qualitative research questions on friendship

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Using qualitative methods to study friendships

2005, New Directions for Child and Adolescent Development

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Meritxell Ramírez-i-Ollé

Friendships formed in the course of scientific research are common and should be foregrounded in discussions of how the sciences are done. Inspired by the Sociology of Scientific Knowledge, I propose a symmetrical analysis of friendships in both the social and natural sciences as a way of comparing knowledge-making practices. The question that this article addresses is: How are friendships with and between subjects generative of new forms of scientific knowledge, particularly understandings of the social life of science and new types of social relations? I provide an answer based on my experience befriending a group of dendroclimatologists to whom I referred metaphorically as “my chimps” in analogy with the primatologist Jane Goodall’s affectionate relation with her subjects. In my case, befriending subjects involved cultivating our curiosity in each other’s life. As a result, my research came to matter to my subjects and we produced it collaboratively. The instrumentalisation of friendships for the purpose of achieving a certain social control and agreement with the beings implicated in the research is a normal aspect of knowledge formation more generally, and therefore, is not unethical. If anything, befriending subjects promotes a better research ethics as it generates a form of sociality based on relatedness, constructive dissent and playfulness rather than hybridity, totalising consensus and domination. Overall, the argument of friendship as a scientific method seeks to criticise the ideal that estrangement, passitivity and indifference are at the heart of how scientific knowledge, both social and natural, is and should be done.

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One of the most powerful aspects of social network data is the fact that they can reproduce social relationships in a formal and comparable way. Relational matrices abstract from the hustle and bustle of everyday interaction, and systematise information in terms of presence or absence of ties expressing them in a directed or undirected, binary or valued form. While the formal approach represents an advantage of social network analysis, as it allows bracketing off the idiosyncratic and subjective content of social structures, the mathematization of the complex nature of social relationships has also been criticised for the lack of engagement with the subjective meaning and context of relationships. Such stream of critique has called for an increase of use of qualitative methods in social network research. The first goal of the paper is to address these critiques by rebalancing the argument and showing how social network analysis has always engaged with both formal and contextual aspe...

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• Published: 23 December 2022

Association between friendship quality and subjective wellbeing among adolescents: a systematic review

• Abdullah Alsarrani 1 , 2 ,
• Ruth F. Hunter 1 ,
• Laura Dunne 3 &
• Leandro Garcia 1  

BMC Public Health volume  22 , Article number:  2420 ( 2022 ) Cite this article

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Social integration with friends has an important role in shaping adolescents’ behavior and determining their wellbeing. Friendship features such as companionship, trust, closeness, intimacy, and conflicts all form the concept of friendship quality. The quality of friendships can either enhance or impede mental development during adolescence. Therefore, this systematic review was conducted to understand the association between friendship quality and adolescents’ mental wellbeing.

In November 2020 and later in August 2022, the search for evidence was conducted on five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO). Only peer-reviewed quantitative studies published from January 2000 to August 2022 that investigated friendship quality as their exposure variable in relation to six constructs of subjective wellbeing (mood, loneliness, life satisfaction, happiness, self-esteem, and subjective wellbeing) were included. After screening for eligibility, two reviewers independently extracted the data based on population characteristics, study design, exposure and outcome variables, outcome measures used, and results. Risk of bias assessment was performed utilizing the NIH Quality Assessment Tool. Narrative evidence synthesis was performed based on the constructs of subjective wellbeing.

Forty-three articles out of 21,585 records were included in the review. The relationship between friendship quality and depression has been investigated extensively in the literature and negative (beneficial) associations were found in eighteen studies out of twenty-three. Poor peer relationship was associated with loneliness in nine studies out of ten. All seven studies on life satisfaction and quality of peer connection found a positive association. In five studies, better peer relationship was found to be associated with happiness. A positive association between friendship quality and self-esteem was observed in five out of six applicable studies. Friendship quality was found to be positively associated with subjective well-being in all of five included studies.

Conclusions

Although majority of the included studies were cross-sectional in nature, this review demonstrates the paramount value of promoting healthy friendship to adolescents’ subjective wellbeing constructs. Interventions that aim to promote subjective wellbeing among adolescents should consider the development and maintenance of healthy friendships.

