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They say that social relationships have a link to morality.

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Julianne Holt-Lunstad,

Timothy B. Smith,

J. Bradley Layton

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Social Relationships Are Key to Health, and to Health Policy

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Abstract

Background

The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.

Objectives

This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

Data Extraction

Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

Results

Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated ( p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).

Conclusions

The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

Citation: Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. https://doi.org/10.1371/journal.pmed.1000316

Academic Editor: Carol Brayne, University of Cambridge, United Kingdom

Received: December 30, 2009; Accepted: June 17, 2010; Published: July 27, 2010

Copyright: © 2010 Holt-Lunstad et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This research was generously supported by grants from the Department of Gerontology at Brigham Young University awarded to JHL and TBS and from TP Industrial, Inc awarded to TBS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: CI, confidence interval; CVD, cardiovascular disease; OR, odds ratio

Editors' Summary

Background

Humans are naturally social. Yet, the modern way of life in industrialized countries is greatly reducing the quantity and quality of social relationships. Many people in these countries no longer live in extended families or even near each other. Instead, they often live on the other side of the country or even across the world from their relatives. Many also delay getting married and having children. Likwise, more and more people of all ages in developed countries are living alone, and loneliness is becoming increasingly common. In the UK, according to a recent survey by the Mental Health Foundation, 10% of people often feel lonely, a third have a close friend or relative who they think is very lonely, and half think that people are getting lonelier in general. Similarly, across the Atlantic, over the past two decades there has been a three-fold increase in the number of Americans who say they have no close confidants. There is reason to believe that people are becoming more socially isolated.

Why Was This Study Done?

Some experts think that social isolation is bad for human health. They point to a 1988 review of five prospective studies (investigations in which the characteristics of a population are determined and then the population is followed to see whether any of these characteristics are associated with specific outcomes) that showed that people with fewer social relationships die earlier on average than those with more social relationships. But, even though many prospective studies of mortality (death) have included measures of social relationships since that first review, the idea that a lack of social relationships is a risk factor for death is still not widely recognized by health organizations and the public. In this study, therefore, the researchers undertake a systematic review and meta-analysis of the relevant literature to determine the extent to which social relationships influence mortality risk and which aspects of social relationships are most predictive of mortality. A systematic review uses predefined criteria to identify all the research on a given topic; a meta-analysis uses statistical methods to combine the results of several studies.

What Did the Researchers Do and Find?

The researchers identified 148 prospective studies that provided data on individuals' mortality as a function of social relationships and extracted an "effect size" from each study. An effect size quantifies the size of a difference between two groups-here, the difference in the likelihood of death between groups that differ in terms of their social relationships. The researchers then used a statistical method called "random effects modeling" to calculate the average effect size of the studies expressed as an odds ratio (OR)-the ratio of the chances of an event happening in one group to the chances of the same event happening in the second group. They report that the average OR was 1.5. That is, people with stronger social relationships had a 50% increased likelihood of survival than those with weaker social relationships. Put another way, an OR of 1.5 means that by the time half of a hypothetical sample of 100 people has died, there will be five more people alive with stronger social relationships than people with weaker social relationships. Importantly, the researchers also report that social relationships were more predictive of the risk of death in studies that considered complex measurements of social integration than in studies that considered simple evaluations such as marital status.

What Do These Findings Mean?

These findings indicate 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. Furthermore, the overall effect of social relationships on mortality reported in this meta-analysis might be an underestimate, because many of the studies used simple single-item measures of social isolation rather than a complex measurement. Although further research is needed to determine exactly how social relationships can be used to reduce mortality risk, physicians, health professionals, educators, and the media should now acknowledge that social relationships influence the health outcomes of adults and should take social relationships as seriously as other risk factors that affect mortality, the researchers conclude.

Introduction

"Social relationships, or the relative lack thereof, constitute a major risk factor for health-rivaling the effect of well established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity"
-House, Landis, and Umberson; Science 1988 [1]

Two decades ago a causal association between social relationships and mortality was proposed after a review of five large prospective studies concluded that social relationships predict mortality [1]. Following the publication of this provocative review, the number of prospective studies of mortality that included measures of social relationships increased exponentially. Although the inverse association between social relationships and nonsuicide mortality has received increased attention in research, neither major health organizations nor the general public recognize it as a risk factor for mortality. This may be due in part to the fact that the literature has become unwieldy, with wide variation in how social relationships are measured across a large number of studies and disappointing clinical trials [2]. "Social relationships" has perhaps become viewed as a fuzzy variable, lacking the level of precision and control that is preferred in biomedical research. Thus, the large corpus of relevant empirical research is in need of synthesis and refinement.

Current evidence also indicates that the quantity and/or quality of social relationships in industrialized societies are decreasing. For instance, trends reveal reduced intergenerational living, greater social mobility, delayed marriage, dual-career families, increased single-residence households, and increased age-related disabilities [3],[4]. More specifically, over the last two decades there has been a three-fold increase in the number of Americans who report having no confidant-now the modal response [3]. Such findings suggest that despite increases in technology and globalization that would presumably foster social connections, people are becoming increasingly more socially isolated. Given these trends, understanding the nature and extent of the association between social relationships and mortality is of increased temporal importance.

There are two general theoretical models that propose processes through which social relationships may influence health: the stress buffering and main effects models [5]. The buffering hypothesis suggests that social relationships may provide resources (informational, emotional, or tangible) that promote adaptive behavioral or neuroendocrine responses to acute or chronic stressors (e.g., illness, life events, life transitions). The aid from social relationships thereby moderates or buffers the deleterious influence of stressors on health. From this perspective, the term social support is used to refer to the real or perceived availability of social resources [6]. The main effects model proposes that social relationships may be associated with protective health effects through more direct means, such as cognitive, emotional, behavioral, and biological influences that are not explicitly intended as help or support. For instance, social relationships may directly encourage or indirectly model healthy behaviors; thus, being part of a social network is typically associated with conformity to social norms relevant to health and self-care. In addition, being part of a social network gives individuals meaningful roles that provide self-esteem and purpose to life [7],[8].

Social relationships have been defined and measured in diverse ways across studies. Despite striking differences, three major components of social relationships are consistently evaluated [5]: (a) the degree of integration in social networks [9], (b) the social interactions that are intended to be supportive (i.e., received social support), and (c) the beliefs and perceptions of support availability held by the individual (i.e., perceived social support). The first subconstruct represents the structural aspects of social relationships and the latter two represent the functional aspects. Notably, these different subconstructs are only moderately intercorrelated, typically ranging between r = 0.20 and 0.30 [9],[10]. While all three components have been shown to be associated with morbidity and mortality, it is thought that each may influence health in different ways [11],[12]. Because it is presently unclear whether any single aspect of social relationships is more predictive than others, synthesis of data across studies using several types of measures of social relationships would allow for essential comparisons that have not been conducted on such a large scale.

Empirical data suggest the medical relevance of social relationships in improving patient care [13], increasing compliance with medical regimens [13], and promoting decreased length of hospitalization [14],[15]. Likewise, social relationships have been linked to the development [16],[17] and progression [18]-[21] of cardiovascular disease [22] -a leading cause of death globally. Therefore, synthesis of the current empirical evidence linking social relationships and mortality, along with clarifications of potential moderators, may be particularly relevant to public health and clinical practice for informing interventions and policies aimed at reducing risk for mortality.

To address these issues, we conducted a meta-analysis of the literature investigating the association between social relationships and mortality. Specifically, we addressed the following questions: What is the overall magnitude of the association between social relationships and mortality across research studies? Do structural versus functional aspects of social relationships differentially impact the risk for mortality? Is the association moderated by participant characteristics (age, gender, health status, cause of mortality) or by study characteristics (length of clinical follow-up, inclusion of statistical controls)? Is the influence of social relationships on mortality a gradient or threshold effect?

Methods

Identification of Studies

To identify published and unpublished studies of the association between social relationships and mortality, we used three techniques. First, we conducted searches of studies from January 1900 to January 2007 using several electronic databases: Dissertation Abstracts, HealthSTAR, Medline, Mental Health Abstracts, PsycINFO, Social Sciences Abstracts, Sociological Abstracts via SocioFile, Academic Search Premier, ERIC, and Family & Society Studies Worldwide. To capture the broadest possible sample of relevant articles, we used multiple search terms, including mortality, death, decease(d), died, dead, and remain(ed) alive, which were crossed with search words related to social relationships, including the terms social and interpersonal linked to the following words: support, network, integration, participation, cohesion, relationship, capital, and isolation To reduce inadvertent omissions, we searched databases yielding the most citations (Medline, PsycINFO) two additional times. Next, we manually examined the reference sections of past reviews and of studies meeting the inclusion criteria to locate articles not identified in the database searches. Finally, we sent solicitation letters to authors who had published three or more articles on the topic.

Inclusion Criteria

We included in the meta-analysis studies that provided quantitative data regarding individuals' mortality as a function of social relationships, including both structural and functional aspects [23]. Because we were interested in the impact of social relationships on disease, we excluded studies in which mortality was a result of suicide or injury. We also excluded studies in which the only measurement of social support was an intervention provided within the context of the study (e.g., support group), the source of social support was nonhuman (e.g., a pet or higher power), or the social support was provided to others (i.e., giving support to others or measures of others' benefit from the support provided) rather than to the individual tracked for mortality status. We coded studies that included participant marital status as one of several indicators of social support, but we excluded studies in which marital status was the only indicator of social support. We also excluded studies in which the outcome was not explicitly and solely mortality (e.g., combined outcomes of morbidity/mortality). Reports with exclusively aggregated data (e.g., census-level statistics) were also excluded. Manuscripts coded were all written in English, which accounted for 98% of the total retrieved. See Figure 1 for additional details.

Data Abstraction

To increase the accuracy of coding and data entry, each article was initially coded by two raters. Subsequently, the same article was independently coded by two additional raters. Coders extracted several objectively verifiable characteristics of the studies: (a) the number of participants and their composition by age, gender, marital status, distress level, health status, and pre-existing health conditions (if any), as well as the percentage of smokers and percentage of physically active individuals, and, of course, the cause of mortality; (b) the length of follow up; (c) the research design; and (d) the aspect of social relationships evaluated.

Data within studies were often reported in terms of odds ratios (ORs), the likelihood of mortality across distinct levels of social relationships. Because OR values cannot be meaningfully aggregated, all effect sizes reported within studies were transformed to the natural log OR (lnOR) for analyses and then transformed back to OR for interpretation. When effect size data were reported in any metric other than OR or lnOR, we transformed those values using statistical software programs and macros (e.g., Comprehensive Meta-Analysis [24]). In some cases when direct statistical transformation proved impossible, we calculated the corresponding effect sizes from frequency data in matrices of mortality status by social relationship status. When frequency data were not reported, we recovered the cell probabilities from the reported ratio and marginal probabilities. When survival analyses (i.e., hazard ratios) were reported, we calculated the effect size from the associated level of statistical significance, often derived from 95% confidence intervals (CIs). Across all studies we assigned OR values less than 1.00 to data indicative of increased mortality and OR values greater than 1.00 to data indicative of decreased mortality for individuals with relatively higher levels of social relationships.

When multiple effect sizes were reported within a study at the same point in time (e.g., across different measures of social relationships), we averaged the several values (weighted by standard error) to avoid violating the assumption of independent samples. In such cases, the aggregate standard error value for the lnOR were estimated on the basis of the total frequency data without adjustment for possible correlation among the averaged values. Although this method was imprecise, the manuscripts included in the meta-analysis did not report the information necessary to make the statistical adjustments, and we decided not to impute values given the wide range possible. In analyzing the data we used the shifting units of analysis approach [25] which minimizes the threat of nonindependence in the data while at the same time allowing more detailed follow-up analyses to be conducted (i.e., examination of effect size heterogeneity).

When multiple reports contained data from the same participants (publications of the same database), we selected the report containing the whole sample and eliminated reports of subsamples. When multiple reports contained the same whole sample, we selected the one with the longest follow-up duration. When multiple reports with the same whole sample were of the same duration, we selected the one reporting the greatest number of measures of social relationships.

