'Not having friends is as harmful as smoking or being an alcoholic' - why your mates are the key to a longer life
We obsess over food and fitness - but focusing on friends and family may give a bigger health boost
We have all manner of relationships in our lives: friends and family, partners and spouses, colleagues and acquaintances, people we nod at on the way to work each morning.
Over the last 40 years, researchers have been examining how these relationships affect us. And what they've found is that the people we surround ourselves with have a huge effect on our mental and physical health.
For example, researchers at the University of North Carolina at Chapel Hill discovered that good social relationships could reduce abdominal obesity, inflammation and high blood pressure in adolescents. And a study by Carnegie Mellon University, in Pittsburgh, Pennsylvania, found that, in addition to being happier and more physically active, older adults with very active social lives had better lung function, which - among other things - reduces the risk of cardiovascular disease.
In fact, some researchers believe that our relationships are more important than diet or exercise. At Brigham Young University, in Utah, having found that having friends, family, neighbours and colleagues in our lives can improve our odds of survival by 50pc, they calculated that not having them is equivalent to smoking 15 cigarettes a day - or being an alcoholic.
"We take relationships for granted as humans - we're like fish that don't notice the water," said Timothy Smith, a professor at the university, when the study was published in 2010. "That constant interaction is not only beneficial psychologically but directly to our physical health."
For the 2,900 Irish women diagnosed with breast cancer each year, the study conducted by the US health provider Kaiser Permanente will be of particular interest.
They asked 9,267 women diagnosed with stages 1-4 invasive breast cancer to complete surveys about their social networks - their friends and family, partners and spouses, colleagues, religious and community ties.
Based on their survey replies, the women were classified as belonging to one of three categories. Those with few social relationships were classified as 'socially isolated'; those with many relationships were classified as 'socially integrated', while those in between were deemed 'moderately integrated'.
When researchers checked on the women 20 years later, they found that successful breast cancer outcomes were very strongly linked with social integration. When compared to the 'socially isolated' women, the 'socially integrated' women were significantly less likely to have died from the cancer or to have had a recurrence of the cancer.
"It is well established that women who have more social ties generally, including those with breast cancer, have a lower risk of death overall," said Candyce H Kroenke, who led the Kaiser Permanente study.
"Our findings demonstrate the beneficial influence of women's social ties on breast cancer, including recurrence and breast cancer death."
Though the mechanism behind these findings is not fully understood, the effects are very real. And other researchers have had similar results. In 2011, researchers at Vanderbilt University Medical Centre, in Nashville, Tennessee, found that women who have strong social support in the first year following their breast cancer diagnosis have better outcomes.
In addition to increasing her chances of survival and reducing the risk of recurrence, the people in a woman's life can also help lessen the ordeal of breast cancer. In an earlier study, Candyce Kroenke and her team at Kaiser Permanente found that just having a laugh with friends could help breast cancer patients deal with the pain and other physical symptoms of the cancer.
Though the team looked at all kinds of relationships and the various forms of support - such as tangible, emotional, affection and positive social interaction - they provide, they found that having someone to have a laugh with, also known as positive social interaction, was the "most important predictor of physical quality of life".
Having a good quality of life following a breast cancer diagnosis has been found to be a crucial factor in achieving good outcomes. But also, as Kroenke commented at the time: "It is possible that positive social interaction may enable women to forget for a while the distress of being a cancer patient."
A frequent finding in many of the studies of relationships and health is that it's those with the largest and widest variety of relationships that enjoy the greatest health benefits. The Kaiser Permanente team found that the most 'socially integrated' women, those with large webs of relationships, enjoy better outcomes, and studies involving the health of older adults have found that those with the most social roles enjoy the best health.
But it's not the whole picture. "It's not the number of friends that matters - it's the quality of friends," says Dr Jolanta Burke, a senior lecturer at the University of East London and the author of Happiness After 30: The Paradox of Aging. "It's the depths of the relationships we have."
This seems to be particularly true when it comes to mental health. A University of Michigan study found that it's very much the quality of the relationships in a person's life, rather than the quantity, that determines their risk of suffering from depression in the future.
Though the effects of relationships on physical health can be quite dramatic, they are generally hidden from us. Unless you're part of a study of thousands of women, it's impossible to tell that your risk of cancer has been greatly reduced. However, how our relationships affect our mental health can be much more obvious and immediate.
