Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-05-05T15:45:24.026Z Has data issue: false hasContentIssue false

Chapter 10 - Healthy Relationships

from Section 3 - The Lifestyle Medicine Pillars

Published online by Cambridge University Press:  01 May 2025

By
Mohanpal Singh Chandan  and
Vikesh Sharma
Edited by
Richard Pinder ,
Christopher-James Harvey  and
Ellen Fallows
Richard Pinder
Affiliation:
Imperial College of Science, Technology and Medicine, London
Christopher-James Harvey
Affiliation:
Imperial College of Science, Technology and Medicine, London
Ellen Fallows
Affiliation:
British Society of Lifestyle Medicine
Get access

Summary

Healthy relationships are interpersonal connections that are mutually beneficial, supportive, and respectful, with an emphasis on open communication and trust. Social isolation and loneliness can negatively impact the development and quality of healthy relationships and are associated with poor physical and mental health outcomes. Social isolation and loneliness are influenced by various risk factors, such as disability, bereavement, family structure, urbanisation, and technology use, and affect different groups of people differently.

Interventions to enhance healthy relationships can include improving social skills, enhancing social support, increasing opportunities for social contact, addressing maladaptive social cognition, and facilitating community engagement and volunteering. The relationship between clinician and patient is also a key factor for health outcomes, and can be improved by continuity of care, empathy, and trust. Clinicians can apply a Lifestyle Medicine approach to identify and address the impact of relationships on health, and support people to develop and maintain healthy relationships.