Systematic review registration

PROSPERO CRD42020219312.

Peer Review reports

Introduction

Adolescents represent a considerable proportion of the human population, amounting to over one billion worldwide [ 1 ]. A crucial period of growth in all aspects of individual development, including psychological and social domains, occurs during adolescence age, which ranges from 10 to 19 years [ 1 ]. It is also a sensitive period as it determines the individuals’ intellectual abilities, social skills, and future behaviors, which need to be enhanced to ensure ideal transition to adulthood [ 1 ]. This stage of life carries its own risk as several health and behavioral issues develop during this important period, such as smoking initiation, illicit drug use, academic difficulties, unprotected sexual intercourse and its related outcomes, self-harm, and suicidal behavior [ 2 ]. Moreover, suicide and homicide are amongst the leading causes of mortality during adolescence [ 1 ]. Hence, adolescents’ wellbeing should be considered a priority by governments, public health agencies, and relevant stakeholders in order to mitigate anticipated challenges and enhance adolescents’ lives.

Several behavioral factors can either positively or negatively impact adolescents’ health and wellbeing. It has been known that poor diet [ 3 ], physical inactivity [ 4 ], inadequate sleep [ 5 ], tobacco use [ 6 ], and alcohol drinking [ 7 ] contribute to poor wellbeing outcomes. However, almost all behaviors can be influenced by social factors, particularly friendships. That is because friendship formation and socializing with same-age peers occupy a significant part in most adolescents’ social life [ 8 ]. Several studies have examined the role of friends in the adoption of unhealthy behavior and on developing negative wellbeing outcomes. For instance, Kim and Chun [ 9 ] found that friendship plays a key role on tobacco use among youth. It has also been evidenced that not only being involved with friends who are smokers affects one’s initiation of tobacco use, but also having no friends has an even greater impact on adoption of this behavior [ 10 , 11 ]. Marijuana use between friends, if adopted, tended to be more mutually adopted and influenced by a user’s popularity [ 10 , 12 ].

Furthermore, a study on youth population (with a mean age of 23.1 years, n  = 183, 53.0% female), have found that alcohol consumption is increased with higher number of friends present in drinking occasions [ 13 ]. The same pattern of behavior and social effect was found on individuals’ meal choice and intake, which was similar to their friends’ food quality and quantity [ 14 ]. This phenomenon was more obvious between close friends. In the same regard, it was found that suicidal behavior between friends during adolescence occurs in the same manner, in which the likelihood of suicidal ideation and attempts is increased with exposure to friends’ suicidal behavior [ 15 ]. It was also found that adolescents who intentionally harmed themselves were more likely to had adopted this behavior from their friends [ 16 ]. Interestingly, this friendship effect on self-harm was observed among youths irrespective of their mental health status [ 16 ]. In another study, You et al. [ 17 ] addressed the moderating role of friendship characteristics and their impact on the relationship between psychological wellbeing and adoption of self-harm behavior. Additionally, work by Long et al. [ 18 ] has clarified how sharing of a certain risky behavior (i.e., disruptive behavior) among adolescents with mental health problems can play a role in the friendship formation and hence worsen their outcome.

The social interaction with friends is not limited to affecting adolescents’ behavior, it can also impact their subjective wellbeing. The area of how social support that adolescents received or perceived from their friends and significant others affect their wellbeing has been extensively researched. For instance, a meta-analysis study conducted by Chu et al. [ 19 ] have examined whether different social support sources and measures have an Impact on wellbeing of children and teens. They found that teacher and school personnel support have a greater value to wellbeing of children and adolescents than other sources of support, including friends support. Among the five measures of social support that the study categorized (size of social network, perceived social support, number of already enacted or received support, number of previously sought social support from others, other or undifferentiated measure of social support), perceived social support was the strongest measure linked to overall wellbeing (r = .201) while social network size was the weakest predictor (r = .01).