Having said that, at a time when the people in your life might make a huge difference, reaching out can be difficult. "With a mood disorder, withdrawing yourself from people is quite a common thing to do," says Dr Burke. "I've worked with over 2,000 people with depression and anxiety; I'd say most of them told me that they chose not to be around others."
During her own struggle with depression, Dr Burke withdrew from her friends. It was only when she reached out to them that her journey to recovery began.
"I remember reading an article at the time about just talking to people about nothing. You don't have to talk about your depression. You don't have to talk about how you feel. Just talk about anything else - just to cheer yourself up. And I thought, you know what, I can do that.
"It was a turning point for me," she says. "And I have to say, working with people with depression or anxiety, this is the one thing that I encourage them all to do. Sometimes it's enough to start with saying 'hello' to the people in your street."
Getting emotional support from friends doesn't necessarily entail baring your soul or sharing your troubles with them. "It's not having someone to share every trouble with," Dr Burke explains. "Our friends can be overwhelmed by this. In a healthy set-up, you have to have the situation where there is a lot of joy that you enjoy together, and a lot of exciting moments and happiness, rather than just talking about problems."
According to Dr Burke, a lot of the emotional support we get from friends comes from "perceived support".
"Research is showing us that it's not actually going out and getting the support that matters - it's knowing that you have the support. So, on days when things don't go your way, you know there will be people who care. And that really is crucial. It is a huge benefit, knowing that you are not on your own."
And sometimes, she says, the support we receive is in the form of being allowed to forget that we're adults with problems. "Friends allow us to be children, in a way. Friends allow us to just play. And by 'play', I mean doing something without any purpose, just throwing yourself into something, even though there's very little point in doing it. You're doing it just to have fun. And play is really important in life. It's associated with well-being, and it reduces aggression."
According to researchers at the University of North Carolina at Chapel Hill, relationships are so important to our health that schoolchildren should be encouraged to develop their social skills and build broad social relationships in the same way that they're encouraged to eat right and exercise.
And such is the influence of relationships on breast cancer outcomes that the researchers at Kaiser Permanente concluded that establishing the quantity and quality of a woman's relationships should become part of the diagnostic procedure.
But what about the 'socially isolated'? What about those of us who have lost touch with friends - or never had a lot of friends to begin with?
"There are lots of options," says Dr Burke. "For rekindling a friendship, send a little text or email, or even connect on Facebook."
But do it without expectations, she advises. "Don't ask too much - because you haven't given enough. Friendships are all about investing in something. It's like putting your savings into a bank: you're not expecting any money out yet. Give it some time.
"With regards to making new friends, I always say to people who would like more friends in their life to go to meetup.com."
A keen hiker, Dr Burke used the site to connect with other hikers, some of whom have now become close friends.
"First of all, you exercise, which is good for you," she says. "But you get to talk to the people around you. And if you don't like someone, you step away and you talk to someone else."
There are some less direct options, like taking an evening class. In a study by the University of Oxford, researchers found that students attending weekly classes had increased their network of friends and their sense of belonging.
And though those attending the likes of singing classes and creative writing classes bonded quickest, when it comes to making new friends, the researchers discovered that it didn't really matter what subject a student took, as long as it was a subject they enjoyed.
"Do what you feel comfortable with," says Dr Burke. "But you need to make the effort. Take the first step - don't wait for others to do it.
"You need to get a little bit outside your comfort zone, every now and then."
Face-to-face v Facebook
Can online friends offer the same benefits as the old-fashioned kind?
Facebook is a good way to reconnect with old friends, according to Dr Jolanta Burke. But can keeping in touch with friends this way provide the same benefits as face-to-face encounters?
Well, according to research by Carnegie Mellon University in Pennsylvania, as long as your interactions go beyond clicking ‘Like’, interacting with your friends on Facebook can have a major effect on your well-being.
“It turns out that when you talk with a little more depth on Facebook to people you already like, you feel better,” said Dr Robert Kraut, a professor at the university’s Human-Computer Interaction Institute. “This also happens when people talk in person.”
And, according to William Hobbs and James Fowler at the University of California, San Diego, interacting with friends on Facebook can help you live longer. In any given year, they say, the average Facebook user is less likely to die than someone who doesn’t use the site.
“Interacting online seems to be healthy when the online activity is moderate and complements interactions offline. It is only on the extreme end — spending a lot of time online with little evidence of being connected to people otherwise — that we see a negative association,” said Hobbs.
Health & Living