Poor social relationships are as risky for your health as smoking 15 cigarettes a day

New research by psychologists uncovers the health risks of loneliness and the benefits of strong social connections. While research on relationships has forgotten about adult friendships — tending to focus on adolescent friendships and adult romances — the importance of strong social connections throughout life is gaining scientific consensus, having been linked with such benefits as a greater pain tolerance, a stronger immune system, and a lower risk of depression and early death.

What we’re learning is that emotions cause physiological processes to activate that are directly bad for your health. The most “biologically toxic” aspect of loneliness is that it can make you feel chronically threatened, an emotion that can wear on the immune system.

Yet forging platonic relationships isn’t always easy. According to a meta-analysis with more than 177,000 participants, people’s personal and friendship networks have shrunk over the last 35 years (Psychological Bulletin, 2013).

I’m so lonesome I could die

Combine that trend with the rising age of first marriage, a divorce rate nearing 50 percent in some countries and a life expectancy that’s at an all-time high, and you get “a demographic shift such that there are now [more] people who don’t have a marital partner to supply the intimacy they need,” says Beverley Fehr, PhD, a social psychologist at the University of Winnipeg. “In light of those shifts, I think that friendships are more important today than ever before.”

A lack of friends isn’t simply an inconvenience when you want a movie partner or a ride to the hospital. A sparse social circle is a significant health risk, research suggests. In one meta-analysis of 148 studies comprising more than 308,000 people, for example, Brigham Young University psychologists found that participants with stronger social relationships were 50 percent more likely to survive over the studies’ given periods than those with weaker connections — a risk comparable to smoking up to 15 cigarettes a day and one double that of obesity.

There’s some evidence that more really is merrier. In one recent study tracking 6,500 British men and women ages 52 and older, psychologist Andrew Steptoe, PhD, of the University College London and colleagues found that both feeling lonely and being socially isolated raised the risk of death. However, only social isolation — measured in terms of frequency of contact with family and friends, and participation in organizations outside of work — appeared to be related to increased mortality when the researchers adjusted for demographic factors and baseline health.

But contrary to Steptoe’s findings, most research indicates that feeling isolated is more dangerous than being isolated, says psychologist John Cacioppo, PhD, co-author of the 2008 book “Loneliness: Human Nature and the Need for Social Connection.” In one 2012 study, he and colleagues looked at data from more than 2,100 adults ages 50 and older and found that feelings of loneliness were associated with increased mortality over a six-year period. The finding was unrelated to marital status and number of relatives and friends nearby, as well as to health behaviors such as smoking and exercise (Social Science and Medicine, 2012).

“It’s not being alone or not” that affects your health, Cacioppo says. “You can feel terribly isolated when you’re around other people.” In his ongoing Chicago Health Aging and Social Relations Study, funded by the National Institute on Aging, Cacioppo and colleagues have also linked loneliness with depressive symptoms and an increase in blood pressure over time. Other research indicates positive social connections might accelerate disease recovery. In a study of 200 breast cancer survivors, psychologist Lisa Jaremka, PhD, and colleagues at the Ohio State University found that lonelier women experienced more pain, depression and fatigue than those who had stronger connections to friends and family. The more disconnected women also had elevated levels of a particular antibody associated with the herpes virus — a sign of a weakened immune system (Psychoneuroendocrinology, 2013).

Friends in adulthood

As researchers work to better understand the link between friendships and health, they’re also helping to answer a question familiar to anyone who’s ever moved to a new city, lost a spouse or otherwise found themselves feeling alone: How do you make friends as an adult? Here’s what the research suggests might work:

Be a familiar face. The idea that familiarity breeds attraction is long-established by research, and was again supported in a 2011 study led by psychologist Harry Reis, PhD, at the University of Rochester. In the first experiment, same-sex strangers rated how much they liked one another after having several structured conversations. In the other, strangers chatted freely online. In both cases, the amount participants liked their partners increased with each exchange (Journal of Personality and Social Psychology, 2011).

Divulge a secret. There are ways to make fast friends, too, psychologists say. Research by Stony Brook University professor Arthur Aron, PhD, showed that gradually increasing the depth of questions and answers between strangers can spawn friendships in just 45 minutes (Personality and Social Psychology Bulletin, 1997).

Realize it’s in your head. Loneliness is a subjective experience that can often be a self-fulfilling prophecy, says Cacioppo. “When people feel isolated, the brain goes into self-preservation mode,” he says, meaning that they become preoccupied with their own — not others’ — welfare. While the response is an innate one meant to protect us from threats, over time, it harms physical and mental health and well-being, and makes us more likely to see everything in a negative light. It can also make us seem cold, unfriendly and socially awkward. But recognizing what’s in your head can help you get out of it, Cacioppo says.

Log on, with caution. Liz Scherer, a copywriter in Silver Spring, Md., used social media to forge friendships when she moved from New York City to Annapolis, Md., about 10 years ago at age 42. Through Twitter, she connected online with others in her business and met many of them in person at social media conferences. “I’ve made some really good friends who I talk to … every single day,” she says. “They’re good social supports and business supports.”Research suggests Scherer’s positive experience with social media is most common among people who are already well connected. A review of four studies by psychologist Kennon Sheldon, PhD, of the University of Missouri, and colleagues, for example, found that more time on Facebook was linked to both high and low levels of connectedness. Psychologists posit this may be the case because Facebook supports relationships among those who are already highly socially connected, but might make those who are isolated feel even more so (Journal of Personality and Social Psychology, 2011).“If you rely on virtual relationships entirely, that’s probably bad for you,” Carstensen says. “But when you’re using email and face time to supplement real relationships, that’s a good thing.”

Don’t force it. If the pressure to forge new relationships is more external than internal, put away the “friend wanted” ad and focus on what and who does make you happy, says Carstensen. “If people are not very socially active and they aren’t necessarily interested in expanding their social networks, and they seem OK emotionally, then you shouldn’t feel alarmed,” she says.

The bottom line? Whether you’re content with two close friends or prefer to surround yourself with 20 loose acquaintances, what matters is that you feel a part of something greater than yourself, Carstensen says.

An article by Anna Miller (short version), American Psychological Association, Monitor on Psychology (Jan 2014)

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