For instance, a longitudinal study conducted by Son and Padilla-Walker [ 20 ] have examined how different aspects of prosocial behavior towards friend among children and teens influence their relationships and impacts them psychologically. They found that in terms of quality, the more emotional support, in particular for girls, an adolescent perceives from their friends, the healthier their friendship outcomes and the lower their psychological distress in the future. In addition, Zhang et al. [ 21 ] suggest that youths should maintain healthy relationships and avoid conflicts with their peers and parents in order to have healthy mood. Moreover, Van Harmelen et al. [ 22 ] have demonstrated the protective role of social support from peers and parents against psychological distress for those who experienced early life stress. They found that higher perception of family and friend support at age 14 indirectly contribute to lower depressive symptoms at age 17 for those who have history of peer bullying and/or negative family environment.

Considering the important role of friends in shaping adolescents’ behavior and influencing their self-perception of wellbeing, ensuring they develop high-quality relationships is important. Berndt [ 23 ] claimed that friendship quality should not be confused with other characteristics of the friendship such as conflict, intimacy, companionship. He suggested that friendship quality should be dealt with as a global measure to describe the friendship either as rich or poor in quality regarding to how close to perfect the friendship features are. Another global measure that is important in adolescent life is subjective wellbeing. One’s subjective appraisal of his or her life in general as well as certain aspects of their life and activities is referred to subjective wellbeing [ 24 ]. According to Diener et al. [ 25 , 26 ], subjective wellbeing is an important concept in assessing the health of community members. It encompasses an individual’s perception of happiness, feelings, mood, satisfaction in life and other important aspects of life (e.g., joy, affection, stress, and financial and future satisfaction). Accordingly, it is evident that several constructs make up and also influence the overall perception of subjective wellbeing. These are mood, life satisfaction, self-esteem, loneliness, and happiness. Each of these constructs has its own definition and unique value. The American Psychological association offered two psychological definitions of mood [ 27 ], each of them complements the other. Considering both of these definitions, mood can be defined as a self-perceived state of mind that varies in nature and degree which one may experience without an apparent reason but usually does not last for long time [ 28 ]. One may confuse mood with emotions, which are short-lived feelings, whereas mood is developed gradually and lasts longer [ 29 , 30 ]. Depressed mood is linked to a number of negative outcomes during adolescence and young adulthood, such as poor academic performance [ 31 ], tobacco use [ 32 ], and early onset of alcohol use and its consequences [ 33 ]. Life satisfaction, the second construct, is an overall individual’s perception of their life quality that measures how satisfied someone is with his life [ 34 ]. Fostering life satisfaction among youth is crucial to promote their mental health, academic success, and healthy behavior [ 35 , 36 ]. Regarding to happiness, which is referred to the perception of joy in life [ 37 ], one may experience happiness when their exposure to negative emotions is minimal and their perception of positive emotions, regardless of their intensity, occurs more frequently [ 38 ]. “Happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success” [ 39 ]. Loneliness construct can be described as one’s perception of being lonely or self-isolated as a result of not feeling integrated with people associated with [ 25 , 26 ]. Loneliness can manifest at any age, particularly throughout adolescence, and is associated with poor mental health outcomes [ 40 , 41 ]. One’s overall judgment and viewing on himself as a worthy human being is referred to self-esteem [ 34 ]. Higher levels of self-esteem not only help people achieve particular goals and alleviate the consequences of potential failure, it is also associated with better decision-making prior to failure [ 42 ]. It was found that people who reported having low levels of self-esteem during childhood and adolescence were more prone, albeit only to a small degree, to develop anxious and depressive symptoms in early adulthood [ 43 ].

It is known that reviews have been conducted that investigate certain aspects of friendship or types of friendship and their association with subjective well-being or other outcomes [ 19 , 30 , 44 ], but no manuscript was found that aimed to verify the association between friendship quality and subjective well-being outcomes in adolescents. A metanalysis conducted by Chu et al. [ 19 ] has examined various forms of social support and its impact on a broad range of children and adolescents’ wellbeing outcomes, including their mental state. They found that all areas of social support, including friendship support, that adolescents received or perceived are important to their mental health and wellbeing. Another systematic review conducted by Schacter et al. [ 44 ] looked at how friendship could play a positive role through buffering the relationship between exposure to bullying and mental health outcomes. The review failed to reach a conclusion due to a lack of consistency between the study results; the buffering effect was absent in some studies, while in the rest the results contradicted each other either in favor or against the existence of a moderating effect. On the other hand, a systematic review done by Webster et al. [ 30 ] investigated the role of social networking with friends either online or virtually on several subjective wellbeing outcomes. The study highlighted the beneficial effect of socializing with others rather than being isolated on adolescents’ self-esteem, loneliness perception, and mood, but not on body image. The study also successfully explained how subjective wellbeing outcomes are affected in the context of online social networking through excessive use of social media sites, exposure to direct negative comments, lack of interaction, and fear of not being up to date regarding friends’ posts or state.

