Friendship and mental health

Reviewed by Dr. Kirsten Davin, OTD, OTR/L, ATP, SMS

Why is friendship important? 

Friendship plays a significant role in our physical, mental, and emotional health. It’s a relationship of mutual care, affinity, and comfort, as well as a key component of social health—meaning the way you interact with and relate to others. Friendship gives us the chance to build community and form deeper bonds. It also lessens the impact of loneliness and isolation. 

Friendship in other relationships 

When you think of friendship, you might picture two strangers who connect through a shared experience. Maybe they took a class together or went to the same party. Many friendships do start that way, but there are other paths too. 

Friendship can grow in the context of existing relationships, which often results in a stronger bond. You can find friendship in a variety of relationships, including family, romantic partnerships, coworkers, and pets. 

Is it okay to not have friends? 

The love and social support offered by friendship can be found in other relationships, such as family and romantic partners. A meaningful platonic friendship isn’t inherently better than other kinds of relationships—its benefits stem from the quality of the friendship.  

If you don’t make or keep friends easily, it may be temporary. People often struggle to maintain friendships during transitional periods, like moving to a new place, starting a new job, or becoming a parent. In those situations, it’s important to rely on other meaningful relationships until you can prioritize new friendships again. 

Different types of friendships 

We may long for someone to call a “best friend,” but there are many kinds of healthy, beneficial friendships. As two people grow closer over time, they move through several phases of building a friendship. 

1. Formation 

The start of any friendship or relationship typically includes three distinct stages: 

  • Stranger: All friends start as strangers. At this level, small talk is exchanged as both people try to figure out if they want to learn more about each other. 
  • Role player: You may consider some people friends because of a certain role they play in your life, even if your feelings for them don’t run especially deep. Coworkers, classmates, and neighbors tend to fall into this category. 
  • Acquaintance: This is a good example of a “friendly but not friends” relationship. You probably know this person fairly well, and you may even like them—but you’re not really invested beyond keeping track of how they’re doing. Social media friends are often acquaintances. 

2. Maintenance 

At the heart of most true friendships is the maintenance stage. This involves putting in the work to cultivate and deepen the friendship. 

  • Close friend: Close friends spend time together in all kinds of settings and play multiple roles. At this stage, trust is being tested. One person may share a secret or ask a tough question, hoping their vulnerability will be reciprocated.  
  • Best friend: Best friendships often feel similar to family relationships or romantic partnerships. These friends know everything about each other, including all the embarrassing details. They know how to disagree without jeopardizing their relationship. They work hard to affirm each other and keep each other’s trust. 

3. Dissolution 

Many friendships end. Some may last a lifetime, but they usually cycle through different levels. It’s helpful to remember that the dissolution of a friendship isn’t always a bad thing. While some friendships end poorly, plenty of them fade out on good terms. 

Healthy vs. unhealthy friendships 

How can you tell if a friendship is healthy? Think about it in terms of mutual care, affinity, and comfort. 

  • Care: Does your friend truly care about you as a person, or do they only like what you can do for them? Do they ever put your health and safety at risk? Keep in mind that abuse can occur in all types of relationships, including friendships. 
  • Affinity: This may seem silly, but it’s important to ask: Do you truly like your friend? Sometimes we get so caught up in the excitement of a new relationship, we forget to pay attention to how we really feel about the person. 
  • Comfort: Can you be yourself around your friend? Do you trust them? In a healthy friendship, you shouldn’t have to deny any part of your identity to be accepted. 

Friendship at different life stages 

Childhood 

A child’s first experiences with friendship can teach them important lessons about sharing, socializing, and caring about others.  

A lot of people place a high value on friendships formed in childhood. You may have childhood friends whose identities and values evolved similarly to yours, so moving to a deeper level of friendship felt natural. But you may grow apart from others over the years. 

Adolescence 

Many of us form deep, meaningful relationships for the first time at this stage. As teenagers experiment with identity, they’re looking for peers who’ll support them. 

Adolescent friendship can be messy. Most teenagers are still building social skills and self-esteem, which makes it hard to open up in a way that fosters close friendships. Teen friendship is often a group experience full of acceptances and rejections decided on a whim. 

Adulthood 

People of a similar age and status may live very different lives depending on their backgrounds, goals, and obstacles. As a result, adult friendships often form due to shared experiences and stages of life, including: 

  • Single friends may prefer to spend time with others who can related to the upsides and challenges of single life. 
  • Couples friends in long-term partnerships or marriages often choose to spend time with other couples who have similar experiences. 
  • Parent friends know that having kids radically changes your priorities and access to leisure time. A lot of parents, especially new parents, want to spend time with people who understand how that feels. 
  • Coworker friends often enjoy talking about the technical aspects of their careers or workplaces with people who understand the larger context. 
  • Neighborhood friends are invested in their communities and may want friends to chat with about schools, parks, construction, taxes, and other local concerns. 
  • Shared-interest friends connect through groups or institutions that reflect shared interests, such as gyms, book clubs, or faith communities. 
  • Retirement friends are less involved with work and raising their families. They may prefer to spend time with others who’ve been through a similar life transition. 

Friendship and mental health 

Friendship plays an important role in mental health. By investing in healthy friendships, you can: 

  • Reduce stress: Chronic stress can seriously impact your health. A study from Carnegie Mellon University1 found that friends can act as a buffer in stressful situations. 
  • Improve self-esteem: Giving and receiving love and acceptance from others makes it easier to extend the same courtesy to yourself. 
  • Avoid risky behavior: For those who struggle with drinking, smoking, addiction, or other risky behaviors, friendship can be a great source of support. 
  • Invest in your health: Friends can offer accountability in choosing healthier behaviors, such as eating better, exercising, and getting enough sleep. 
  • Combat loneliness: Friendship can help alleviate the devastating health effects of loneliness and isolation. 
  • Feel like you belong: Knowing that your identity is accepted, affirmed, and celebrated can give you a sense of belonging. 

How to help a friend who’s struggling with mental health 

Mental health is often stigmatized, which makes people who struggle with mental illness feel ashamed and alone. Healthy friendships let you be honest about your own needs while supporting others who may be having a hard time. 

Remember that a mental health disorder may complicate someone’s ability to build and maintain friendships. When friends communicate honestly about their expectations and needs, it helps both people feel understood and cared for. 

Talking about mental health with friends 

Here are some tips on how to start having conversations about mental health with your friends: 

  • Be honest: Open up about your own mental health journey. Talking about your experience with anxiety or depression may help a friend feel safe doing the same. 
  • Avoid the need to fix: Instead of recommending the latest “cure” you heard about, just listen quietly and let your friend share their story. Your love and support are much more valuable than any advice you could offer. 
  • Take the pressure off: It can be hard to be honest about your struggles if you feel like you always have to perform positively with your friends. Take the pressure off, and let your friends know you’ll be there for them in hard times, too. 
  • Don’t disappear: When a friend goes through a hard time, it’s difficult to know what to do or say. Be present when your friend experiences loss or heartbreak. Often the best thing you can do is simply show up. 
  • Normalize professional treatment: It’s great to rely on friends for perspective and insight, but even the best friendships can’t treat mental illness effectively. Encourage your friends to find a therapist if they need expert help with their mental health.

https://www.cmu.edu/dietrich/psychology/stress-immunity-disease-lab/publications/stresssocial/pdfs/socsupchap91.pdf