In cases where multiple effect sizes were reported across different levels of social relationships (i.e., high versus medium, medium versus low), we extracted the value with the greatest contrast (i.e., high versus low). When a study contained multiple effect sizes across time, we extracted the data from the longest follow-up period. If a study used statistical controls in calculating an effect size, we extracted the data from the model utilizing the fewest statistical controls so as to remain as consistent as possible across studies (and we recorded the type and number of covariates used within each study to run post hoc comparative analyses). We coded the research design used rather than estimate risk of individual study bias. The coding protocol is available from the authors.

The majority of information obtained from the studies was extracted verbatim from the reports. As a result, the inter-rater agreement was quite high for categorical variables (mean Cohen's kappa = 0.73, SD = 0.13) and for continuous variables (mean intraclass correlation [26] = 0.80, SD  = .14). Discrepancies across coding pairs were resolved through further scrutiny of the manuscript until consensus was obtained.

Aggregate effect sizes were calculated using random effects models following confirmation of heterogeneity. A random effects approach produces results that generalize beyond the sample of studies actually reviewed [27]. The assumptions made in this meta-analysis clearly warrant this method: The belief that certain variables serve as moderators of the observed association between social relationships and mortality implies that the studies reviewed will estimate different population effect sizes. Random effects models take such between-studies variation into account, whereas fixed effects models do not [28]. In each analysis conducted, we examined the remaining variance to confirm that random effects models were appropriate.

Results

Statistically nonredundant effect sizes were extracted from 148 studies ([29]-[176]; see Table 1). Data were reported from 308,849 participants, with 51% from North America, 37% from Europe, 11% from Asia, and 1% from Australia. Across all studies, the average age of participants at initial evaluation was 63.9 years, and participants were evenly represented across sex (49% female, 51% male). Of the studies examined, 60% involved community samples, but 24% examined individuals receiving outpatient medical treatment, and 16% utilized patients in inpatient medical settings. Of studies involving patients with a pre-existing diagnosis, 44% were specific to cardiovascular disease (CVD), 36% to cancer, 9% to renal disease, and the remaining 11% had a variety of conditions including neurological disease. Research reports most often (81%) considered all-cause mortality, but some restricted evaluations to mortality associated with cancer (9%), CVD (8%), or other causes (2%). Participants were followed for an average of 7.5 years ( SD  = 7.1, range = 3 months to 58 years), with an average of 29% of the participants dying within each study's follow-up period.

Omnibus Analysis

Across 148 studies, the random effects weighted average effect size was OR = 1.50 (95% confidence interval [CI] = 1.42 to 1.59), which indicated a 50% increased likelihood of survival as a function of stronger social relations. Odds ratios ranged from 0.77 to 6.50, with substantial heterogeneity across studies ( I² = 81% [95% CI = 78% to 84%]; Q₍₁₄₇₎ = 790, p<0.001; τ ²  = 0.07), suggesting that systematic effect size variability was unaccounted for. Thus factors associated with the studies themselves (e.g., publication status), participant characteristics (e.g., age, health status), and the type of evaluation of social relationships (e.g., structural social networks versus perceptions of functional social support) may have moderated the overall results. We therefore conducted additional analyses to determine the extent to which these variables moderated the overall results.

To assess the possibility of publication bias [177], we conducted several analyses. First, we calculated the fail-safe N [177] to be 4,274, which is the theoretical number of unpublished studies with effect sizes averaging zero (no effect) that would be needed to render negligible the omnibus results. Second, we employed the "trim and fill" methodology described by Duval and Tweedie [178],[179] to estimate the number of studies missing due to publication bias, but this analysis failed to reveal any studies that would need to be created on the opposite side of the distribution, meaning that adjustment to the omnibus effect size was unnecessary. Third, we calculated both Egger's regression test and the alternative to that test recommended by Peters and colleagues [180] that is better suited to data in lnOR format. The results of both analyses failed to reach statistical significance ( p>0.05). Finally, we plotted a contour-enhanced funnel plot ( Figure 2) [181]. The data obtained from this meta-analysis were fairly symmetrical with respect to their own mean; fewer than ten studies were "missing" on the left side of the distribution that would have made the plot symmetrical. Based on these several analyses, publication bias is unlikely to threaten the results.

Moderation by Social Relationship Assessment, and by Participant and Study Characteristics

Given that structural versus functional components of social relationships may influence health in different ways [11],[12], the high degree of heterogeneity observed in the omnibus results may have been due in part to differences between the components of social relationships evaluated within and across studies. Hence the remaining analyses separately evaluate effect sizes obtained from structural, functional, and combined (structural and functional) measures of social relationships. Table 2 provides definitions of the types and subtypes of social relationships evaluated.

Structural aspects of social relationships.

Sixty-three studies had data exclusive to structural measures of social relationships (see Figure 3). Across these studies, the random effects weighted average effect size was OR = 1.57 (95% CI = 1.46 to 1.70), which value fell within the CI of the omnibus results reported previously. The heterogeneity across studies was still quite large ( I² = 84% [95% CI = 80% to 87%]; Q₍₆₂₎ = 390, p<0.001; τ ²  = 0.07), so we undertook metaregression with prespecified participant and study characteristics.

Metaregression is an analogue to multiple regression analysis for effect sizes. Its primary purpose is to ascertain which continuous and categorical (dummy coded) variables predict variation in effect size estimates. Using random effects weighted metaregression, we examined the simultaneous association (with all variables entered into the model) between effect sizes and prespecified participant and study characteristics ( Table 3). To examine the most precise effect size estimates available and to increase the statistical power associated with this analysis, we shifted the unit of analysis [24] and extracted effect sizes within studies that were specific to measures of structural aspects of social relationships. That is, if a study contained effect sizes from both structural and functional types of social relationships, we extracted the structural types for this analysis (with identical subtypes aggregated), which resulted in a total of 230 unique effect sizes across 116 studies. A total of 18% of the variance in these effect sizes was explained in the metaregression ( p<0.001). As can be seen in Table 3, effect sizes based on data controlling for other variables were lower in magnitude than those based on raw data. Moreover, effect sizes differed in magnitude across the subtype of structural social relationships measured. Complex measures of social integration were associated with larger effect size values than measures of social participation. Binary measures of whether participants lived alone (yes/no) were associated with smaller effect size values. Average random effects weighted odds ratios for the various subtypes of social relationships are reported in Table 4.

Functional aspects of social relationships.

Twenty-four studies had data exclusive to functional measures of social relationships (see Figure 4). Across these studies, the random effects weighted average effect size was OR = 1.46 (95% CI = 1.28 to 1.66), which value fell within the CI of the omnibus results reported previously. There was moderate heterogeneity across studies ( I² = 47% [95% CI = 16% to 68%]; Q₍₂₃₎ = 44, p<0.01; τ ² = 0.04), so we conducted a random effects metaregression using the same variables and analytic procedures described previously. We extracted 87 unique effect sizes that were specific to measures of functional social relationships within 72 studies. A total of 16.5% of the variance in these effect sizes was explained in the metaregression, but the model did not reach statistical significance ( p  = 0.46). The results were not moderated by any of the specified participant characteristics (age, sex, initial health status, cause of mortality) or study characteristics (length of follow-up, geographic region, statistical controls).

Combined assessments of social relationships.

Sixty-one studies had combined data of both structural and functional measures of social relationships (see Figure 5). Across these studies, the random effects weighted average effect size was OR = 1.44 (95% CI = 1.32 to 1.58). A large degree of heterogeneity characterized studies ( I² = 82% [95% CI = 78% to 86%]; Q₍₆₀₎ = 337, p<0.001; τ ² = 0.09), and we conducted a random effects metaregression using the same variables and analytic procedures described previously. We extracted 64 unique effect sizes that evaluated combined structural and functional measures of social relationships within 61 studies. The metaregression explained only 6.8% of the variance in these effect sizes, and the model failed to reach statistical significance ( p  = 0.95). None of the variables in the metaregression moderated the results.

Discussion

Cumulative empirical evidence across 148 independent studies indicates that individuals' experiences within social relationships significantly predict mortality. The overall effect size corresponds with a 50% increase in odds of survival as a function of social relationships. Multidimensional assessments of social integration yielded an even stronger association: a 91% increase in odds of survival. Thus, the magnitude of these findings may be considered quite large, rivaling that of well-established risk factors ( Figure 6). Results also remained consistent across a number of factors, including age, sex, initial health status, follow-up period, and cause of death, suggesting that the association between social relationships and mortality may be generalized.

Note: Effect size of zero indicates no effect. The effect sizes were estimated from meta analyses: ; A = Shavelle, Paculdo, Strauss, and Kush, 2008 [205]; B = Critchley and Capewell, 2003 [206]; C = Holman, English, Milne, and Winter, 1996 [207]; D = Fine, Smith, Carson, Meffe, Sankey, Weissfeld, Detsky, and Kapoor, 1994 [208]; E = Taylor, Brown, Ebrahim, Jollife, Noorani, Rees et al., 2004 [209]; F, G = Katzmarzyk, Janssen, and Ardern, 2003 [210]; H = Insua, Sacks, Lau, Lau, Reitman, Pagano, and Chalmers, 1994 [211]; I = Schwartz, 1994 [212].

The magnitude of risk reduction varied depending on the type of measurement of social relationships (see Table 4). Social relationships were most highly predictive of reduced risk of mortality in studies that included multidimensional assessments of social integration. Because these studies included more than one type of social relationship measurement (e.g., network based inventories, marital status, etc.), such a measurement approach may better represent the multiple pathways (described earlier) by which social relationships influence health and mortality [182]. Conversely, binary evaluations of living alone (yes/no) were the least predictive of mortality status. The reliability and validity of measurement likely explains this finding, and researchers are encouraged to use psychometrically sound measures of social relationships (e.g., Table 2). For instance, while researchers may be tempted to use a simple single-item such as "living alone" as a proxy for social isolation, it is possible for one to live alone but have a large supportive social network and thus not adequately capture social isolation. We also found that social isolation had a similar influence on likelihood of mortality compared with other measures of social relationships. This evidence qualifies the notion of a threshold effect (lack of social relationships is the only detrimental condition); rather, the association appears robust across a variety of types of measures of social relationships.

This meta-analysis also provides evidence to support the directional influence of social relationships on mortality. Most of the studies (60%) involved community cohorts, most of whom would not be experiencing life-threatening conditions at the point of initial evaluation. Moreover, initial health status did not moderate the effect of social relationships on mortality. Although illness may result in poorer or more restricted social relationships (social isolation resulting from physical confinement), such that individuals closer to death may have decreased social support compared to healthy individuals, the findings from these studies indicate that general community samples with strong social relationships are likely to remain alive longer than similar individuals with poor social relations. However, causality is not easily established. One cannot randomly assign human participants to be socially isolated, married, or in a poor-quality relationship. A similar dilemma characterizes virtually all lifestyle risk factors for mortality: for instance, one cannot randomly assign individuals to be smokers or nonsmokers. Despite such challenges, "smoking represents the most extensively documented cause of disease ever investigated in the history of biomedical research" [183]. The link between social relationships and mortality is currently much less understood than other risk factors; nonetheless there is substantial experimental, cross-sectional, and prospective evidence linking social relationships with multiple pathways associated with mortality (see [182] for review). Existing models for reducing risk of mortality may be substantially strengthened by including social relationship factors.

Notably, the overall effect for social relationships on mortality reported here may be a conservative estimate. Many studies included in the meta-analysis utilized single item measures of social relations, yet the magnitude of the association was greatest among those studies utilizing complex assessments. Moreover, because many studies statistically adjusted for standard risk factors, the effect may be underestimated, since some of the impact of social relationships on mortality may be mediated through such factors (e.g., behavior, diet, exercise). Additionally, most measures of social relations did not take into account the quality of the social relationships, thereby assuming that all relationships are positive. However, research suggests this is not the case, with negative social relationships linked to greater risk of mortality [184],[185]. For instance, marital status is widely used as a measure of social integration; however, a growing literature documents its divergent effects based on level of marital quality [186],[187]. Thus the effect of positive social relationships on risk of mortality may actually be much larger than reported in this meta-analysis, given the failure to account for negative or detrimental social relationships within the measures utilized across studies.