Given all the above, it is clear that friendship support matters to adolescents’ wellbeing; however, the role that friendship quality can play on influencing subjective wellbeing outcomes among adolescents is still not well understood. The combined positivity and negativity effects model [ 45 ] suggests that the quality of all types of social relationships and subjective wellbeing are interrelated. According to this model, positive social relationships can influence wellbeing outcomes just as strongly as negative social relationships. Several studies supported this mode [ 46 , 47 , 48 ]. However, more empirical evidence is required to support this assumption, particularly for friendship quality among adolescents. Therefore, this systematic review aims to synthesize the evidence regarding the association between friendship quality and six constructs of subjective wellbeing in adolescents.

Prior to the initial search, the review was registered at PROSPERO (registration number CRD42020219312). We followed PRISMA [ 49 ] and SWiM reporting guidelines [ 50 ] in this work (for more details, see Additional files 1 , 2 and 3 ). On 10 November 2020 (and later on 18 August 2022), a systematic search of five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO) was conducted using the following keywords and their synonyms: friend, peer relation, loneliness, life satisfaction, mood, happiness, wellbeing, self-esteem, quality of life, adolescent, teen, and youth (see Table  1 ). The search was constructed after consultation with a subject librarian at the Center for Public Health at Queen’s University Belfast. Due to the expansion of survey and research methods in this area over the last two decades, and to be up to date with the current knowledge and practice relevant to the current generation, the search was restricted to articles published from January 2000 to August 2022. Only peer-reviewed English articles were included in the review. Materials that fell in one of the following categories were excluded from the review: qualitative articles, review articles, dissertations, books, reports, conference, and editorial papers. Only studies that measured global friendship quality as their exposure variable were included. Papers that investigated individual facets of friendship quality (e.g., closeness, companionship, trust, and conflict) were excluded. The outcomes could be any of the following subjective wellbeing outcomes: self-esteem, happiness, mood, life satisfaction, loneliness, and subjective wellbeing. Articles must have quantitatively investigated the relationship between friendship quality and at least one of the preidentified wellbeing outcomes. An article was included if it had a mean population age between 10 to 19 years. No restrictions were set on the health status of the population.

The above-mentioned search strategy and selection criteria are different from what was originally set in the PROSPERO record (CRD42020219312) in two ways. First, we considered to include studies that investigated individual features of friendship quality (e.g., closeness, intimacy, and conflicts), but with further discussion we decided to amend the study protocol and only include studies that used a global measure of friendship quality. This decision was based on the definition of friendship quality offered by Berndt [ 23 ], which suggests that friendship quality should be differentiated from friendship features and viewed as a single construct to facilitate the judgment of the quality of any friendship. Second, we originally considered to include qualitative as well as quantitative original studies, but then decided to exclude qualitative ones to make data synthesis more consistent by focusing only on one class of research methods. Both changes in the protocol happened during the titles and abstracts screening phase.

Articles’ titles and abstract were screened against the eligibility criteria by one reviewer. The second reviewer screened 10% of the articles (1455 records) to establish the quality of screening at this stage and ascertain the level of agreement. Divergences happened in only 18 articles (1.2%), mostly in the direction of increased sensitivity (i.e., the first reviewer did not exclude an article that the second reviewer would have it). The conflicts were settled through discussion.

