connected, or the state of being connected’. Relationships include the intimate relationships we have with our respective partners, those we form with our parents, siblings and grandparents, and those we form socially with our friends, work colleagues, teachers, healthcare professionals and community.
Extensive evidence shows that having good-quality relationships can help us to live longer and happier lives with fewer mental health problems. Having close, positive relationships can give us a purpose and sense of belonging.
Loneliness and isolation remain the key predictors for poor psychological and physical health. Having a lack of good relationships and long-term feelings of loneliness have been shown by a range of studies to be associated with higher rates of mortality, poor physical health outcomes and lower life satisfaction.
A review of 148 studies concluded that ‘the influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity and obesity’ and that ‘physicians, health professionals, educators, and the media should […] take social relationships as seriously as other risk factors that affect mortality’.1
It is the quality of our relationships that matters. In seeking to combat loneliness and isolation we need to be aware that poor-quality relationships can be toxic and worse for our mental health than being alone. Research shows that people in unhappy or negative relationships have significantly worse outcomes than those who are isolated or have no relationships.
While 86.7% of people report that they had someone to rely on in times of stress2, such as a family member, spouse or friend, we are becoming a society that feels lonelier than we ever have before. This has been reflected in the changing nature of our society.
How we interact and form relationships has changed considerably over the past decade. The evolving family structure, development and reliance on online technologies, longer working hours, and changes in how we define community mean that who we connect with and how we connect may never be the same again.
Recognising the importance of good relationships and defining new ways of developing and maintaining strong social connections are integral to our wellbeing as a nation.
In 1938, Harvard University began following 724 participants as part of the longest-running study on human development in history. The study was developed to determine what makes us happy. The study explored every part of who we are, from physical and psychological traits to social life and IQ, to learn how we can flourish. Findings from the study were published in the 2012 book Triumphs of Experience, with key results showing that happiness and health aren’t a result of wealth, fame or working hard, but come instead from our relationships.3
Exploring relationships across the life course: why our relationships matter
Children and young people
During childhood and adolescence, we learn how to engage with others from our parents, families and guardians. We mimic the behaviour and emotions of those around us, and this early socialisation shapes how we understand and model relationship-forming behaviour throughout life.
The attachment that a child has with its parent or guardian is a central predictor for mental health and wellbeing, as well as relationship satisfaction, during adulthood. Changes in family structure, and increased levels of relationship and family breakdown, can act to interrupt the forming of positive bonds and have been found to impact negatively on academic attainment, as well as future attitudes to relationships.
While families, parents and caregivers are central to our wellbeing, during adolescence, friends and peers become more significant as young people become more independent and start to build their own social networks. As a result, toxic relationships and negative experiences, such as bullying or social isolation, can be more relevant and have a serious impact on young people’s mental health.
Schools and the teacher-student relationship, and positive support from organisations such as youth clubs, can act as a buffer and help protect young people during this difficult time.
Family harmony is more predictive of a child’s wellbeing than the family structure itself.
Higher rates of mental health problems such as depression and anxiety have been associated with loneliness, isolation and social rejection during adolescence.
In 2015, 43% of young people aged 10 to 15 in the UK reported having been bullied4. Of these, 29% reported they self-harmed, 27% skipped class, 14% developed an eating disorder and 12% ran away from home as a result of bullying. Thirty per cent had suicidal thoughts, 14% used drugs and/or alcohol, and 6% engaged in risky behaviours.
Adulthood can be a time of stability and brings the joys of discovering new relationships, including building a family. However, it is also a time when key risks for loneliness and isolation can significantly impact on us, including relationship breakdowns and divorce, poor work-life balance, children leaving the family home, retirement, and bereavement.
As a result, the relationships we maintain throughout our adult lives are more important to our mental health than we sometimes realise. Those in a stable relationship have been found to be happier, healthier and more satisfied with life.
Longer working hours, money problems and less time to spend with family have been reported as some of the most important stress factors for relationships during this time of life. The recession has had a significant impact on people, increasing stress and putting relationships under strain. Friendships have been found to decline with age and many adults wish they could spend more time with friends.