Other possible limitations of this review should be acknowledged. Statistical controls (e.g., age, sex, physical condition, etc.) employed by many of the studies rule out a number of potentially confounding variables that might account for the association between social relationships and mortality. However, studies used an inconsistent variety of controlling variables, and some reports involved raw data ( Table 1). Although effect size magnitude was diminished by the inclusion of statistical controls only within the data obtained by measures of structural social relationships (but not functional or combined measures), future research can better specify which variables are most likely to impact the overall association. It must also be acknowledged that existing data primarily represent research conducted in North America and Western Europe. Although we found no differences across world region, future reviews inclusive of research written in all languages (not only English) with participants better representing other world regions may yield better estimates across populations.

Approximately two decades after the review by House and colleagues [1], a generation of empirical research validates their initial premise: Social relationships exert an independent influence on risk for mortality comparable with well established risk factors for mortality ( Figure 6). Although limited by the state of current investigations and possible omission of pertinent reports, this meta-analysis provides empirical evidence (nearly 30 times the number of studies previously reported) to support the criteria for considering insufficient social relationships a risk factor of mortality (i.e., strength and consistency of association across a wide range of studies, temporal ordering, and gradient of response) [188]. The magnitude of the association between social relationships and mortality has now been established, and this meta-analysis provides much-needed clarification regarding the social relationship factor(s) most predictive of mortality. Future research can shift to more nuanced questions aimed at (a) understanding the causal pathways by which social participation promotes health, (b) refining conceptual models, and (c) developing effective intervention and prevention models that explicitly account for social relations.

Some steps have already been taken identifying the psychological, behavioral, and physiological pathways linking social relationships to health [5],[182],[189]. Social relationships are linked to better health practices and to psychological processes, such as stress and depression, that influence health outcomes in their own right [190]; however, the influence of social relationships on health cannot be completely explained by these processes, as social relationships exert an independent effect. Reviews of such findings suggest that there are multiple biologic pathways involved (physiologic regulatory mechanisms, themselves intertwined) that in turn influence a number of disease endpoints [182],[191]-[193]. For instance, a number of studies indicate that social support is linked to better immune functioning [194]-[197] and to immune-mediated inflammatory processes [198]. Thus interdisciplinary work and perspective will be important in future studies given the complexity of the phenomenon.

Perhaps the most important challenge posed by these findings is how to effectively utilize social relationships to reduce mortality risk. Preliminary investigations have demonstrated some risk reduction through formalized social interventions [199]. While the evidence is mixed [2],[6], it should be noted that most social support interventions evaluated in the literature thus far are based on support provided from strangers; in contrast, evidence provided in this meta-analysis is based almost entirely on naturally occurring social relationships. Moreover, our analyses suggest that received support is less predictive of mortality than social integration ( Table 4). Therefore, facilitating patient use of naturally occurring social relations and community-based interventions may be more successful than providing social support through hired personnel, except in cases in which patient social relations appear to be detrimental or absent. Multifaceted community-based interventions may have a number of advantages because such interventions are socially grounded and include a broad cross-section of the public. Public policy initiatives need not be limited to those deemed "high risk" or those who have already developed a health condition but could potentially include low- and moderate-risk individuals earlier in the risk trajectory [200]. Overall, given the significant increase in rate of survival (not to mention quality of life factors), the results of this meta-analysis are sufficiently compelling to promote further research aimed at designing and evaluating interventions that explicitly account for social relationship factors across levels of health care (prevention, evaluation, treatment compliance, rehabilitation, etc.).

Conclusion

Data across 308,849 individuals, followed for an average of 7.5 years, indicate that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity). These findings also reveal significant variability in the predictive utility of social relationship variables, with multidimensional assessments of social integration being optimal when assessing an individual's risk for mortality and evidence that social isolation has a similar influence on mortality to other measures of social relationships. The overall effect remained consistent across a number of factors, including age, sex, initial health status, follow-up period, and cause of death, suggesting that the association between social relationships and mortality may be general, and efforts to reduce risk should not be isolated to subgroups such as the elderly.

To draw a parallel, many decades ago high mortality rates were observed among infants in custodial care (i.e., orphanages), even when controlling for pre-existing health conditions and medical treatment [201]-[204]. Lack of human contact predicted mortality. The medical profession was stunned to learn that infants would die without social interaction. This single finding, so simplistic in hindsight, was responsible for changes in practice and policy that markedly decreased mortality rates in custodial care settings. Contemporary medicine could similarly benefit from acknowledging the data: Social relationships influence the health outcomes of adults.

Physicians, health professionals, educators, and the public media take risk factors such as smoking, diet, and exercise seriously; the data presented here make a compelling case for social relationship factors to be added to that list. With such recognition, medical evaluations and screenings could routinely include variables of social well-being; medical care could recommend if not outright promote enhanced social connections; hospitals and clinics could involve patient support networks in implementing and monitoring treatment regimens and compliance, etc. Health care policies and public health initiatives could likewise benefit from explicitly accounting for social factors in efforts aimed at reducing mortality risk. Individuals do not exist in isolation; social factors influence individuals' health though cognitive, affective, and behavioral pathways. Efforts to reduce mortality via social relationship factors will require innovation, yet innovation already characterizes many medical interventions that extend life at the expense of quality of life. Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also survival.

Acknowledgments

We would like to thank Jennie Bingham, Wendy Birmingham, Anne Brown, Hoku Conklin, Shawna Rae Cope, Kaitie Dyson, Stacie Fraire, Jeffrey Gale, Karen Gochnour, Angela Salas Hamaker, Adam Howard, Brian Mead, Esther Rawlings, Keely Smith, Effie Thacker, and Hiroko Umeda for their assistance with coding. We would also like to thank Bert Uchino, University of Utah, and Teresa Seeman, UCLA, for their helpful feedback on an earlier version of this paper.

Author Contributions

ICMJE criteria for authorship read and met: JHL TS JBL. Agree with the manuscript's results and conclusions: JHL TS JBL. Designed the experiments/the study: TS. Analyzed the data: JHL TS JBL. Collected data/did experiments for the study: JHL TS JBL. Wrote the first draft of the paper: JHL TS. Contributed to the writing of the paper: JHL TS JBL.

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Social Relationships and Mortality Risk: A Meta-analytic Review

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Julianne Holt-Lunstad, Timothy B. Smith, J. Bradley Layton has COMPANION Social Relationships Are Key to Health, and to Health Policy Subject Areas For more information about PLOS Subject Areas, click here. We want your feedback. Do these Subject Areas make sense for this article?

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They say that it is extremely unhealthy to live a life without friends.

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How often do you see friends or family? Go to a sports club or church group? If the answer is rarely, then you need to get out more. Being socially isolated is terribly unhealthy. Studies since the 1980s have shown that if you haven't got friends, family or community ties, your chance of dying early may be 50% higher than if you did. Social isolation is now being touted as similarly detrimental to health as smoking or not taking exercise.

While most studies have concentrated on people around the age of 60, research in the latest Proceedings of the National Academy of Sciences has looked at adolescents, "middle adulthood" and older people. The researchers used data from American national surveys and compared how socially connected and supported people felt with markers of disease - blood pressure, body mass index, waist size and C-reactive protein levels (a measure of inflammation). They asked many questions, including how often people saw their families, how close they felt to their mothers, their "friend count" and how much their spouse cared about them.

Acknowledging that being social can be a double-edged sword, there were also questions on whether friends made too many demands. Overall, the results showed that social relationships reduced the risk of having markers of disease at every stage of life. In adolescence, social isolation increased the risk of having higher levels of C-reactive protein. In middle adulthood, when people are more likely to interact at work and their children's school, the quality of the connections mattered more than the number, and protected them from obesity.

Researchers talk of social isolation getting under the skin to influence the regulation of our hormonal and metabolic systems. Kathleen Mullan Harris, one of the designers of the research, says that knowing someone is "watching your back" if, for example, there's a twister coming (she lives in North Carolina) reduces stress hormones such as cortisol and adrenaline. Without social interaction and support, she says, the body is chronically exposed to these hormones, which increases the risks of high blood pressure, a fat waist, diabetes and heart disease.

But what if you are happy being on your own? While there may be some happy loners, Mullan Harris does not think there are enough to affect her study. A meta-analysis in PLOS Medicine of the link between levels of social relationships and morbidity and mortality cited the saddest study ever, which in 1945 found that infants in orphanages were more likely to die if they did not have social interaction. Being social is not always easy - particularly for older people. But for those of us who can modify this risk factor, we should remember that seeing friends and family and supporting your partner is at least as good for us as broccoli.

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Is having no social life as bad for you as smoking?

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How often do you see friends or family? Go to a sports club or church group? If the answer is rarely, then you need to get out more. Being socially isolated is terribly unhealthy. Studies since the 1980s have shown that if you haven't got friends, family or community ties, your chance of dying early may be 50% higher than if you did.

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They say that when you find really good friends they are extremely beneficial to your overall life.

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Most people count good friends among the most important people in their lives. Not all friends are good, though.

Good friends communicate openly. They usually don't shy away from telling the truth, even when they think you may not like it. Still, they accept you for you - just as you accept them. You can trust them to respect your boundaries, even when you disagree with one another.

Healthy friendships also involve mutual support, so a good friend won't just expect you to help them out. They also support you when they can - even if all they can offer is a listening ear.

The cherry on top? Solid friendship is also good for your health. Here's how.

Loneliness and social isolation can affect mental and physical well-being, and more and more people are feeling lonely these days.

To understand the difference between these concerns, think of it this way: Friends help you avoid isolation, but good friends help prevent loneliness.

Ever heard the phrase "lonely in a crowd"? You can have plenty of friends and still feel lonely, even though you aren't isolated.

It's the relationship quality that really counts. Casual or superficial friendships often don't provide much in the way of emotional support. You might have gaming buddies, coffee friends, or exercise partners, but if you don't have anyone to confide in, you'll likely experience some loneliness.

On the other hand, even a few close friends can help you avoid loneliness. And when you do feel lonely, you know you can address it by reaching out to talk, joke, or spend time with a friend.

Distance and other factors might prevent you from physically hanging out, but simply knowing you share a strong connection can help you feel less alone.

Everyone faces some stress. It can come in large or small doses, but no matter how minor it seems at first, it can quickly pile up and overwhelm you.

You might notice mood symptoms, such as anxiety, depression, or irritability, but stress can affect you in other ways, too.

Prolonged stress can contribute to:

There's some good news, though. suggests maintaining strong friendships can help you cope with stress more effectively and help lower your chances of facing some types of stress in the first place.

Think back to the last time you felt upset or worried about something. Maybe you mentioned your concerns to a friend who listened to you vent and helped you brainstorm solutions.

If you know you have friends who care and want to help, potential stressors often don't have the chance to build up and cause significant distress.

Emotional support is an important benefit of relationships.

Your friends might support you by:

listening - really listening - to your problems

validating your feelings

doing nice things for you just because

helping distract you when you feel sad or upset

If you have a romantic relationship, you might go to your partner first. This is perfectly normal, and romantic partners can absolutely offer comfort and reassurance. However, they shouldn't be your only source of emotional support.

Relationship experts generally recommend maintaining friendships with people besides your partner, as this can benefit emotional health alongside relationship health.

When you and your partner disagree or want to spend time on different hobbies, friends who share your interests can help you maintain your sense of self.

If you want to create positive change in your life or have a habit you want to break, friends can help you maintain your resolve to practice healthier habits. This may be one reason why strong friendships can lengthen your life.

One way friends can help you change for the better is by providing good examples. Maybe your best friend's recent decision to give up smoking inspires you to quit, too.

Your friends might also support your choices by making changes with you. If you want to join a gym or start running, for example, having an exercise buddy can encourage you to stick with it until it becomes part of your routine.

No matter what else they do, they'll probably cheer you on. This encouragement can boost your self-confidence, increasing your chances of success with your goals.

We all want to know we matter to others - that our life has purpose. In fact, belonging needs come in third on Maslow's hierarchy of needs, just after basic needs (think food and shelter) and safety needs.

Developing and maintaining close friendships helps foster feelings of belonging.