For full-text review, a data extraction form was developed by the first author and two colleagues, and the following items were extracted for each of the included studies: number of the participants, mean age, date of the study, type of the study, outcome(s), type of exposure, country in which the study took place, and the study finding(s). The data extraction was completed by the first author and the quality of the extraction was ascertained by double-checking the entire extraction process by a second reviewer, with disagreements settled through discussion and consultation with a third independent researcher. Along with the interpretation of the study finding in the data extraction form, the direction of the significant statistical association found in each study was denoted by “+ve” or “-ve” (positive and negative, respectively), while “null” was added if no significant association was found. In descriptive studies, where the comparison between groups is based on the difference in means or proportions in the outcome, only a brief description of the result was given.

The methodological quality of each study was assessed using The National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort, Cross-Sectional, and Case-Control Studies [ 51 ]. Although this tool is not standardized, it gives the researchers the freedom to set their own parameters and hence better judgment on quality of a study can be achieved [ 51 ]. Several systematic review studies employed this tool and benefited from its flexibility [ 52 , 53 , 54 ]. The tool contains 14 questions to assess the quality of cohort and cross-sectional studies, while the case-control studies’ tool has 12 questions. These questions were designed to capture potential methodological flaws in the included studies. The main focus of these questions is on whether a paper properly identified, explained, measured, and/or provided information about the following: research objectives, study population, sample size justification, participation rate, exposure and outcome variables and timeframe between them, adjusted for confounding variables, and dropout. For the purpose of this review, three items were added to the quality assessment tool, with one point in the final score added for an item if the answer was “yes”. These items are: the study is not limited to a very specific population group (i.e., lack of generalizability to general adolescent population); use of validated measure for each exposure and outcome variable, and the study is not descriptive or correlational in nature. The quality assessment was done by one researcher. After adding those elements to the assessment tool, cross sectional and cohort studies were assessed on a scale of 0 to 17, while case-control studies were assessed on 0 to 15 scale (for more details, see Additional file 4 ).

The evidence was synthesized based on the six preidentified constructs of subjective wellbeing under investigation. The narrative description of the results focused on the consistency of the findings between studies, while taking into account the study design, methodological quality, and the generalizability of the findings according to the characteristics of the sample of the included studies.

A total of 21,585 articles were found in the five databases, out of which 14,524 articles remained after duplicates were removed. Title and abstract screening resulted in the exclusion of 14,481 irrelevant articles. Seventy-nine articles were deemed eligible for full text screening, of which 36 papers, the majority because the exposure variable, were not eligible for our systematic review (e.g., the use of only one domain of friendship quality scales or multidimensional measures that combine relationship quality for friends and significant others). Thus, 43 articles were included in the final analysis and data extraction [ 4 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]. Figure  1 shows the steps of the data screening and extraction. Table  2 shows a breakdown of the included studies by outcome and study design along with a brief summary of the findings for each subjective wellbeing constructs.

Data screening and extraction stages

Of the 43 articles included (Table  3 ), 31 were cross-sectional [ 4 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 87 , 88 , 89 , 91 , 95 , 97 ] and only 10 longitudinal [ 61 , 83 , 84 , 85 , 86 , 90 , 92 , 93 , 94 , 96 , 98 ] and 2 case-control studies were found [ 55 , 56 ]. Depressive symptoms were the most investigated wellbeing outcome (23 studies: [ 4 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 83 , 84 , 85 , 86 , 88 , 92 , 93 , 94 , 95 , 97 , 98 ]), followed by loneliness (10 studies: [ 55 , 56 , 62 , 67 , 68 , 69 , 70 , 71 , 72 , 93 ]), life satisfaction (8 studies: [ 73 , 74 , 75 , 76 , 77 , 89 , 90 , 91 ]), self-esteem (6 studies: [ 66 , 67 , 78 , 79 , 80 , 87 , 93 ]), happiness (5 studies: [ 67 , 70 , 76 , 81 , 83 , 86 ]), and subjective wellbeing (5 studies: [ 78 , 79 , 82 , 91 , 96 ]).

Friendship quality and depressive symptoms

Of the twenty-three studies that looked at the impact of the quality of the relationship between peers on developing of depressive symptoms among adolescents, sixteen studies investigated that relationship cross sectionally [ 4 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 88 , 93 , 95 , 97 ] and six studies utilized longitudinal design [ 83 , 84 , 85 , 86 , 92 , 94 , 98 ], while case-control study has been employed in one study [ 56 ]. The quality of the included studies is of great concern as the methodological quality index of the included studies varies widely and ranges from six to fourteen. Besides, nine studies had weak analysis plan that does not extend to regression analysis [ 4 , 57 , 61 , 65 , 66 , 67 , 88 , 93 , 95 ]. Gender ratio imbalance was also noticed in one study [ 62 ]. For these reasons, the results must be interpreted with caution.