Keywords

Healthy relationshipsSocial isolationLonelinessSocial connectednessSocial safety theorySocial prescribingLifestyle MedicineSocial cognitionSexualityContinuity of care
Type
Chapter
Information
Essential Lifestyle Medicine , pp. 86 - 101
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Collins, N. L. and Feeney, B. C., Working models of attachment shape perceptions of social support: Evidence from experimental and observational studies. J Pers Soc Psychol. September 2004;87(3):363.CrossRefGoogle ScholarPubMed
Holtzworth-Munroe, A. and Stuart, G. L., Typologies of male batterers: Three subtypes and the differences among them. Psychol Bull. November 1994;116(3):476.CrossRefGoogle ScholarPubMed
Community Life Survey 2020/21. Dept for Digital, Culture, Media & Sport, London. 2021.Google Scholar
Biordi, D. L. and Nicholson, N. R.. Social isolation. In I. M. Lubkin and P. D. Larsen, editors. Chronic Illness: Impact and Intervention. 2013, Jones and Bartlett Learning, Boston PA, pp. 85–115.Google Scholar
Hawkley, L. C. and Cacioppo, J. T., Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 1 October 2010;40(2):218–227.CrossRefGoogle ScholarPubMed
Holt-Lunstad, J., Social isolation and health. Health Affairs Health Policy Brief 21 June 2020. DOI: 10.1377/hpb20200622.253235.CrossRefGoogle Scholar
Crouch, T. and Wright, J., A connected Society; A strategy for tackling loneliness. Dept for Culture, Media and Sport Policy Paper, 2018.Google Scholar
National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press, 2020. https://doi.org/10.17226/25663.Google Scholar
Perlman, D. and Peplau, L. A., Toward a social psychology of loneliness. In Gilmour, R. and Duck, S., editors. Personal Relationships: Relationships in Disorder. London: Academic Press, 1981. pp. 31–56.Google Scholar
What Characteristics and Circumstances Are Associated with Feeling Lonely? 2018, Office of National Statistics, London, UK.Google Scholar
Masi, C. M., Chen, H. Y., Hawkley, L. C. and Cacioppo, J. T., A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. August 2011;15(3):219–266. https://doi.org/10.1177/1088868310377394. 17August 2010 Epub. PMID: 20716644; PMCID: PMC3865701.CrossRefGoogle ScholarPubMed
Landry, J., Asokumar, A., Crump, C., Anisman, H. and Matheson, K., Early life adverse experiences and loneliness among young adults: The mediating role of social processes. Front Psychol. 20 September 2022;13:968383. https://doi.org/10.3389/fpsyg.2022.968383.CrossRefGoogle ScholarPubMed
Goodman, L. A. and Epstein, D., Loneliness and the COVID-19 pandemic: Implications for intimate partner violence survivors. J Fam Violence. November 2020;5:1–8.Google Scholar
Surkalim, D. L., Luo, M., Eres, R., et al., The prevalence of loneliness across 113 countries: Systematic review and meta-analysis. BMJ. 9 February 2022;376:e067068.Google ScholarPubMed
McPherson, M., Smith-Lovin, L. and Brashears, M. E., Social isolation in America: Changes in core discussion networks over two decades. Am Sociol Rev. 2018;83(5):1111–1134.Google Scholar
Loneliness and Social Isolation: A New Decade of Action – The Jo Cox Foundation. www.jocoxfoundation.org/2020/01/23/loneliness-and-social-isolation-a-new-decade-of-action/https://www.jocoxfoundation.org/2020/01/23/loneliness-and-social-isolation-a-new-decade-of-action/.Google Scholar
www.gov.uk/government/statistics/community-life-survey-202021.Google Scholar
https://share-eric.eu/publications, European Social Survey | European Social Survey (ESS) and hitt blanc (curatiofoundation.org).Google Scholar
EU-LS 2022 Loneliness Prevalence in the EU. EU Science Hub https://joint-research-centre.ec.europa.eu/loneliness/loneliness-prevalence-eu_en.Google Scholar
Heu, L. C., van Zomeren, M. and Hansen, N., Does loneliness thrive in relational freedom or restriction? The culture-loneliness framework. Rev Gen Psychol. 2021;25(1):60–72. https://doi.org/10.1177/1089268020959033.Google Scholar
Hammoud, R., Tognin, S., Bakolis, I., et al., Lonely in a crowd: Investigating the association between overcrowding and loneliness using smartphone technologies. Sci Rep. 20 December 2021;11(1):24134. https://doi/org/10.1038/s41598-021-03398-2.Google Scholar
Klinenberg, E., Palaces for the People: How to Build a More Equal and United Society. London: The Bodley Head, 20 September 2018.Google Scholar
Holt-Lunstad, J., Birmingham, W. and Jones, B. Q., Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health. Ann Behav Med. 2008;35:239–244.CrossRefGoogle ScholarPubMed
Margolis, R. and Verdery, A. M., Older adults without close kin in the United States. J Gerontol: Series B. 1 July 2017;72(4):688–693.CrossRefGoogle ScholarPubMed
Furstenberg, F. F., Family change in global perspective: How and why family systems change. Fam Relat. July 2019;68(3):326–341. https://doi.org/10.1111/fare.12361. Epub 23 May 2019. PMID: 34305222; PMCID: PMC8298013.CrossRefGoogle ScholarPubMed