Caring about others makes life more meaningful. When you care for others, you take on the responsibility of offering compassion and emotional support. This can make you a stronger, better person.

At the same time, knowing you have a support network can help you feel more secure in your own life.

Even when your friends are scattered over several cities, states, or even countries, you still have those connections to trusted friends who have your back.

Life isn't always easy. Sometimes, it can get downright awful.

At any given time, without warning, you might face traumatic or difficult events that affect emotional well-being, such as:

Any of these challenges can have a significant impact on long-term mental health outcomes. However, 2017 research suggests that if you have strong friendships, you'll probably find it easier to handle whatever life throws at you.

This study, which looked at resilience in more than 2,000 adolescents between the ages of 14 and 24, found evidence to suggest friendship strongly predicted resilience, or the ability to recover after distressing experiences.

Study authors noted that while family support also helped boost immediate resilience, friendship predicted greater resilience later in life, while family support did not.

It's possible that friendship could prove particularly beneficial for managing distress associated with family problems, including neglect and abuse.

Now that you know more about the benefits of strong friendships, you might wonder how to go about finding (and keeping) good friends.

Developing and maintaining friendships is often easier said than done, especially in adulthood when the demands of daily life keep you busy. These tips can help.

Pursue your interests

While it's not necessary for friends to like all the same things, some common ground can help provide a foundation for friendship.

Finding new friends can often be as simple as spending time doing things you enjoy, whether that's by joining a hiking club, taking an art class, or attending programs at your local library.

If your current hobbies don't involve much socialization, consider a new hobby that provides the opportunity to meet new people.

Make the first move

Consider your recent interactions with others. Maybe there's a co-worker you always chat with at lunch, or another parent you keep running into at the playground. They might make a great friend, but you won't know for sure until you spend more time together.

Extending an invitation can feel a little scary, especially if you fear rejection. But if they feel nervous, too, your friendship may never get off the ground.

Keep your invitation simple and casual. You can always ask if they'd like to grab coffee or mention something you've both expressed interest in:

"You know that book signing we were talking about the other day? Why don't we go together?"

"I heard there's a new Vietnamese restaurant opening up downtown. Want to get lunch there next week?"

Find more tips on getting to know people here.

Stay in touch

Once you build a friendship, you'll need to make an effort to keep it alive:

Reach out to make plans instead of letting them do all the work.

Call or text from time to time, even if it's just to share a joke or ask how they're doing.

When you ask questions, listen to their answers.

Check in if you know they're struggling.

Share your own struggles when they ask - this helps deepen the bond on both sides.

Find tips on improving communication in friendships and other relationships here.

If you find it difficult to keep up multiple friendships, consider focusing on the ones that really matter to you. Many people lack the time and emotional energy to nurture numerous close friendships.

At the end of the day, the number of friends you have matters far less than the quality of those relationships. You don't need to have a specific number of friends to see benefits. Even a few close friendships can make plenty of difference in your well-being.

Know when to let go

Unhealthy or toxic friendships can cause stress and bring you down just as easily as healthy friendships lift you up.

You may want to consider moving on if your friend:

gossips

treats you unkindly

manipulates you

takes without giving

doesn't seem to care much about your feelings

Find more signs of toxic friendships and tips on how to cope here.

Good friends are important at every stage in life.

Some things about your friendship may change over time as you grow and change as individuals.

But strong friendships will continue to strengthen you, year in and year out, because the important things - trust, respect, forgiveness, and support - will always stay the same.
Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she's committed to helping decrease stigma around mental health issues.

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Here's How Friendships Help Boost Health

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Having friends makes you feel good, but it can affect your physical health, too. Here are 6 ways friends can enrich your mind, body, and soul.

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They say different ways in which living a life alone could be beneficial to your overall mental health.

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You've probably heard plenty about why friendships are so important, particularly if you don't have many friends yourself.

Maybe well-meaning loved ones regularly encourage you to break out of your shell and meet new people. Their concern might lead you to wonder whether you're missing out or prompt some self-consciousness about not having friends.

Or maybe you worry others judge you or assume you can't make friends.

Yet just as every story has two sides, there's more than one way to look at a solitary life. It really comes down to what you want.

Sure, healthy friendships are good for your physical and mental health. People need at least a little human contact in order to thrive, and true isolation can take a toll on your overall well-being.

If you're not totally isolated, though, and your lack of friends doesn't trouble you, it can be perfectly fine to be satisfied with your own company. Being alone doesn't automatically translate to feelings of loneliness, and it isn't necessarily a problem in need of fixing.

The next time you start to feel bad about not being a social butterfly, keep the following in mind.

According to research from 2017, people who spend time alone due to unsociability tend to report higher levels of creativity. Unsociability isn't a negative thing - it just means that you don't particularly care whether you interact with others.

You might already recognize that alone time boosts your imagination and allows creativity to flourish. Talking and interacting with others can distract you from attempts to brainstorm or contemplate possibilities.

That's not to say the words of others don't have value - time with friends can be enjoyable. All the same, there's nothing wrong with aspiring to greater self-awareness.

If you write, draw, make music, or engage in other creative activities, you probably need plenty of time to sort through ideas and pursue sources of inspiration in order to develop your work.

Solitude allows you to tune out chatter and other background noise and heighten your awareness of your own thoughts.

You might notice spending time with other people sometimes brings out different personality traits. Even if you aren't entirely conscious of these changes, your words, actions, or mood might subtly shift to reflect the behavior of those around you.

With a loud, outgoing friend you might find yourself similarly energized. After a day with your sister, you might come home to find you've picked up her habit of dropping sarcastic remarks.

Mirroring isn't a bad thing. It's a prosocial behavior that helps people bond. Yet simply being in the presence of others can somewhat alter your experiences, even your self-awareness.

Instead of focusing on your own perspective, you might consider what they're thinking or feeling or perhaps adjust your own behavior to make them more comfortable.

These concerns can disconnect you from what you think and feel, making it harder to stay fully present in a given moment.

Being alone grants you the freedom to stay fully present with your true self and experience things as you truly see them. Having fewer friends, in turn, may sometimes allow you to be more in tune with yourself.

Feeling pressured to make friends with people who don't have much interest in your needs won't do you any good.

Forced casual friendships can provide some social contact in the form of an occasional lunch or coffee break, but they don't offer much else. And often, they can just leave you feeling drained and slightly annoyed.

Here's an example:

At work, you talk with co-workers occasionally, but feel no need to make friends. You spend your lunch break reading or listening to music. One day, your boss calls you in and says, "I hate to see you always sitting alone. Why don't you try talking to people during lunch? Everyone will think you don't like them."

You don't actively dislike anyone, but you don't enjoy small talk and prefer to avoid sharing personal details at work. But your boss seems to be insisting, so you make an effort to be more social.

The result? You start feeling anxious as lunchtime approaches and dread the break instead of looking forward to an hour of peace.

Losing that time to recharge makes you feel more stressed at work and irritable at home. Before long, you start to resent your boss and co-workers and dislike a job you previously felt very satisfied with.

Whether you realize it or not, your identity is partially shaped by the people in your life. You might see this impact in minor ways: the TV shows you watch, activities you participate in, or the types of exercise you choose.

Sometimes, though, the impact is more significant. Maintaining relationships with others and paying attention to their needs can occasionally detract from your ability to take care of yourself and achieve positive self-growth.

To be clear, there's nothing wrong with caring about loved ones and supporting their emotional needs. But concern for others can sometimes affect you negatively when it prevents you from supporting yourself. Many people discover this when trying to divide their time between too many friends.

Spending more time alone - not out of anxiety but because you enjoy solitude - can lead to greater self-compassion and a stronger motivation to meet your own needs. Maybe you've already noticed it's easier to stick to positive habits when you focus on nurturing yourself.

You can always choose to spend time with other people, but you can't really get away from yourself. It makes sense, then, to prioritize your relationship with yourself. This relationship is perhaps the most important one you'll ever have - and when it's strong, it can strengthen your other relationships in turn.

What do you look forward to most at the end of a long day?

Some people want nothing more than to gather a circle of friends and enjoy their company. Perhaps your ideal evening involves a favorite hobby or craft, cooking a fancy meal for yourself, or a long workout.

Messages from loved ones or society in general might make you feel as if you should spend your free time engaging in social activities.

These subtle (or not-so-subtle) hints to "be a little more friendly" can make you feel guilty when you'd rather have a quiet night at home cleaning or watching a movie with nothing but popcorn and your pet to keep you company.

Pushing yourself to socialize when you'd rather spend your time on other pursuits can leave you frustrated and resentful, especially when socializing doesn't relax you or fulfill other needs.

People who don't get enough time to recharge often end up dealing with more stress and even burnout. Spending time alone not only gives you more time to focus on what you really want to do, it also helps protect you from stress.

While some people need a lot of social time, others don't.

If you're more introverted, you probably feel most comfortable with a few close friends. Too much socializing likely drains your energy and leaves you in urgent need of solitude.

Introversion is simply one part of your personality, not a flaw you need to address or anything to feel bad about. Introverted people often have few friends simply because they thrive best without constant companionship.

If you already interact with people at work or school, you may not want to dedicate more time to social pursuits once your workday ends.

The benefits of friendship can't be denied, but those benefits don't necessarily outweigh your personal needs.

If you'd much rather take a long walk alone than spend a morning at brunch, treat yourself with respect and honor that. You know your needs better than anyone else, and by prioritizing them, you're doing yourself a big favor.

The best friend ideal is pretty common: A rock-solid relationship with a trusted companion you've known for years, who understands everything about you and never lets you down.

Some people do have this type of relationship, but it's not quite as typical as you might assume. Realistically speaking, it's pretty unlikely for one person to meet all of your friendship needs, just as it's not possible for romantic partners to meet each other's needs all the time.

Consistently turning to just one person for friendship and emotional support can put you both at a disadvantage when you struggle to fulfill that role.

If you do desire more emotional support and companionship, a better goal is to find a few close friends to share your time with.

You might turn to one friend when you have something difficult on your mind, another when you want to do something adventurous, and a third for movie nights when you want to enjoy some company without necessarily having to interact.

When you truly care about spending time with someone, that's a relationship to cultivate.

At the end of the day, it doesn't really matter how many friends you have. If you don't feel the need to make more friends, trust your instincts without letting the opinions of others sway you.

That said, loneliness can contribute to mental health symptoms, including anxiety and depression. Getting to know new people isn't always easy, and struggling to make new friends can leave you feeling isolated.

Therapy can offer a safe space to cope with feelings of loneliness and get compassionate guidance on strategies for building meaningful connections with others.
Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she's committed to helping decrease stigma around mental health issues.

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Have No Friends? Why It May Not Be a Bad Thing

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You've probably heard plenty about why friendships are so important, particularly if you don't have many friends yourself. Maybe well-meaning loved ones regularly encourage you to break out of your shell and meet new people. Their concern might lead you to wonder whether you're missing out or prompt some self-consciousness about not having friends.

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They say that we overemphasize the quality and importance of our relationships.

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Can we be Happy without Friends? | The Social Minimalist

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They say that we do not need friends in order to live, but they are a vital part in our human development.

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The Social Minimalist | Can we be Happy without Friends? - Einzelgänger

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A minimalist lifestyle concerns itself with minimizing the number of material resources we need to be satisfied. A tremendous benefit of this approach is the reduced cost of living. The less we need, the more time, money, and energy we save. So, can we also apply minimalism to our social connections…

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They say all sorts of different viewpoints on the topic of are friends necessary for happiness.

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Do I really need friends in order to live a happy life?

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Answer (1 of 11): No, you don't need friends to live a happy life. However, they may provide you with a happier life. Often times, friends give us comfort when we are down, and give us support when we are up. Usually when people feel lonely they resort to their friends.

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They say that good mental health and having a partner make people happier than doubling their income.

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"In the past, the state has successively taken on poverty, unemployment, education and physical health. But equally important now are domestic violence, alcoholism, depression and anxiety conditions, alienated youth, exam-mania and much else. These should become centre stage."

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Mental health and relationships 'key to happiness'

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"In the past, the state has successively taken on poverty, unemployment, education and physical health. But equally important now are domestic violence, alcoholism, depression and anxiety conditions, alienated youth, exam-mania and much else. These should become centre stage."

