Connection and mental health
Relationships, a sense of belonging and mental health are part of health throughout life. How we feel and relate to others influences wellbeing and is also connected to other pillars, such as sleep, stress and movement.
That is why we look at this dimension as part of each person's context, without reducing mental health to a questionnaire or a single indicator.
Relationships are also part of health.
Research has associated stronger social relationships and greater social support with better health outcomes and longevity.1 Loneliness and social isolation, although different concepts, are also associated with different health outcomes, including higher mortality and a higher risk of coronary heart disease and stroke.2,3
Mental health is part of this same broad view of health. Mood, anxiety, a sense of belonging and wellbeing relate to other dimensions of life, including sleep,4 stress, movement and social context.
What is asked and what is measured.
Face-to-face contact and support network
We try to understand the frequency and quality of contact with significant people and whether the person feels they have someone they can count on.
UCLA-3, loneliness
A brief, validated instrument for assessing perceived loneliness.6 It helps follow this dimension over time.
OSSS-3, social support
A brief questionnaire that assesses different dimensions of perceived social support, including the availability of help and the interest shown by others.7
PHQ-9 and GAD-7
Validated screening instruments for symptoms of depression and anxiety.8,9 They can help identify the need for a more thorough assessment, but on their own they do not establish a diagnosis.
Purpose in life
The Life Engagement Test explores the perception of involvement in activities considered personally meaningful.10 It is one more dimension of the person's context, not an isolated measure of health or longevity.
What the person says
No questionnaire replaces the conversation. Instruments help organise information; understanding what that information means requires context and listening.
None of these pieces is read alone.
Loneliness and social support are not the same thing. A person can have many relationships and feel lonely, or have a small network and feel supported.
Mental health questionnaires can help follow symptoms over time, but they should be interpreted together with sleep, stress, social context and what the person reports.
Purpose, belonging and meaningful relationships add context, but none of these dimensions defines a person's mental health on its own.
The platform organises and presents the information. Interpreting the whole belongs to the health professional.
Habits that help you care for relationships and mental health.
Cultivate meaningful relationships
Making room for regular contact with important people can contribute to a sense of connection and belonging.
Take part and belong
Groups, sport, volunteering or other shared activities can create opportunities for contact, participation and a sense of belonging.
Ask for or offer help
Asking for help when we need it and being available for others are ways of strengthening supportive relationships. When there is persistent emotional distress, seeking professional support is also part of caring for your health.
What people ask about relationships and mental health.
Do relationships affect longevity?
A meta-analysis of 148 studies and more than 300,000 participants found an association between stronger social relationships and about 50% higher likelihood of survival over the periods studied (Holt-Lunstad et al., 2010). It is an association in observational studies, not a prescription.
Are loneliness and isolation the same thing?
No. A person can have many relationships and feel alone, or have a small network and feel supported. Both are associated with higher mortality and a higher risk of coronary heart disease and stroke (Holt-Lunstad et al., 2015; Valtorta et al., 2016), which is why we look at perceived loneliness and social support separately.
What are the PHQ-9 and the GAD-7?
Validated screening instruments for symptoms of depression (PHQ-9) and anxiety (GAD-7). They help to see whether a deeper assessment makes sense, but they do not establish a diagnosis; no questionnaire replaces the conversation.
When should I seek professional support?
When there is persistent emotional distress. Asking for help is part of caring for your health, and the appointment is the place to say it. In Portugal, the SNS 24 line (808 24 24 24) offers psychological counselling 24 hours a day.
References (10)
- Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. doi:10.1371/journal.pmed.1000316
- Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-237. doi:10.1177/1745691614568352
- Valtorta NK, Kanaan M, Gilbody S, Ronzi S, 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. doi:10.1136/heartjnl-2015-308790
- Baglioni C, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1-3):10-19. doi:10.1016/j.jad.2011.01.011
- Alimujiang A, et al. Association between life purpose and mortality among US adults older than 50 years. JAMA Netw Open. 2019;2(5):e194270. doi:10.1001/jamanetworkopen.2019.4270
- Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys. Res Aging. 2004;26(6):655-672. doi:10.1177/0164027504268574
- Kocalevent RD, et al. Social support in the general population: standardization of the Oslo social support scale (OSSS-3). BMC Psychol. 2018;6:31. doi:10.1186/s40359-018-0249-9
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x
- Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092
- Scheier MF, et al. The Life Engagement Test: assessing purpose in life. J Behav Med. 2006;29(3):291-298. doi:10.1007/s10865-005-9044-1
The references describe results observed in populations. They do not determine what happens to each person. Individual interpretation belongs to the health professional.
The five pillars are part of the same approach.
Caring for health means thinking long term.
In the appointment, we look at your health, movement and context to define an approach suited to your needs.