Assessment of the studies indicated that there is an observed consistency in the findings across all but two cross-sectional studies which suggests a beneficial association between better peer relationship and depressive symptomology during adolescence, but this consistency was not observed in the results of the six longitudinal studies as they varied in their conclusions. Of these six studies, two methodologically-sound studies supported the evidence of presence of a beneficial association between better peer bonds and lower depressive symptoms [ 83 , 86 , 94 ]. On the other hand, one short-term study demonstrates null effect of peer relationships on depressive symptoms [ 85 ]. One study suggested a direct impact only for poor peer relationships and higher depressive symptoms [ 84 ], while two studies revealed a bidirectional relationship between friendship quality and depressive symptoms [ 92 , 98 ]. Therefore, based on the limitations and variations of the studies’ findings, high certainty of whether enhancing of friendship quality is of great benefit to prevent depression among teens could not be achieved.

Friendship quality and loneliness

The association between friendship quality and perception of loneliness during adolescence was cross-sectionally examined in eight studies [ 62 , 67 , 68 , 69 , 70 , 71 , 72 , 93 ] and two case-control studies [ 55 , 56 ]. The methodological quality index ranges from seven to fifteen. Irrespective of the quality of evidence, the replicability of the same results and conclusions across different populations, stages of adolescence, types of friendship quality in respect to gender and whether it is between best friends only, all supported the hypothesis that positive peer relationships were associated with lower levels of loneliness [ 55 , 62 , 67 , 68 , 69 , 70 , 71 , 93 ]. However, this claim might not apply to adolescents with Asperger’s syndrome and those who live in rural areas as was highlighted in two studies [ 56 , 72 ]. Furthermore, whether loneliness is more likely to affect those who experience non-ideal relationships with their peers or loneliness negatively impact friendship quality could not be judged as there is a lack of longitudinal studies in this area.

Friendship quality and life satisfaction

Seven cross-sectional [ 73 , 74 , 75 , 76 , 77 , 89 , 91 ] and one longitudinal studies [ 90 ] have been identified and included into our review that assessed whether good peer relationship is associated with adolescents’ perception of life satisfaction. The quality index score of these studies ranges from eight to thirteen. Although the methodological quality index of the included studies does not vary significantly, major weaknesses were noticed in two studies which had an imbalance in gender ratio [ 75 , 76 ], while one study drew its conclusion from the results of the univariate analysis [ 76 ]. However, the findings were homogenous across all the studies and suggested a significant association between experiencing a healthy relationship and adolescents’ life satisfaction.

Friendship quality and happiness

Five included studies assessed whether happiness level is associated with maintaining a positive relationship with peers. This association was cross-sectionally examined in four studies [ 67 , 70 , 76 , 81 ] while a longitudinal design was utilized in one study [ 83 , 86 ]. The methodological quality index ranges from eight to thirteen. Two studies were poorly designed as both utilized weak statistical analysis method [ 67 , 76 ] and one of them had gender ratio imbalance [ 76 ]. However, all of the included studies support the claim that better peer relationship is associated with higher levels of happiness among adolescents. Besides, the directionality of the relationship between friendship quality and happiness can be assumed, with low confidence, as this aspect was tested longitudinally in one study.

Friendship quality and self-esteem

Six studies utilized cross-sectional analysis were carried out to investigate the association between quality of relationship and self-esteem during adolescence [ 66 , 67 , 78 , 79 , 80 , 87 , 93 ]. In regard to the methodological quality index, no major variation in the quality scores were noticed as the scores range from seven to ten. Five studies assumed that good companionship is associated with better self-esteem perception among teens [ 66 , 67 , 78 , 79 , 93 ], while only one study suggests the opposite [ 80 , 87 ]. Although the results of majority of the studies are consistent, the directionality of the relationship cannot be confirmed due to lack of longitudinal evidence.