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They say that happiness is the feeling of pleasure and having life pleasure.

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A smiling 95-year-old man from Pichilemu, Chile

Happiness is a positive and pleasant emotion, ranging from contentment to intense joy. Moments of happiness may be triggered by positive life experiences or thoughts, but sometimes it may arise from no obvious cause. The level of happiness for longer periods of time is more strongly correlated with levels of life satisfaction, subjective well-being, flourishing and eudaimonia. In common usage, the word happy can be an appraisal of those measures themselves or as a shorthand for a "source" of happiness (for example, "find happiness in life" as in finding the meaning in life). As with any emotion, the precise definition of happiness has been a perennial debate in philosophy.

Definitions

The word is mostly used in relation to two factors:

Some usages can include both of these factors. Subjective well-being (swb) includes measures of current experience (emotions, moods, and feelings) and of life satisfaction. For instance Sonja Lyubomirsky has described happiness as " the experience of joy, contentment, or positive well-being, combined with a sense that one's life is good, meaningful, and worthwhile." Eudaimonia, is a Greek term variously translated as happiness, welfare, flourishing, and blessedness. Xavier Landes has proposed that happiness include measures of subjective wellbeing, mood and eudaimonia.

These differing uses can give different results. Whereas Nordic countries often score highest on swb surveys, South American countries score higher on affect-based surveys of current positive life experiencing.

The implied meaning of the word may vary depending on context, qualifying happiness as a polyseme and a fuzzy concept.

Some users accept these issues, but continue to use the word because of its convening power.

Changes of meaning over time

Measurement

Worldwide levels of happiness as measured by the World Happiness Report (2023)

People have been trying to measure happiness for centuries. In 1780, the English utilitarian philosopher Jeremy Bentham proposed that as happiness was the primary goal of humans it should be measured as a way of determining how well the government was performing.

Today, happiness is typically measured using self-report surveys. Self-reporting is prone to cognitive biases and other sources of errors, such as peak-end rule. Studies show that memories of felt emotions can be inaccurate. Affective forecasting research shows that people are poor predictors of their future emotions, including how happy they will be.

Happiness economists are not overly concerned with philosophical and methodological issues and continue to use questionaries to measure average happiness of populations.

Several scales have been developed to measure happiness:

The Subjective Happiness Scale (SHS) is a four-item scale, measuring global subjective happiness from 1999. The scale requires participants to use absolute ratings to characterize themselves as happy or unhappy individuals, as well as it asks to what extent they identify themselves with descriptions of happy and unhappy individuals.

The Positive and Negative Affect Schedule (PANAS) from 1988 is a 20-item questionnaire, using a five-point Likert scale (1 = very slightly or not at all, 5 = extremely) to assess the relation between personality traits and positive or negative affects at "this moment, today, the past few days, the past week, the past few weeks, the past year, and in general". A longer version with additional affect scales was published 1994.

The Satisfaction with Life Scale (SWLS) is a global cognitive assessment of life satisfaction developed by Ed Diener. A seven-point Likert scale is used to agree or disagree with five statements about one's life.

The Cantril ladder method has been used in the World Happiness Report. Respondents are asked to think of a ladder, with the best possible life for them being a 10, and the worst possible life being a 0. They are then asked to rate their own current lives on that 0 to 10 scale.

Positive Experience; the survey by Gallup asks if, the day before, people experienced enjoyment, laughing or smiling a lot, feeling well-rested, being treated with respect, learning or doing something interesting. 9 of the top 10 countries in 2018 were South American, led by Paraguay and Panama. Country scores range from 85 to 43.

The UK began to measure national well-being in 2012, following Bhutan, which had already been measuring gross national happiness.

Academic economists and international economic organizations are arguing for and developing multi-dimensional dashboards which combine subjective and objective indicators to provide a more direct and explicit assessment of human wellbeing. There are many different contributors to adult wellbeing, such as the point that happiness judgements partly reflect the presence of salient constraints, and that fairness, autonomy, community and engagement are key aspects of happiness and wellbeing throughout the life course. Although these factors play a role in happiness, they do not all need to improve simultaneously to help one achieve an increase in happiness.

Philosophy

A smiling butcher slicing meat

Relation to morality

Philosophy of happiness is often discussed in conjunction with ethics. Traditional European societies, inherited from the Greeks and from Christianity, often linked happiness with morality. In this context, morality was the performance in a specific role in a certain kind of social life.

In psychology, connections between happiness and morality have been studied in a variety of ways. Empirical research suggests that laypeople's judgments of a person's happiness in part depend on perceptions of that person's morality, suggesting that judgments of others' happiness involve moral evaluation. A large body of research also suggests that engaging in prosocial behavior can increase happiness.

Ethicists have made arguments for how humans should behave, either individually or collectively, based on the resulting happiness of such behavior. Utilitarians, such as John Stuart Mill and Jeremy Bentham, advocated the greatest happiness principle as a guide for ethical behavior. This principle states that actions are proportionately right or wrong by how much happiness or unhappiness they bring. Mill defines happiness as that which brings about an intended pleasure and avoids an unnecessary pain, and he defines unhappiness as the reverse, namely an action that brings about pain and not pleasure. He is quick to specify that pleasure and pain are to be understood in an Epicurean light, referring chiefly to the higher human pleasures of increased intellect, feelings, and moral sentiments not what one might call beastly pleasures of mere animal appetites. Critics of this view include Thomas Carlyle, Ferdinand Tönnies and others within the German philosophical tradition. They posit that a greater happiness is to be found in choosing to suffer for others, rather than allowing others to suffer for them, declaring this to be a form of satisfying, and heroic, nobility.

Many studies have observed the effects of volunteerism (as a form of altruism) on happiness and health and have consistently found that those who exhibit volunteerism also have better current and future health and well-being. In a study of older adults, those who volunteered had higher life satisfaction and will to live, and less depression, anxiety, and somatization. Volunteerism and helping behavior have not only been shown to improve mental health but physical health and longevity as well, attributable to the activity and social integration it encourages. One study examined the physical health of mothers who volunteered over 30 years and found that 52% of those who did not belong to a volunteer organization experienced a major illness while only 36% of those who did volunteer experienced one. A study on adults aged 55 and older found that during the four-year study period, people who volunteered for two or more organizations had a 63% lower likelihood of dying. After controlling for prior health status, it was determined that volunteerism accounted for a 44% reduction in mortality.

Aristotle described eudaimonia ( Greek: εὐδαιμονία) as the goal of human thought and action. Eudaimonia is often translated to mean happiness, but some scholars contend that "human flourishing" may be a more accurate translation. Aristotle's use of the term in Nicomachiean Ethics extends beyond the general sense of happiness.

In the Nicomachean Ethics, written in 350 BCE, Aristotle stated that happiness (also being well and doing well) is the only thing that humans desire for their own sake, unlike riches, honour, health or friendship. He observed that men sought riches, or honour, or health not only for their own sake but also in order to be happy. For Aristotle the term eudaimonia, which is translated as 'happiness' or 'flourishing' is an activity rather than an emotion or a state. Eudaimonia (Greek: εὐδαιμονία) is a classical Greek word consists of the word "eu" ("good" or "well-being") and "daimōn" ("spirit" or "minor deity", used by extension to mean one's lot or fortune). Thus understood, the happy life is the good life, that is, a life in which a person fulfills human nature in an excellent way.

Specifically, Aristotle argued that the good life is the life of excellent rational activity. He arrived at this claim with the "Function Argument". Basically, if it is right, every living thing has a function, that which it uniquely does. For Aristotle human function is to reason, since it is that alone which humans uniquely do. And performing one's function well, or excellently, is good. According to Aristotle, the life of excellent rational activity is the happy life. Aristotle argued a second-best life for those incapable of excellent rational activity was the life of moral virtue.

The key question Aristotle seeks to answer is "What is the ultimate purpose of human existence?" A lot of people are seeking pleasure, health, and a good reputation. It is true that those have a value, but none of them can occupy the place of the greatest good for which humanity aims. It may seem like all goods are a means to obtain happiness, but Aristotle said that happiness is always an end in itself.

Friedrich Nietzsche critiqued the English Utilitarians' focus on attaining the greatest happiness, stating that "Man does not strive for happiness, only the Englishman does". Nietzsche meant that making happiness one's ultimate goal and the aim of one's existence, in his words "makes one contemptible." Nietzsche instead yearned for a culture that would set higher, more difficult goals than "mere happiness." He introduced the quasi-dystopic figure of the "last man" as a kind of thought experiment against the utilitarians and happiness-seekers.

These small, "last men" who seek after only their own pleasure and health, avoiding all danger, exertion, difficulty, challenge, struggle are meant to seem contemptible to Nietzsche's reader. Nietzsche instead wants us to consider the value of what is difficult, what can only be earned through struggle, difficulty, pain and thus to come to see the affirmative value suffering and unhappiness truly play in creating everything of great worth in life, including all the highest achievements of human culture, not least of all philosophy.

Causes and achievement methods

Theories on how to achieve happiness include "encountering unexpected positive events", "seeing a significant other", and "basking in the acceptance and praise of others". Some others believe that happiness is not solely derived from external, momentary pleasures.

Research on positive psychology, well-being, eudaimonia and happiness, and the theories of Diener, Ryff, Keyes, and Seligmann covers a broad range of levels and topics, including "the biological, personal, relational, institutional, cultural, and global dimensions of life." The psychiatrist George Vaillant and the director of longitudinal Study of Adult Development at Harvard University Robert J. Waldinger found that those who were happiest and healthier reported strong interpersonal relationships. Research showed that adequate sleep contributes to well-being. Good mental health and good relationships contribute more to happiness than income does. In 2018, Laurie R. Santos course titled " Psychology and the Good Life" became the most popular course in the history of Yale University and was made available for free online to non-Yale students.

Viktor Frankl, a psychiatrist who had the opportunity to observe his own experience and that of fellow prisoners in the Nazi concentration camps during WWII, noticed something similar. He noted that those who lost hope soon died, while those who held to meaning and purpose tended to live on. Joy and misery, Frankl observed, had more to do with a person's perspective and choice than with their surroundings. He posited that meaning, more than mere pleasant circumstances, brought about the most life-satisfaction. Three key sources of meaning that he highlights in his writings include, 1. Creation of an important work, or doing a deed. 2. Love, as manifest in thoroughly encountering another person or experience. 3. Finding meaning in unavoidable suffering, such as seeing it as a sacrifice or learning opportunity.

Psychologist Robert Emmons has identified the centrality of goals in pursuing happiness. He found that when humans pursue meaningful projects and activities without primarily focusing on happiness, happiness often results as a by-product. Indicators of meaningfulness predict positive effects on life, while lack of meaning predicts negative states such as psychological distress. Emmons summarizes the four categories of meaning which have appeared throughout various studies. He proposes to call them WIST, or work, intimacy, spirituality, and transcendence.

Self-fulfilment theories

Woman kissing a baby on the cheek

Maslow's hierarchy of needs is a pyramid depicting the levels of human needs, psychological, and physical. When a human being ascends the steps of the pyramid, self-actualization is reached. Beyond the routine of needs fulfillment, Maslow envisioned moments of extraordinary experience, known as peak experiences, profound moments of love, understanding, happiness, or rapture, during which a person feels more whole, alive, self-sufficient, and yet a part of the world. This is similar to the flow concept of Mihály Csíkszentmihályi. The concept of flow is the idea that after our basic needs are met we can achieve greater happiness by altering our consciousness by becoming so engaged in a task that we lose our sense of time. Our intense focus causes us to forget any other issues, which in return promotes positive emotions.

Erich Fromm said "Happiness is the indication that man has found the answer to the problem of human existence: the productive realization of his potentialities and thus, simultaneously, being one with the world and preserving the integrity of his self. In spending his energy productively he increases his powers, he „burns without being consumed.""

Smiling woman from Vietnam

Self-determination theory relates intrinsic motivation to three needs: competence, autonomy, and relatedness. Competence refers to an individual's ability to be effective in their interactions with the environment, autonomy refers to a person's flexibility in choice and decision making, and relatedness is the need to establish warm, close personal relationships.

