August 25, 2026
Friendship may belong alongside diet, sleep, and exercise as a pillar of health
A survey of more than 200,000 adults across 22 countries found that satisfaction with friendships was closely tied to mental and physical health
ByLuis Arrais
Author
People buy gym memberships, cook careful meals, and track their sleep to stay healthy. Spending time on friendships rarely gets framed as a health habit. A new survey of more than 200,000 adults in 22 countries links the two: people most content with their friendships also rated their mental and physical health the best
Dr. Veli Durmuş, a health management researcher at Kütahya Health Sciences University in Türkiye, is the study’s only author
“Social connection should be seen as part of our health and well-being, rather than as something separate from it,” Durmuş told Earth.com. “Making time for meaningful conversations, friendships and relationships can be an important part of a healthy life.”
Global survey tracked friendship and health
The answers came from the first wave of the Global Flourishing Study, an international survey of what helps adults live well. Gallup collected the data in person and by phone, mostly during 2023, from 204,907 adults aged 18 and older
The countries ranged from the United States, the United Kingdom, and Sweden to Egypt, Kenya, Indonesia, and the Philippines. Everyone rated the statement “I am content with my friendships and relationships” from 0 for strongly disagree to 10 for strongly agree
They also described their childhood relationships with their mother and father, from very good to very bad. They scored their own mental and physical health the same way, from 0 for poor to 10 for excellent. The full dataset is open to researchers through the Center for Open Science
Friendship satisfaction tied to better health
People who put their friendship contentment at 10 rated their mental health about 4.6 points higher, on average, than people who put it at 0. Age, income, education, marriage, employment, gender, and religion were factored out first
For physical health, the same comparison came to about 3.4 points. Other recent research suggests the feeling of connection matters more for mental health than the amount of contact
Married respondents reported better health than unmarried ones, and so did people who called their finances sufficient. In earlier work, lonely adults on low incomes reported the most pain and the lowest mood. People who identified with a religion also reported higher scores, with the largest gap among Muslims
Durmuş was careful about what the numbers can say
“My study cannot show that improving relationships will directly improve health, but it does show a consistent association across 22 countries between greater relationship satisfaction and better self-rated mental and physical health,” he said
Current friendships outweighed childhood ties
People who remembered very good childhood relationships with their parents also tended to rate their adult health higher. The pattern was the same for mothers and fathers, and it was weaker than the one for current friendships
The difference between a very good and a very bad childhood relationship came to about a third of a point of adult mental health. That is small next to the friendship gap
Asked by Earth.com what other findings he would highlight, Durmuş started with that contrast
“Childhood experiences may matter, but they do not tell the whole story,” he explained. “Relationships and social experiences continue to evolve throughout life, potentially shaping how people perceive their health and well-being.”
Satisfaction is not the same as company. Young adults with plenty of friends can still feel lonely, and this survey measured how relationships feel, not how many there are
Friendship satisfaction varied by country
Indonesia’s respondents averaged 8.75 out of 10 on friendship contentment, the highest in the survey. Japan’s averaged 5.83, the lowest
Japan also reported the lowest average mental and physical health. Tanzania reported the highest mental health average, at 9.02. Adults between 35 and 64 rated their mental health lower than adults under 35 did, and adults 65 and older rated theirs higher
Durmuş would not guess at what separates the two countries
“The study shows that the level of satisfaction varies considerably across countries, but it does not establish the reasons for these differences,” he said. “I do not think it can be explained by a single cultural characteristic.”
Other researchers working with the same survey data have linked frequent religious attendance to higher relationship quality. He called that one possibility worth exploring, not an established explanation
One survey cannot prove cause and effect
Each person answered the survey once, so the data cannot show whether satisfying friendships lead to better health, healthier people find friendships easier to keep, or both
The health measures were self-descriptions rather than medical exams. People answered the childhood questions from memory, and people struggling today may remember their early years more harshly
Earlier studies mostly covered one country at a time and reported inconsistent results. Here the same questions were asked, the same way, in 22 countries at once. Durmuş also ran the numbers one country at a time as a check on the combined result
“I would like policymakers to make social connection a more visible part of public health policy,” he explained in an interview with Earth.com. “Health strategies should recognize that meaningful social relationships are part of the broader social environment in which people experience and perceive their mental and physical health.”
He named community programs and chances to take part in social life, especially for people who are isolated. His advice for readers is about the quality of what they already have
“Rather than simply trying to expand their social circle, it may be more meaningful to invest time and attention in friendships and relationships that are satisfying and supportive,” he added
In recent work on single adults, most new experiences happened alongside friends or family. Friendship then belongs on the same list as the small daily habits already linked to a longer life
Whether improving a friendship improves health is the question this survey cannot answer. This survey has not yet followed the same adults over time to see which changes first, the relationships or the health
The Global Flourishing Study team plans to survey the same people again in later waves. That is the next place to look
The full study was published in the journal Journal of Mental Health
Like what you read? Subscribe to our newsletter for engaging articles, exclusive content, and the latest updates
Check us out on EarthSnap, a free app brought to you by Eric Ralls and Earth.com
—–