Being in a stable relationship is linked to both physical and mental health benefits, including lower morbidity and mortality5. However, while being in a relationship can have positive benefits for health, it is important to recognise that unhappy relationships are more destructive than being single. Research has found that poor-quality or unhappy relationships have a higher negative influence on physical and mental health than not being in a relationship.6
Evidence suggests that men and women treat friendships differently, with women being more likely to have broader, more intimate relationships than men. As a result, men are less likely to discuss personal matters with their friends than women, so may be less socially and emotionally supported during times of stress and crisis7,8.
Having a friend who is happy and lives close by can increase happiness by as much as 25%. Similar results have been found for cohabitant spouses (8%), siblings (14%) and next-door neighbours (34%)9.
Many people continue to have an active role within society well into their later years, with retirement and changing care responsibilities providing more time and opportunity to take on new hobbies and interests. While this is true for many people in later life, loneliness and isolation has been found to be a significant issue for older people aged over 65.
An increasing number of older people living in the UK report feeling isolated and lonely within their everyday lives. This is particularly relevant for those living with long-term conditions that can make it difficult to leave the house.
During this time of life, we can often forget the importance of intimate relationships and friendships, and the changing role from being a parent to being a carer or grandparent. These bring about significant changes that impact on and alter our relationships.
People aged 75 and over are the least likely to have at least one close friend, with 11% having no close friends at all, compared to only 2% of those aged 18 to 2410.
Having few close relationships has been linked to higher rates of depression and stress in older adults.
Being part of a community helps us feel connected, supported and gives us a sense of belonging. Involvement in local activities, such as volunteering or playing sports as part of a team, has been shown to improve mental health and wellbeing.
However, communities are changing from the traditional neighbourhoods where everyone knows each other. This is because of the impact of longer working hours, differing family structures, more movement and fluctuation in where we live, and the emergence of, and modern society’s reliance on, online technologies and social media.
Many of us use social media or online networking sites, often as a way of feeling connected to our friends and to increase feelings of belonging. Despite the increased use of online communication, almost half of internet users in the UK reported that the internet had not increased their contact with friends or family who had moved away11.
While online communities can help us connect, they can also be damaging and blur the line of who our friends really are. They can expose people to unhealthy communication, including trolling. It is important that, as a society, we evolve to become skilled in developing and sustaining healthy online relationships.
The importance of community appears to be declining in modern society, with only 42.5% of people aged 16 to 25 rating associations with others in their community as important, compared to 73.1% of over 75s.12
Moving away from one’s hometown, family and friends can have a very real impact on our relationships. Moving means having to adapt to a new physical and social environment. Studies suggest that one of the biggest challenges facing individuals when they move is building relationships and connecting with others.13
While online and mobile technologies can provide a means of connecting and can increase our sense of belonging – therefore having a positive impact on our relationships – research suggests that this cannot replace our offline relationships. It is the neurochemical response that occurs during face-to-face interactions that contributes to wellbeing.14
Mental health experiences
While our relationships impact on our mental health, it is important to remember that our mental health can impact on how we connect with others and how we develop relationships. Mental health problems such as depression and anxiety can influence whether someone feels able to interact and connect to others.
This means that developing relationships and socialising in traditional ways can be challenging for some people. Part of someone’s recovery journey may be to develop more confidence in social settings and to build healthy relationships.
It is important to recognise the challenges that someone with a mental health problem can encounter in navigating social settings or relationships. Most people with mental health problems recover and go on to live full lives, but this can take time and the right kind of support.
Investing in relationships - time for us all to commit to going the extra mile
The relationships we form as children and young people are predictors of our future mental health and wellbeing. They remain important throughout our life. In terms of physical health, the quality of our relationships is as critical as not smoking and is more important than eating well or exercising.
For our mental health, having few close relationships has been linked to higher rates of depression and stress. However, as we get older, relationships often get forgotten as life gets busier with work and commitments.
We need a sea change in thinking. Instinctively, we recognise that relationships are important. However, for many of us, our approach to building and maintaining relationships is passive – it is something we do subconsciously and without deliberate effort. We often overlook that it requires an investment of time to maintain good relationships.