Ronald Inglehart has traced cross-national differences in the level of happiness based on data from the World Values Survey. He finds that the extent to which a society allows free choice has a major impact on happiness. When basic needs are satisfied, the degree of happiness depends on economic and cultural factors that enable free choice in how people live their lives. Happiness also depends on religion in countries where free choice is constrained.

Sigmund Freud said that all humans strive after happiness, but that the possibilities of achieving it are restricted because we "are so made that we can derive intense enjoyment only from a contrast and very little from the state of things."

Positive psychology

These factors include six key virtues:

1. Wisdom and knowledge, which includes creativity, curiosity, love of learning and open-mindedness.

2. Courage, which includes bravery, persistence, integrity, and vitality.

3. Humanity, which includes love, kindness, and social intelligence.

4. Justice, which includes leadership, fairness, and loyalty.

5. Temperance, which includes self-regulation, prudence, forgiveness, humility, and modesty.

6. Transcendence, which includes religious/spirituality, hope, gratitude, appreciation of beauty and excellence, and humor.

Indirect approaches

Various writers, including Camus and Tolle, have written that the act of searching or seeking for happiness is incompatible with being happy.

William Inge said that "on the whole, the happiest people seem to be those who have no particular cause for being happy except the fact that they are so." Orison Swett Marden said that "some people are born happy."

Cognitive behavioral therapy

Cognitive behavioral therapy is a popular therapeutic method used to change habits by changing thoughts and problematic behaviors. It focuses on emotional regulation and uses a lot of positive psychology practices. It is often used for people with depression, anxiety, or addictions and works towards how to lead a happier life. Common processes in cognitive behavioral therapy are reframing thoughts from problematic thinking patterns by replacing them with beneficial or supportive ones, roleplaying, finding beneficial coping skills, and choosing new activities that support desired behaviors and avoid negative behaviors.

Happiness research understands "happiness" as "life satisfaction" or "well-being". Since it has proved difficult to find a definition of happiness, individual people are instead asked how happy they feel. Numerous surveys are then summarized and analyzed using static methods. Although some researchers believe that the scales are fundamentally unsuitable for estimating happiness, other researchers argue that the happiness indices formed on the basis of the survey have a high statistical correspondence with characteristics that are generally understood to indicate a happy person. For example, individuals who report high happiness on scales smile more often, exhibit more social behavior, are more helpful, and are less likely to commit suicide. For this reason, happiness indices determined on the basis of the survey are considered reliable by happiness researchers.

Before recommending strategies, it is crucial to rely on rigorous, large-scale experiments that confirm their effectiveness. Over the past decade, there has been a significant shift in what constitutes 'high-quality evidence' in psychology (there were adopted e. g. practices like pre-registration, committing to specific methodological and analytical decisions in advance, and increased sample sizes to avoid underpowered studies). A meta analysis of 2023 has used this modern evidence-based approach, evaluating evidence for common happiness-boosting strategies. The study aimed to shed light on the effectiveness of these strategies and their impact on subjective well-being. As a first step, the autors analyzed numerous media articles on happiness to identify the five most commonly recommended strategies, these were: expressing gratitude, enhancing sociability, exercising, practicing mindfulness/meditation, and increasing exposure to nature. Next, the published scientific literature was searched but limited to the above-described high-quality criteria that tested the effects of these strategies on subjective well-being in everyday individuals (non-clinical samples). Only 10% of the initially retrieved studies met those rigorous criteria. The findings revealed that unlike so far suggested by scientific studies, there is currently still a lack of robust scientific evidence to support some of the most frequently suggested happiness strategies. Among the five most common happiness strategies, there was "reasonably solid evidence" of positive effects from a) Gratitude messages or lists, b) conversations with strangers or Gratitude and sociability - that is, establishing and maintaining social relationships. In contrast, no convincing evidence could be found that c) sports, d) mindfulness training, or e) walks in the countryside make people happier.

Other positive effects of happiness and being in a good mood, that have been studied and confirmed, are that happier people tend to be more helpful, attentive, and generous to others, as well as to themselves. Happy people also have been shown to act more cooperatively and less aggressively, and be more likely to help others in need. They were also found to be more sociable and communicative.

More positive effects that happiness seems to evoke are creative problem solving, persisting through challenges, more intrinsic motivation for work related or responsible tasks, and being more effective at using efficient decision-making strategies.

While some believe that success breeds happiness, Lyubomirsky, King and Diener found that happiness precedes success in income, relationships, marriages, work performance, and health.

Low mood is correlated with many negative life outcomes such as suicide, poor health, substance abuse, and low life expectancy. By extension, happiness protects from those negative outcomes.

June Gruber argued that happiness may trigger a person to be more sensitive, more gullible, less successful, and more likely to undertake high risk behaviours. She also conducted studies suggesting that seeking happiness can have negative effects, such as failure to meet over-high expectations. Iris Mauss has shown that the more people strive for happiness, the more likely they will set up too high of standards and feel disappointed. One study shows that women who value happiness more tend to react less positively to happy emotions. A 2012 study found that psychological well-being was higher for people who experienced both positive and negative emotions.

Society and culture

Government

Newly commissioned officers celebrate their new positions by throwing their midshipmen covers into the air as part of the U.S. Naval Academy class of 2011 graduation and commissioning ceremony.

Jeremy Bentham believed that public policy should attempt to maximize happiness, and he even attempted to estimate a "hedonic calculus". Thomas Jefferson put the "pursuit of happiness" on the same level as life and liberty in the United States Declaration of Independence. Presently, many countries and organizations regularly measure population happiness through large-scale surveys, e.g., Bhutan.

Richer nations tend to have higher measures of happiness than poorer nations. The relationship between wealth and happiness is not linear and the same GDP increase in poor countries will have more effect on happiness than in wealthy countries.

Some political scientists argue that life satisfaction is positively related to the social democratic model of a generous social safety net, pro-worker labor market regulations, and strong labor unions. Others argue that happiness is strongly correlated with economic freedom, preferably within the context of a western mixed economy, with free press and a democracy.

Cultural values

Personal happiness can be affected by cultural factors. Hedonism appears to be more strongly related to happiness in more individualistic cultures. Forcing people to marry and stay married can have adverse consequences. Research has shown that unhappily married couples suffer 3-25 times the risk of developing clinical depression.

Cultural views on happiness have changed over time. For instance Western concern about childhood being a time of happiness has occurred only since the 19th century. Not all cultures seek to maximize happiness, and some cultures are averse to happiness. It has been found in Western cultures that individual happiness is the most important. Some other cultures have opposite views and tend to be aversive to the idea of individual happiness. For example, people living in Eastern Asian cultures focus more on the need for happiness within relationships with others and even find personal happiness to be harmful to fulfilling happy social relationships.

People in countries with high cultural religiosity tend to relate their life satisfaction less to their emotional experiences than people in more secular countries.

Tibetan Buddhist monk

Happiness forms a central theme of Buddhist teachings. For ultimate freedom from suffering, the Noble Eightfold Path leads its practitioner to Nirvana, a state of everlasting peace. Ultimate happiness is only achieved by overcoming craving in all forms. More mundane forms of happiness, such as acquiring wealth and maintaining good friendships, are also recognized as worthy goals for lay people (see ). Buddhism also encourages the generation of loving kindness and compassion, the desire for the happiness and welfare of all beings.[unreliable source? ][unreliable source? ]

In Advaita Vedanta, the ultimate goal of life is happiness, in the sense that duality between Atman and Brahman is transcended and one realizes oneself to be the Self in all.

Patanjali, author of the Yoga Sutras, wrote quite exhaustively on the psychological and ontological roots of bliss.

Confucianism

The Chinese Confucian thinker Mencius, who had sought to give advice to ruthless political leaders during China's Warring States period, was convinced that the mind played a mediating role between the "lesser self" (the physiological self) and the "greater self" (the moral self), and that getting the priorities right between these two would lead to sage-hood. He argued that if one did not feel satisfaction or pleasure in nourishing one's "vital force" with "righteous deeds", then that force would shrivel up (Mencius, 6A:15 2A:2). More specifically, he mentions the experience of intoxicating joy if one celebrates the practice of the great virtues, especially through music.

Happiness or ( Hebrew: שמחה) in Judaism is considered an important element in the service of God. The biblical verse "worship The Lord with gladness; come before him with joyful songs," ( Psalm 100:2) stresses joy in the service of God. A popular teaching by Rabbi Nachman of Breslov, a 19th-century Chassidic Rabbi, is " Mitzvah Gedolah Le'hiyot Besimcha Tamid," it is a great mitzvah (commandment) to always be in a state of happiness. When a person is happy they are much more capable of serving God and going about their daily activities than when depressed or upset.[self-published source? ]

Christianity

The primary meaning of "happiness" in various European languages involves good fortune, blessing, or a similar happening. The meaning in Greek philosophy refers primarily to ethics.

In Christianity, the ultimate end of human existence consists in felicity, Latin equivalent to the Greek eudaimonia ("blessed happiness"), described by the 13th-century philosopher-theologian Thomas Aquinas as a beatific vision of God's essence in the next life.

According to Augustine of Hippo and Thomas Aquinas, man's last end is happiness: "all men agree in desiring the last end, which is happiness." Aquinas agreed with Aristotle that happiness cannot be reached solely through reasoning about consequences of acts, but also requires a pursuit of good causes for acts, such as habits according to virtue.

Human complexities, like reason and cognition, can produce well-being or happiness, but such form is limited and transitory. In temporal life, the contemplation of God, the infinitely Beautiful, is the supreme delight of the will. Beatitudo, or perfect happiness, as complete well-being, is to be attained not in this life, but the next.

Al-Ghazali (1058-1111), the Sufi thinker, wrote that " The Alchemy of Happiness", is a manual of religious instruction that is used throughout the Muslim world and widely practiced today.

Genetics and heritability

As of 2016, no evidence of happiness causing improved physical health has been found; the topic is being researched at the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. A positive relationship has been suggested between the volume of the brain's gray matter in the right precuneus area and one's subjective happiness score.

Sonja Lyubomirsky has estimated that 50 percent of a given human's happiness level could be genetically determined, 10 percent is affected by life circumstances and situation, and a remaining 40 percent of happiness is subject to self-control.

When discussing genetics and their effects on individuals it is important to first understand that genetics do not predict behavior. It is possible for genes to increase the likelihood of individuals being happier compared to others, but they do not 100 percent predict behavior.

At this point in scientific research, it has been hard to find a lot of evidence to support this idea that happiness is affected in some way by genetics. In a 2016 study, Michael Minkov and Michael Harris Bond found that a gene by the name of SLC6A4 was not a good predictor of happiness level in humans.

On the other hand, there have been many studies that have found genetics to be a key part in predicting and understanding happiness in humans. In a review article discussing many studies on genetics and happiness, they discussed the common findings. The author found an important factor that has affected scientist findings this being how happiness is measured. For example, in certain studies when subjective wellbeing is measured as a trait heredity is found to be higher, about 70 to 90 percent. In another study, 11,500 unrelated genotypes were studied, and the conclusion was the heritability was only 12 to 18 percent. Overall, this article found the common percent of heredity was about 20 to 50 percent.

References

Further reading

Robert Waldinger M.D.; Marc Schulz Ph.D (2023). The Good Life: Lessons from the World's Longest Scientific Study of Happiness. Simon & Schuster. ISBN 978-1982166694.

External links

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Happiness is a positive and pleasant emotion, ranging from contentment to intense joy. Moments of happiness may be triggered by positive life experiences or thoughts, but sometimes it may arise from no obvious cause. The level of happiness for longer periods of time is more strongly correlated with levels of life satisfaction, subjective well-being, flourishing and eudaimonia.

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They say that happiness comes from having goals in life and feeling like you having a meaning in life.

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Can we make ourselves happier? According to studies from all over the globe collated by the World Happiness Database in Rotterdam, we can. But the path to happiness may not be where we are looking for it.

Prof Ruut Veenhoven, Director of the Database and Emeritus professor of social conditions for human happiness at the Erasmus University in Rotterdam, says his own study found a slight negative correlation between the number of times people in a study spontaneously mentioned "goals" and their happiness.