Hampton, K. N. and Wellman, B., Social media and social capital revisited. In Handbook of Social Capital and Development. Cheltenham, UK: Edward Elgar Publishing, 2018. pp. 331–362.Google Scholar
Stieger, S., Lewetz, D. and Willinger, D., Face-to-face more important than digital communication for mental health during the pandemic. Sci Rep. 2023;13:8022. https://doi.org/10.1038/s41598-023-34957-4.Google ScholarPubMed
Wels, J., Wielgoszewska, B., Moltrecht, B., et al., Home working and social and mental wellbeing at different stages of the COVID-19 pandemic in the UK: Evidence from 7 longitudinal population surveys. PLoS Medicine. 2023;20(4):e1004214. https://doi.org/10.1371/journal.pmed.1004214.Google ScholarPubMed
Traeger, M. L., Strohkorb Sebo, S., Jung, M., Scassellati, B. and Christakis, N. A., Vulnerable robots positively shape human conversational dynamics in a human – robot team. Proceedings of the National Academy of Sciences. 2020;117(12): 6370–6375.CrossRefGoogle Scholar
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T. and Stephenson, D., Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–237. https://doi.org/10.1177/1745691614568352.CrossRefGoogle ScholarPubMed
Elovainio, M., Hakulinen, C., Pulkki-Råback, L., et al., Contribution of risk factors to excess mortality in isolated and lonely individuals: An analysis of data from the UK Biobank cohort study. Lancet Public Health. 4 May 2017;2(6):e260–e266. https://doi.org/10.1016/S2468–2667(17)30075–0.CrossRefGoogle ScholarPubMed
Naito, R., McKee, M., Leong, D., et al., Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PLoS ONE. 2023;18(1):e0280308. https://doi.org/10.1371/journal.pone.0280308.CrossRefGoogle ScholarPubMed
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B., Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009–1016.CrossRefGoogle ScholarPubMed
Elovainio, M., Lahti, J., Pirinen, M., et al., Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank Cohort Study. BMJ Open. 2022;12:e053936. https://doi.org/10.1136/bmjopen-2021-053936.CrossRefGoogle ScholarPubMed
Chatterjee, A., Banerjee, S., Stein, C., et al., Risk factors for depression among civilians after the 9/11 world trade center terrorist attacks: A systematic review and meta-analysis. PLoS Currents Disasters. 30 March 2018; 10:ecurrents.dis.6a00b40c8ace0a6a0017. https://doi.org/10.1371/currents.dis.6a00b40c8ace0a6a0017361d7577c50a.Google Scholar
Bell, R., Donkin, A. and Marmot, M., Tackling structural and social issues to reduce inequities in children’s outcomes in low to middle-income countries, Office of Research Discussion Paper No. 2013-02, UNICEF Office of Research, Florence.Google Scholar
Felitti, V. J., Anda, R. F., Nordenberg, D., et al., Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study, Am J Prev Med. 2019;56(6):774–786, ISSN 0749-3797, https://doi.org/10.1016/j.amepre.2019.04.001.CrossRefGoogle ScholarPubMed
Fone, D., White, J., Farewell, D., et al., Effect of neighbourhood deprivation and social cohesion on mental health inequality: A multilevel population-based longitudinal study. Psychol Med. August 2014;44(11):2449–2460.CrossRefGoogle ScholarPubMed
NHS England. Mental Health Services Data Set, associated technical briefing available at https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/submit-data/data-quality-of-protected-characteristics-and-other-vulnerable-groups/gender-identity?key=#chapter-index (Accessed 20 December 2024)Google Scholar
Hensel, D. J., Nance, J. and Fortenberry, J. D., The association between sexual health and physical, mental, and social health in adolescent women. J Adolesc Health. 2016;59(4):416–421.CrossRefGoogle ScholarPubMed
Sandberg-Thoma, S. E. and Kamp Dush, C. M., Casual sexual relationships and mental health in adolescence and emerging adulthood. J Sex Res. 2014;51(2):121–130.CrossRefGoogle ScholarPubMed
Kalra, G., Ventriglio, A. and Bhugra, D., Sexuality and mental health: Issues and what next? Int Rev Psychiatry. 2015;27(5):463–469.Google ScholarPubMed
Russell, S. T. and Fish, J. N., Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annu Rev Clin Psychol. 2016;12:465–487.CrossRefGoogle ScholarPubMed
Yule, M. A., Brotto, L. A. and Gorzalka, B. B., Mental health and interpersonal functioning in self-identified asexual men and women. In Asexuality and Sexual Normativity. Oxford, UK: Routledge, 2015. pp. 25–40.Google Scholar
Miguel, I., von Humboldt, S. and Leal, I., Sexual well-being across the lifespan: Is sexual satisfaction related to adjustment to aging? Sex Res Social Policy. 2024. https://doi.org/10.1007/s13178-024-00939-yCrossRefGoogle Scholar
Team BI. EAST: Four simple ways to apply behavioural insights. Cabinet Office. Retrieved 6 June 2023, from www.bi.team/publications/east-four-simple-ways-to-apply-behavioural-insights/.Google Scholar