In parallel, when it comes to keeping physically well, we recognise that exercise and eating well require commitment and dedication – until good habits become second nature. We need to adopt a similar approach to building and maintaining good relationships.
The Mental Health Foundation believes we urgently need a greater focus on the quality of our relationships. We need to understand just how fundamental relationships are to our health and wellbeing. We cannot flourish as individuals and communities without them. In fact, they are as vital as better-established lifestyle factors, such as eating well, exercising more and stopping smoking.
We are lobbying national governments, public bodies and employers to promote good relationships and to tackle the barriers to forming them, including mounting pressures on work-life balance and the impact of bullying and unhealthy relationships.
But we have a challenge for the public too. We are asking everyone to go the extra mile in prioritising their relationships. We are calling on people to make a relationships resolution: to assess how much time we actively commit to building and maintaining good relationships, and to ask whether we can invest more in being present with and listening to friends, family and colleagues. Make your relationship resolution today and reap the benefits for your health and wellbeing.
Five things you can do
- Give time: put more time aside to connect with friends and family.
- Be present: it can be tempting to check your phone, Facebook messages or even work emails when with family and friends. Try to be present in the moment and be there for your loved ones, and switch out of work mode whenever possible.
- Listen: actively listen to what others are saying in a non-judgemental way and concentrate on their needs in that moment.
- Be listened to: share how you are feeling, honestly, and allow yourself to be listened to and supported.
- Recognise unhealthy relationships: being around positive people can make us happier; however, our wellbeing can be negatively affected by harmful relationships, leaving us unhappy. Recognising this can help us move forward and find solutions to issues.
- Holt-Lunstad, J., Smith, T.B. & Layton, J.B. (2010). Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med, 7 (7), http://dx.doi.org/10.1371/journal.pmed.1000316
- Evans, J. (2015). Measuring National Wellbeing: Life in the UK, 2015. Available at: www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuring... [Accessed on 01/03/16].
- Vaillant, G.E. (2012). Triumphs of Experience. The men of the Harvard Grant study. Belknap Press: World.
- Ditch the Label (2015). The Annual Bullying Survey 2015. Available at: http://ditchthelabel.org/downloads/abs2015.pdf [Accessed on 19/02/16].
- Holt-Lunstad, J., Birmingham, W. & Jones, B.Q. (2008). Is there Something Unique about Marriage? The Relative Impact of Marital Status, Relationship Quality, and Network Social Support on Ambulatory Blood Pressure and Mental Health. Annals of Behavioural Medicine, 35, 239-244.
- Robles, T.F., Slatcher, R.B., Trombello, J.M. & McGinn, M.M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140 (1), 140-187.
- Wright, P.H. (2006). Towards an expanded orientation to the comparative study of women’s and men’s same-sex friendships. In K. Dindia & D.J. Canary (Eds.) Sex differences and similarities in communication (2nd ed., pp.37-57). Mahwah: Lawrence Erbaum Associations Inc.
- Rose, A.J & Rudolph, K.D (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132, 98–131
- Fowler, J. & Christakis, N .A. (2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ, 337:a2338.
- Office of National Statistics (2015). Annual Mid-year Population estimates: 2014. Available at: www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/2015-06-25 [Accessed on 29/02/16].
- Randall, C. (2010). E-Society. Social Trends 41. Office of National Statistics. Available at: http://www.ons.gov.uk/ons/rel/social-trends-rd/social-trends/social-tren... [Accessed on 11/03/16].
- Evans, J. (2015). Measuring National Wellbeing: Life in the UK, 2015. Available at: www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2015-03-25 [Accessed on 01/03/16].
- Hendriks, M., Ludwigs, K. & Veenhoven, R. (2016). Why are locals happier than internal migrants: the role of daily life. Social Indicators Research.
- Griffin, J. (2010). The Lonely Society. Mental Health Foundation. Available at: www.mentalhealth.org.uk/sites/default/files/the_lonely_society_report.pdf [Accessed on 23/02/16].