"Though it is generally assumed that you need goals to lead a happy life, evidence is mixed. The reason seems to be that unhappy people are more aware of their goals, because they seek to change their life for the better."

Although there is some positive correlation between seeing meaning in life and being happy, studies suggest this is not a necessary condition for happiness. In fact, studies suggest leading an active life has the strongest correlation with happiness.

"In order to lead a happy life, a rewarding life, you need to be active," says Veenhoven. "So involvement is more important to happiness than knowing the why, why we are here."

But the best news on file at the World Happiness Database is that we can make ourselves happier, and not just through external changes like having more money.

"Research has shown that we can make ourselves happier because happiness does change over time," says Prof Veenhoven, "and these changes are not just a matter of better circumstances but of better dealing with life. Elderly people tend to be wiser, and for that reason, happier."

So what should we do to make ourselves happier?

Studies collated by the database say you tend to be happier if you:

And there are some surprising findings:

And be careful of that morning commute to work.

A German study (by Frey and Stutzer published in 2004) found a strong link between time spent commuting and satisfaction with life. Those who spent an hour on their journey to work were found to be significantly less happy than those who did not commute.

And the study suggests that higher earnings from a job that involves commuting do not compensate for the time lost.

Prof Veenhoven and his colleagues have been trying to encourage people to do more of what makes them happy with a diary they can fill in online. So far it has attracted more than 20,000 users.

Pensioner Jana Koopman says it has changed her life, not just because it helped her identify what makes her happy, and prompted her to take up a painting class, but because it made her do less of what doesn't make her happy.

"You can make everything clean and tomorrow it's dirty again, so why do it? Or don't do it too often. I like to read. So now I just pick up a book I want to read and leave all the other things."

Don't worry, though, if you can't put down your laptop and pick up a book or a paintbrush. We can't be happy all the time.

Research shows that sadness is useful. It acts as a red traffic light to curb negative behaviour.

According to studies on the database it's actually good for us all to be sad 10% of the time.

Professor Veenhoven and his colleagues have begun analysing the data collected in the online diary to conduct more happiness studies.

So far, analysis on self-confessed workaholics shows, perhaps unsurprisingly, that unwinding after work with exercise rather than a beer on the sofa makes for a happier life.

You can follow the Magazine on Twitter and on Facebook

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Can we make ourselves happier? According to studies from all over the globe collated by the World Happiness Database in Rotterdam, we can. But the path to happiness may not be where we are looking for it.

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They say that girls that are nearly twice as likely as boys to have thoughts about suicide when they feel lonely and have few friends.

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COLUMBUS, Ohio - Relationships with friends play a significant role in whether teenage girls think about suicide, but have little impact on suicidal thoughts among boys, according to a new nationwide study.

The research found that girls were nearly twice as likely to think about suicide if they had only a few friends and felt isolated from their peers. Girls were also more likely to consider suicide if their friends were not friends with each other.

These relationship factors had no significant effect on whether boys considered suicide.

"Close friendships appear to be much more important for adolescent girls than they are for boys, and problems with these relationships have major impacts on girls' mental health," said James Moody, co-author of the study and assistant professor of sociology at Ohio State University.

"Boys tend to hang out in groups, and close relationships do not seem to be as important to them."

Another key finding was that there was no way to tell which teenagers who are thinking about suicide will actually attempt it.

Moody conducted the study with Peter Bearman of the Institute for Social and Economic Research and Policy at Columbia University. Their findings appear in the January 2004 issue of the American Journal of Public Health.

The researchers used data on 13,465 adolescents in grades 7 through 12 from across the United States. The students participated in the National Longitudinal Survey of Adolescent Health. They completed a survey in school and then were interviewed in their homes one year later. They were asked, among many other things, about their friendships, whether they had thought about suicide in the past year and whether they had attempted suicide in the past year.

Moody said he wasn't surprised that friendships played a larger role for girls than for boys, but he was surprised at the size of the difference.

"I think everyone expected there to be differences between boys and girls, but we didn't expect to find that friendships would have essentially no major effect on whether boys considered suicide," he said.

For girls, those who felt isolated and friendless were at as great a risk for considering suicide as girls who knew someone who had committed suicide.

"Whenever a young person commits suicide, a school will send out counselors to help other students," Moody said. "But there is just as much risk of suicidal thoughts among adolescent girls who feel isolated. We need to provide help to these students, too."

Another important finding was that girls had increased risk of suicidal thoughts if people they listed as friends did not name each other as friends.

"When girls are stuck between friends who don't get along, it puts them under a huge amount of stress," Moody said. "The more that happens, the more likely a girl is to think about suicide."

As other studies have shown, both boys and girls were more likely to attempt suicide if they had a friend who attempted suicide. Boys were less likely to attempt suicide if they attended schools in which the friendship network was dense and interlocked - in other words, where many of the boys shared the same friends.

But why do dense friendship networks seem to prevent suicide attempts in boys, but friendship doesn't seem to affect suicidal thoughts?

Moody said the question needs more study, but it may be that boys don't share their thoughts about suicide with friends, but they may admit when they are planning to attempt suicide.

"In a school where there are a lot of interlocking relationships, there are many people who may hear a suicidal boy talking and help him get the support he needs. Boys may not tell people what they are thinking about, but they may talk about what they might do."

But overall, Moody said there wasn't a clear pattern indicating which adolescents who were thinking about suicide would eventually attempt it.

"Essentially, once adolescents start thinking about suicide the factors that trigger an actual attempt are largely random. That means that we have to identify and help any teenager who is thinking about suicide. It is better to get a few false positives than to miss some of them," he said.

The results of the study offer several suggestions for identifying and helping adolescents at risk for suicide, Moody said. In addition to the friendship findings, the study mirrored other studies that show teens are less at risk if they participate in more activities with their parents and if they attend church regularly.

"Parents should talk often to their children, do things with them and, if they're religious, take them to church," he said.

Teachers and parents also need to look for adolescents, especially girls, who don't seem to be socially connected to their peers, or who have friends who don't get along.

"Changing schools, joining clubs, participating in more extracurricular activities -- all could help adolescents who are at risk for thinking about suicide," he said.

The National Institutes of Health funded the National Longitudinal Study of Adolescent Health, which was the data set used in this research.

Contact: James Moody, 614-292-1722; Moody.77@osu.edu.
Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Friendships play key role in suicidal thoughts of girls, but not boys

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Relationships with friends play a significant role in whether teenage girls think about suicide, but have little impact on suicidal thoughts among boys, according to a new nationwide study. The research found that girls were nearly twice as likely to think about suicide if they had only a few friends and felt isolated from their peers.

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They say that having strong a strong social circle around you has been proven to increase humans overall health.

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A group of Germans at Allas Sea Pool, Helsinki, Finland. Traveling abroad together is a strong indicator of friendship.

Friendship is a relationship of mutual affection between people. It is a stronger form of interpersonal bond than an "acquaintance" or an "association", such as a classmate, neighbor, coworker, or colleague.

In some cultures, the concept of friendship is restricted to a small number of very deep relationships; in others, such as the U.S. and Canada, a person could have many friends, and perhaps a more intense relationship with one or two people, who may be called good friends or best friends. Other colloquial terms include besties or Best Friends Forever ( BFF s). Although there are many forms of friendship, certain features are common to many such bonds, such as choosing to be with one another, enjoying time spent together, and being able to engage in a positive and supportive role to one another.

Sometimes friends are distinguished from family, as in the saying "friends and family", and sometimes from lovers (e.g., "lovers and friends"), although the line is blurred with friends with benefits. Similarly, being in the friend zone describes someone who is restricted from rising from the status of friend to that of lover (see also unrequited love).

Friendship has been studied in academic fields, such as communication, sociology, social psychology, anthropology, and philosophy. Various academic theories of friendship have been proposed, including social exchange theory, equity theory, relational dialectics, and attachment styles.

Developmental psychology

The understanding of friendship by children tends to be focused on areas such as common activities, physical proximity, and shared expectations. Such friendships provide opportunity for playing and practicing self-regulation. Most children tend to describe friendship in terms of things like sharing, and children are more likely to share with someone they consider to be a friend. As children mature, they become less individualized and are more aware of others. They gain the ability to empathize with their friends, and enjoy playing in groups. They also experience peer rejection as they move through the middle childhood years. Establishing good friendships at a young age helps a child to be better acclimated in society later on in their life.

Based upon the reports of teachers and mothers, 75% of preschool children had at least one friend. This figure rose to 78% through the fifth grade, as measured by co-nomination as friends, and 55% had a mutual best friend. About 15% of children were found to be chronically friendless, reporting periods of at least six months without mutual friends.

Friendships in childhood can assist in the development of certain skills, such as building empathy and learning different problem solving techniques. Coaching from parents can help children make friends. Eileen Kennedy-Moore describes three key ingredients of children's friendship formation: (1) openness, (2) similarity, and (3) shared fun. Parents can also help children understand social guidelines they have not learned on their own. Drawing from research by Robert Selman and others, Kennedy-Moore outlines developmental stages in children's friendship, reflecting an increasing capacity to understand others' perspectives: "I Want It My Way", "What's In It For Me?", "By the Rules", "Caring and Sharing", and "Friends Through Thick and Thin."

Adolescence

Two friends sitting together in Bhutan

In adolescence, friendships become "more giving, sharing, frank, supportive, and spontaneous." Adolescents tend to seek out peers who can provide such qualities in a reciprocal relationship, and to avoid peers whose problematic behavior suggests they may not be able to satisfy these needs. Particular personal characteristics and dispositions are also features sought by adolescents, when choosing whom to begin a friendship with. During adolescence, friendship relationships are more based on similar morals and values, loyalty, and shared interests than those of children, whose friendships stem from being in the same vicinity and access to playthings.

A large study of American adolescents determined how their engagement in problematic behavior (such as stealing, fighting, and truancy) was related to their friendships. Findings indicated that adolescents who were less likely to engage in problematic behavior had friends who did well in school, participated in school activities, avoided drinking, and had good mental health. The opposite was true of adolescents who did engage in problematic behavior. Whether adolescents were influenced by their friends to engage in problem behavior depended on how much they were exposed to those friends, and whether they and their friendship groups "fit in" at school.

Friendships formed during post-secondary education last longer than friendships formed earlier. In late adolescence, cross-racial friendships tend to be uncommon, likely due to prejudice and cultural differences.

Friendship in adulthood provides companionship, affection, and emotional support, and contributes positively to mental well-being and improved physical health.

Adults may find it particularly difficult to maintain meaningful friendships in the workplace. "The workplace can crackle with competition, so people learn to hide vulnerabilities and quirks from colleagues. Work friendships often take on a transactional feel; it is difficult to say where networking ends and real friendship begins." Many adults value the financial well-being and security that their job provides more than developing friendships with coworkers.

Freundschaft zwischen Jonathan und David by Julius Schnorr von Karolsfeld (1860), which translates in English as Friendship between Jonathan and David

2,000 American adults surveyed had an average of two close friends, defined as "people they had 'discussed important matters' with in the past six months". Numerous studies with adults suggest that friendships and other supportive relationships enhance self-esteem.

Older adults

Older adults report high levels of personal satisfaction in their friendships as they age, even as the overall number of friends tends to decline. This satisfaction is associated with an increased ability to accomplish activities of daily living, as well as a reduced decline in cognitive abilities, decreased instances of hospitalization, and better outcomes related to rehabilitation. The overall number of reported friends in later life may be mediated by increased lucidity, better speech and vision, and marital status. A decline in the number of friends an individual has as they become older has been explained by Carstensen's Socioemotional Selectivity Theory, which describes a change in motivation that adults experience when socializing. The theory states that an increase in age is characterized by a shift from information-gathering to emotional regulation; in order to maintain positive emotions, older adults restrict their social groups to those with whom they share an emotional bond. As one review phrased it:

Research within the past four decades has now consistently found that older adults reporting the highest levels of happiness and general well being also report strong, close ties to numerous friends.

