A vast international study involving more than 200,000 adults has found that people who feel satisfied with their friendships and close relationships are substantially more likely to report excellent mental and physical health. The analysis, published in the peer-reviewed Journal of Mental Health, examined nationally representative survey data from 22 countries across Europe, the Americas, Asia, Africa, the Middle East and Oceania. Its findings suggest that social connection is not merely a source of emotional comfort, but a major factor associated with how people evaluate their overall health. The research also indicates that positive relationships with parents during childhood may continue to be linked to well-being decades later, although these early family connections showed weaker associations than the quality of people’s adult friendships and relationships.
The study was conducted by Dr Veli Durmuş of Kütahya Health Sciences University in Türkiye, whose research focuses on health management, health policy, determinants of health and health law. Durmuş analysed information from 204,907 adults aged 18 and above who participated in the first phase of the Global Flourishing Study, a large international project designed to identify the conditions that help people thrive throughout life. The countries represented included the UK, the United States, Australia, Argentina, Brazil, Germany, Spain, India, Japan, Egypt, Nigeria, South Africa, Mexico and others. By combining data from societies with markedly different cultural, religious and economic backgrounds, the study aimed to determine whether the relationship between social bonds and health appeared consistently across national boundaries.
Participants were asked how strongly they agreed that they were content or satisfied with their friendships and relationships. They also assessed the quality of their childhood relationships with their mothers and fathers, using a scale ranging from “very good” to “very bad.” In a separate part of the survey, participants rated their mental and physical health from “poor” to “excellent.” The researchers then accounted for a range of potentially influential factors, including income, education, age, marital status and religious identification. This statistical adjustment does not eliminate every possible source of bias, but it helps determine whether social and family relationships remain associated with health after important demographic and socioeconomic differences are considered.
The clearest pattern involved present-day social relationships. Adults who reported the greatest satisfaction with their friendships and close relationships also tended to give themselves higher ratings for both mental and physical health. The association was observed across the international sample, suggesting that the benefits of social connection are not restricted to a single cultural model of friendship or family life. Strong relationships can provide practical assistance, emotional reassurance and opportunities for shared activity, while also helping people interpret and manage stressful events. From a psychological perspective, supportive social networks may strengthen self-esteem and emotional regulation. From a physiological perspective, reduced social stress and increased feelings of safety may influence biological systems involved in inflammation, cardiovascular function and stress-hormone regulation.
The study also found a similar, though less pronounced, relationship between childhood family bonds and adult health ratings. Participants who described their relationships with their parents as very good were generally more likely to report better mental and physical health later in life. Early relationships may influence well-being through several pathways. Consistent care can support the development of emotional regulation, trust and coping skills, while a stable family environment may reduce prolonged exposure to childhood stress. These early experiences can shape behavioural patterns and expectations in later relationships. However, the researchers stress that childhood experiences do not determine an individual’s future health. Friendships, partnerships, workplaces and communities continually change a person’s social environment and may reinforce, compensate for or modify the influence of early family life.
Age-related differences also emerged from the analysis. Mental health ratings were lower among people in their mid-thirties to late forties than among adults aged 18 to 34, but they were higher among people aged 65 and above. This pattern may reflect the distinctive pressures associated with midlife, including employment demands, financial responsibilities, parenting, caregiving and relationship changes. Older adults may benefit from improved emotional stability, stronger coping strategies or a clearer sense of personal priorities, although the results cannot establish why the age differences occurred. The findings underline that social health strategies may need to address different forms of isolation and relationship strain at different stages of life rather than treating the population as a single group.
Several additional characteristics were associated with better self-rated health. Being married, having sufficient money and identifying with a religion were each linked to higher mental and physical health scores. Participants who identified with Islam, in particular, reported stronger health ratings in the analysis. These findings should not be interpreted as proof that marriage, income or religious identity directly produces better health. Such characteristics may reflect access to practical support, community participation, social meaning, material security or other factors not fully captured by the survey. The results show associations within a complex network of influences, rather than isolated causes. Nevertheless, they point to the potential importance of social participation and belonging in public-health planning.
The international comparisons revealed striking variation in reported satisfaction with social relationships. Participants living in Indonesia recorded the highest levels of contentment with friendships and relationships, while those in Japan recorded the lowest among the countries included in the analysis. Cultural expectations, working conditions, household structures, urbanisation, social norms and differences in how people interpret survey questions may all contribute to this contrast. A lower average score in one country does not necessarily mean that individuals there have fewer relationships or less support; it may also reflect different standards for expressing satisfaction. Even with these cultural variations, the overall association between stronger social connections and better self-rated health remained visible across the multinational dataset.
Dr Durmuş argues that the findings should encourage policymakers to treat social connection as a central component of health promotion rather than as a private matter outside the healthcare system. Public-health programmes could consider the effects of loneliness, relationship stress and social exclusion when designing prevention strategies, particularly for groups facing unemployment, migration, disability, bereavement or old age. Community centres, peer-support networks, accessible public spaces and initiatives that encourage intergenerational contact could complement conventional medical services. Clinicians may also benefit from asking patients about their social support and relationship satisfaction when assessing well-being. The study does not suggest that friendship can replace medical treatment, but it reinforces the view that health is shaped by social environments as well as by biology and individual behaviour.
Because the research used self-reported information collected at one point in time, it cannot demonstrate cause and effect. Healthier people may find it easier to maintain satisfying relationships, while supportive relationships may also improve health; both processes could operate simultaneously. Participants’ answers may have been influenced by mood, memory, personal expectations or cultural interpretations of “good” health and “satisfying” relationships. Even so, the scale and diversity of the sample make the results an important contribution to research on human flourishing. The study’s central message is clear: across remarkably different societies, people who feel more connected to others generally perceive themselves as healthier. Social relationships therefore appear to function as a universal pillar of well-being—one that public-health systems may no longer be able to overlook.
Subject of Research: People
Article Title: Do social and family relationships affect self-rated mental and physical health? Evidence from nationally representative samples across 22 countries
Web References: https://doi.org/10.1080/09638237.2026.2695973
References: Durmuş, V. “Do social and family relationships affect self-rated mental and physical health? Evidence from nationally representative samples across 22 countries.” Journal of Mental Health. DOI: 10.1080/09638237.2026.2695973
Keywords: Social relationships, friendships, mental health, physical health, family relationships, childhood relationships, social networks, well-being, Global Flourishing Study, public health, social connection, interpersonal relationships