Alcaraz, J., Eddens, K. S., Blase, J. L., et al., Social connectedness and health behaviors among cancer survivors: Data from the Health Information National Trends Survey. J Cancer Surviv. 2021;15(1):33–41. https://doi.org/10.1007/s11764-020-00946-5.Google Scholar
Schuch, F. B., Vancampfort, D., Richards, J., et al., Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. https://doi.org/10.1016/j.jpsychires.2016.02.023.CrossRefGoogle ScholarPubMed
Berkman, L. F., Melchior, M., Chastang, J. F., et al., Social integration and mortality: A prospective study of French employees of Electricity of France-Gas of France: The GAZEL Cohort. Am J Epidemiol. January 2004;159(2):167–174. https://doi.org/10.1093/aje/kwh020.Google ScholarPubMed
Slavich, G. M., Social safety theory: A biologically based evolutionary perspective on life stress, health, and behavior. Annu Rev Clin Psychol. 7 May 2020;16:265–295. https://doi.org/10.1146/annurev-clinpsy-032816-045159.CrossRefGoogle ScholarPubMed
Uchino, B. N., Trettevik, R., Kent de Grey, R. G., et al., Social support, social integration, and inflammatory cytokines: A meta-analysis. Health Psychol. May 2018;37(5):462.CrossRefGoogle ScholarPubMed
Adam, E. K., Hawkley, L. C., Kudielka, B. M. and Cacioppo, J. T., Day-to-day dynamics of experience – cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci USA. 2006;103(45):17058–17063.Google Scholar
Doane, L. D. and Adam, E. K., Loneliness and cortisol: Momentary, day-to-day, and trait associations. Psychoneuroendocrinol. April 2010;35(3):430–441. https://doi.org/10.1016/j.psyneuen.2009.08.005.CrossRefGoogle ScholarPubMed
Fairbank, E. J., McGrath, J. J., Henderson, M., O’Loughlin, J. and Paradis, G., Social support and C-reactive protein in a Québec population cohort of children and adolescents. PLoS ONE. 2022;17(6):e0268210. https://doi.org/10.1371/journal.pone.0268210.Google Scholar
Jopling, E., Rnic, K., Tracy, A. and LeMoult, J., Impact of loneliness on diurnal cortisol in youth. Psychoneuroendocrinol. 2021;132:105345.Google ScholarPubMed
Lam, J. A., Murray, E. R., Yu, K. E., et al., Neurobiology of loneliness: A systematic review. Neuropsychopharmacol. 2021;46(11):1873–1887.CrossRefGoogle ScholarPubMed
Beadle, J. N., Gifford, A. and Heller, A., A narrative review of loneliness and brain health in older adults: Implications of COVID-19. Curr Behav Neurosci Rep. 2022;9:73–83. https://doi.org/10.1007/s40473-021-00237-6.CrossRefGoogle Scholar
Gardiner, P. A., Jette, S., Dash, S. and Severin, C., Physical activity interventions to improve social connectedness and loneliness in older adults: A systematic review and meta-analysis of randomized controlled trials. Health Psychol Rev. 2020;14(2):273–293.Google Scholar
Cheng, S. T., Lee, C. K. L. and Chan, A. C. M., The effects of volunteering and volunteer management on the well-being of older adults in Hong Kong. Gerontol. 2019;59(4):677–687. https://doi.org/10.1093/geront/gnx216.Google Scholar
Daykin, N., Mansfield, L., Meads, C., et al., What works for wellbeing? A systematic review of community-based arts initiatives. Int J Qual Stud Health and Well-being. 2019;14(1):1–18.Google Scholar
Campaign for Loneliness Framework. A framework for loneliness interventions, 2015. Available at https://www.campaigntoendloneliness.org/wp-content/uploads/Promising_Approaches_Revisited_FULL_REPORT.pdf (Accessed 20 December 2024).Google Scholar
Vella-Brodrick, D. A., McBride, K. A. and Millings, A., A qualitative evaluation of the Act-Belong-Commit campaign in Western Australia. Health Promot J Austr. 2016;27(1):56–62.Google Scholar
Gray, D. J., Sidaway-Lee, K., White, E., Thorne, A. and Evans, P. H., Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 1 June 2018;8(6):e021161.CrossRefGoogle Scholar
Sandvik, H., Hetlevik, Ø, Blinkenberg, J. and Hunskaar, S., Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: A registry-based observational study in Norway. Br J Gen Pract. 27 January 2022;72(715):e84–e90. https://doi.org/10.3399/BJGP.2021.0340.Google Scholar
Birkhäuer, J., Gaab, J., Kossowsky, J., et al., Trust in the health care professional and health outcome: A meta-analysis. PLoS One. 7 February 2017;12(2):e0170988. https://doi.org/10.1371/journal.pone.0170988.CrossRefGoogle ScholarPubMed
Derksen, F., Bensing, J. and Lagro-Janssen, A., Effectiveness of empathy in general practice: A systematic review. Br J Gen Pract. January 2013;63(606):e76–e84. https://doi.org/10.3399/bjgp13X660814.CrossRefGoogle ScholarPubMed
RCGP. ‘The power of relationships’ what is relationship-based care and why is it important? 2021. www.rcgp.org.uk/getmedia/ca3e21e7-f742-47d7-9538-77e59bbb1ec7/power-of-relationships-rcgp-2021.pdf.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×