As family responsibilities and vocational pressures lessen, friendships become more important. Among the elderly, friendships can provide links to the larger community, serve as a protective factor against depression and loneliness, and compensate for potential losses in social support previously given by family members. Especially for people who cannot go out as often, interactions with friends allow for continued societal interaction. Additionally, older adults in declining health who remain in contact with friends show improved psychological well-being.

Forming and maintaining

Forming and maintaining friendships often requires time and effort.

Friendships are foremost formed by choice, typically on the basis that the parties involved admire each other on an intimate level, and enjoy commonality and socializing.

Most people underestimate how much other people like them. The liking gap can make it difficult to form friendships.

According to communications professor Jeffery Hall, most friendships involve tacitly agreed-upon expectations in six different areas:

Positive regard

The friends genuinely like each other, and are not merely pretending to like each other for the purpose of social climbing or some other desired benefit.

Self-disclosure

The friends feel that they can discuss topics of deep personal significance.

Instrumental aid

The friends help each other in practical ways. For example, a friend might drive another friend to the airport.

Similarity

The friends have similar worldviews. For example, they might have the same culture, class, religion, or life experiences.

Enjoyment

The friends believe that it is fun and easy to spend time together.

The friends have valuable information, skills, or resources that they can share with each other. For example, a friend with business connections might know when a desirable job will be available, or a wealthy friend might pay for an expensive experience.

Not all relationships have the same balance of each area. For example, women may prefer friendships that emphasize genuine positive regard and deeper self-disclosure, and men may prefer friendships with a little more agency.

Developmental issues

People with certain types of developmental disorders may struggle to make and maintain friendships. This is especially true of children with attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, or children with Down syndrome.

The Persian god Mithra, of covenants, light, oaths, justice, the sun, contracts, and friendship.

Studies found that strong social supports improve a person's prospects for good health and longevity. Conversely, loneliness and a lack of social supports are linked to an increased risk of heart disease, viral infections, and cancer, as well as higher mortality rates overall. Researchers termed friendship networks a "behavioral vaccine" that boosts both physical and mental health.

A large body of research links friendship and health, but the precise reasons for the connection remain unclear. Most studies in this area are large prospective studies that follow people over time, and while there may be a correlation between the two variables (friendship and health status), researchers still do not know if there is a cause and effect relationship (such as: good friendships improve health). Theories that attempt to explain this link include that good friends encourage their friends to lead more healthy lifestyles; that good friends encourage their friends to seek help and access services when needed; that good friends enhance their friends' coping skills in dealing with illness and other health problems; and that good friends actually affect physiological pathways that are protective of health.

Mental health

Lack of friendship plays a role in increasing risk of suicidal ideation among female adolescents. This is also true for having more friends who are not themselves friends with one another. However, no similar effect was observed for males. Having few or no friends is a major indicator in the diagnosis of a range of mental disorders.

Higher friendship quality directly contributes to self-esteem, self-confidence, and social development. A World Happiness Database study found that people with close friendships are happier, although the absolute number of friends did not increase happiness. Other studies suggested that children who have friendships of a high quality may be protected against the development of certain disorders, such as anxiety and depression. Conversely, having few friends is associated with dropping out of school, as well as aggression, adult crime, and loneliness. Peer rejection is also associated with lower later aspiration in the workforce and participation in social activities, while higher levels of friendship were associated with higher adult self-esteem.

Having more close friends is correlated with improved mental health and cognitive ability. However, this association stops once around five friends is reached, after which having more friends is no longer linked to better mental health and is correlated with lower cognition. Additionally, people with few or many friends had more symptoms of attention-deficit/hyperactivity disorder ( ADHD) and were less able to learn from their experiences.

Dissolution

Friendships may end. This is often the result of natural changes over time, as friends grow more distant both physically and emotionally, but it can also be the result of a sudden shock, such as learning that a friend holds incompatible values.

Some social media influencers provide suggestions using therapy speak to break up with a friend. These have been criticized for being impersonal and upsetting, partially because they often reduce a conversation to a 30-second soundbite-sized announcement. Social media posts may also encourage confrontations akin to a workplace performance appraisal, in which one person tells a friend that they are dissatisfied and threatens to break off the relationship if the friend does not conform to their expectations. The end of a friendship is often due to inappropriate expectations on the part of the dissatisfied person, and demanding that a friend meet those expectations is incompatible with friendship's voluntary qualities. Another option would be for the dissatisfied person to look for another friend who can meet the unmet need. For example, if someone is dissatisfied because a friend does not plan events, then that person could find a second friend, someone who enjoys planning events, instead of rejecting the first friend for not being able to single-handedly meet all of their needs.

The dissolution of a friendship may be taken personally as a rejection. Disruptions of friendships are associated with increased guilt, anger, and depression, and may be highly stressful events, especially in childhood. However, potential negative effects can be mitigated if the dissolution of a friendship is replaced with another close relationship.

Demographics

Friends tend to be similar to one another in terms of age, gender, behavior, substance abuse, personal disposition, and academic performance. In ethnically diverse countries, children and adolescents tend to form friendships with others of the same race or ethnicity, beginning in preschool, and peaking in middle or late childhood. As a result of social separation and confinement of the sexes, friendships between men and women have little presence in recorded history, having only become a widely accepted practice in the 20th century.

Gender differences

In general, girl-girl friendship interactions among children tend to focus on interpersonal connections and mutual support. In contrast, boy-boy interaction tends to be more focused on social status, and may discourage the expression of emotional needs. Girls report more anxiety, jealousy, and relational victimization and less stability related to their friendships. Boys, on the other hand, report higher levels of physical victimization. Nevertheless, boys and girls tend to report relative satisfaction levels with their friendships.

Women tend to be more expressive and intimate in their same-sex friendships and have a smaller range of friends. Men are more likely to define intimacy in terms of shared physical experiences. In contrast, women are more likely to define it in terms of shared emotional ones. Men are less likely to make emotional or personal disclosures to other men because the other man could use this information against them. However, they will disclose this information to women (as they are not in competition with them), and men tend to regard friendships with women as more meaningful, intimate, and pleasant. Male-male friendships are generally more like alliances, while female-female friendships are much more attachment-based. This also means that the end of male-male friendships tends to be less emotionally upsetting than that of female-female friendships.

Women tend to be more socially adept than their male peers, among older adults. As a result, many older men may rely upon a female companion, such as a spouse, to compensate for their comparative lack of social skills. One study found that women in Europe and North America were slightly more likely than men to self-report having a best friend.

Which relationships count as a true friend, rather than as an acquaintance or a co-worker, vary by culture. In English-speaking cultures, it is not unusual for people to include weaker relationships as being friends. In other cultures, such as the Russian and Polish cultures, only the most significant relationships are considered friends. A Russian might have one or two friends plus a large number of "pals" or acquaintances; a Canadian in similar circumstances might count all of these relationships as being friends.

In Western cultures, friendships are often seen as lesser to familial or romantic relationships. Friendships in Ancient Greece were more utilitarian than affectionate, being based upon obligation and reliance, though they held a broad view on the variance of friendship. Aristotle wrote of there being three kinds of friendships: those in recognition of pleasure, those in recognition of advantage, and those in recognition of virtue.

When discussing taboos of friendship[example needed ] it was found that Chinese respondents found more than their British counterparts.

Interspecies

A man with an Indian palm squirrel (Funambulus palmarum)

Friendship is found among animals of higher intelligence, such as higher mammals and some birds. Cross-species friendships are common between humans and domestic animals, such as a pet snake. Cross-species friendships may also occur between two non-human animals, such as dogs and cats.

References

Further reading

External links

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Friendship is a relationship of mutual affection between people. It is a stronger form of interpersonal bond than an "acquaintance" or an "association", such as a classmate, neighbor, coworker, or colleague. In some cultures, the concept of friendship is restricted to a small number of very deep relationships; in others, such as the U.S.

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They say that people do not need friends in order to be happy and use real life example in order to explain why.

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So I decided to google the definition of the word "friend." Google defines a friend as "a person whom one knows and with whom one has a bond of mutual affection." Other definitions associated with a friend is a person who is on the same side, a contact on a social media website, a member of a religious society, or a person who supports a cause. Society has pushed this notion that all of mankind needs friends to survive. I want to give a different perspective. Let's talk about it.

For me a friend is someone who is loyal, trustworthy, kind, compassionate, supportive, and always has your back and vice versa. A friend is not jealous spirited or fake. A friend doesn't just support you sometimes and then bounce. A friend doesn't just call you when they need something but throughout the rest of the year you don't hear from them. A friend doesn't just befriend you on social media but then if you know them in real life you hardly hear from them. I feel a lot of people accept these kind of flawed "friendships." These are one sided relationships. The truth is most people don't know the real definition of true friendship. I feel what most people have are acquaintances and associates. So, is that what humans really need to be happy, fake friendships?

One of my friends who is actually a supporter of this blog told me that he has a friend who barely listens to him and only calls him when she needs something mostly. Good friends communicate effectively. To me it doesn't matter where you met your friend or how long you've known your friend. If that person is not loyal, trustworthy, compassionate, and supportive that is not a true friend. I have had to cut off people for being fake. I've also gotten away from people who barely call, text, or visit. I understand that I can make the first move as well but I've gotten so comfortable in my introversion that sometimes I don't feel like I need to do that. I see you when I see you. LOL.

As usual I checked Reddit to research this topic about friendship and came across an interesting post posted a few months ago. I enjoy reading Reddit from time to time because I see people posting similar viewpoints to what I post on social media and on this blog. It makes me feel good that there is actually a growing population in the world not afraid to share their unpopular opinions on society. This person who started this thread on Reddit basically said you don't need friends to have a happy life and that people that say otherwise are ignorant and hateful. This person says people need to stop judging folks for not having friends. I agree because you never know a person's situation as to why they don't have these friends. Maybe that person has a habit of befriending people who are not real or trying to "fit in" with society. Maybe that person may be a proud loner.

I'm going to tell you that your family can be considered friends if you have a true, loving, and supportive family. I feel that I have always had that. However, I understand that even some people don't have a loving family and are not close to their family. I've seen some people who are complete loners and still enjoy their lives and do whatever they want. I've seen some of these same people be content with a pet or a goldfish and I think there's nothing wrong with that at all.

When you live a single and childfree life like myself you have to understand that you won't have a lot of friends in this life and that's ok. You have to love yourself first and foremost. Most people in this world are sheep and programmed to do "what's normal" so they won't understand your lifestyle. They are extroverts in need of social interaction. Everything is just not for everyone. Making friends as a child is a lot easier than as an adult. Having a lot of friends has never been my thing. Heck, I don't need friends at all because according to SOCIETY'S DEFINITION of friendship 99% of the people on this planet don't fit the description! Ha! I have a supportive family and a few very supportive friends and that's all I need. Create your own happiness in life and whatever that looks like for you, good for you!

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Courtesy of Pinterest/The Minds Journal So I decided to google the definition of the word "friend." Google defines a friend as "a person whom one knows and with whom one has a bond of mutual affection." Other definitions associated with a friend is a person who is on the same side, a contact on a...

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#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective

# data[].attributes.wish_content.attachment_props.entities.urls[].description
Courtesy of Pinterest/The Minds Journal So I decided to google the definition of the word “friend.” Google defines a friend as “a person whom one knows and with whom one has a bon…

# data[].attributes.wish_content.attachment_props.original_text
#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective

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#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective
— From A Unique Perspective 💫✏️ (@fau_perspective) November 1, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective

# data[].attributes.attachment_link.metadata.attachment_props_source.data.entities.urls[].description
Courtesy of Pinterest/The Minds Journal So I decided to google the definition of the word “friend.” Google defines a friend as “a person whom one knows and with whom one has a bon…

# data[].attributes.attachment_link.metadata.attachment_props.original_text
#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective

# data[].attributes.attachment_link.metadata.attachment_props.text
#TrueFriendship #friendship #introverts #HappyHalloween

Do You Really Need Friends To Be Happy? https://t.co/1XQvRvOfKf via @fau_perspective

# data[].attributes.attachment_link.metadata.attachment_props.entities.urls[].description
Courtesy of Pinterest/The Minds Journal So I decided to google the definition of the word “friend.” Google defines a friend as “a person whom one knows and with whom one has a bon…