Friendship quality and subjective wellbeing

There is a little evidence regarding the influence of quality of relationship in relation to subjective wellbeing during adolescence. One longitudinal [ 96 ] and four cross sectional studies [ 78 , 79 , 82 , 91 ] were included with the methodological quality index ranging from nine to twelve. One of these studies was specific for adolescents aged 13 [ 82 ], while one small-scale study had imbalance in gender ratio [ 78 ]. The findings are consistent across the studies and suggested that healthy peer relationship is associated with a better perception of subjective wellbeing. However, due to the scarcity of studies in this area, especially longitudinal studies, generalization of this finding is not encouraged, nor directionality of the relationship can be established.

This systematic review included 43 studies investigating the association between friendship quality and six subjective wellbeing outcomes in adolescents [ 4 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]. More than half of these studies [ 4 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 83 , 84 , 85 , 86 , 88 , 92 , 93 , 94 , 95 , 97 , 98 ] focused on depressive symptoms as their main wellbeing outcome, which reflect the shortage of studies in other domains of wellbeing outcomes. This shortage was more evident in the area of quality of peer tie in relation to happiness and subjective wellbeing, where only five studies for each have been found [ 67 , 70 , 76 , 78 , 79 , 81 , 82 , 83 , 86 , 91 , 96 ]. Beside this shortage, the cross-sectional design that have been used for most of the studies precludes us from reaching to more conclusive answers. Therefore, the interpretation of these results should be approached with caution. However, different conclusion and limitations for each relationship investigated can be drawn.

The evidence is indicative of an association between peer relationship quality and depressed mood [ 4 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 83 , 84 , 85 , 86 , 88 , 92 , 93 , 94 , 95 , 97 , 98 ]. Although there are concerns regarding the quality of the cross-sectional studies that assessed this relationship, the replicability of the same conclusion across studies increased the reliability of the evidence, which suggest that poor mood is related to poor friendship quality. Consistent with the finding, a review conducted by Roach [ 157 ] have found that support from friends has a beneficial buffering effect on poor mental health outcomes including depressive symptoms in adolescents, especially for those who are not in optimal mental health status. However, their review did not provide a causal explanation of how this mechanism occurs and it was only related to the influence of social support, not the potential effect of friendship quality. Moreover, the directionality of this relationship remains unclear due to the limited number of longitudinal studies, and the lack of consistency in the findings of the longitudinal studies. The ambiguity regarding how this mechanism occurs has several explanations. The stress prevention model developed by Gore [ 158 ] suggests that individual’s exposure to negative stressors can be decreased or prevented by the presence of support from close ones. Another model, called stress-buffering model, suggests that social support operates as a moderator between stress and negative mental health outcome, in which the individual’s ability to cope with difficulties is enhanced for those who have a better social support, as their interpretation of stressful life events they may experience are influenced positively in a pathway called cognitive appraisal process [ 159 , 160 ]. The conflicting findings of the longitudinal studies in this review neither confirm nor deny this claim. Therefore, this arena of research needs further investigation. More longitudinal studies are needed to address the temporality concern. Studies on mediators and moderators are also required to address the ambiguity around the relationship between peer relationship quality and depressive symptoms. Hence, the reliance on this evidence alone while designing an intervention to reduce the prevalence of depression may not serve the purpose. A novel approach that avoids the shortcomings in the previous studies is required to fill this gap in the evidence base and uncover the mechanism that underlies the potential association between friendship quality and depression to help develop suitable interventions.

The studies included in this review regarding the association between friendship quality and loneliness [ 55 , 56 , 62 , 67 , 68 , 69 , 70 , 71 , 72 , 93 ] indicated that adolescents who experienced a higher friendship quality score reported less loneliness than their peers with lower quality friendships. A previous review identified the presence of intimacy in friendship as one of the important factors on lowering loneliness level in older adults [ 161 ]. The Belonging Hypothesis developed by Baumeister and Leary [ 162 ] suggests that searching for, and maintenance of, secure social relationships is part of our psychological formation as a social being (p. 497). Indeed, friendship formation itself satisfies our needs for social interaction with others and limits our sense of loneliness. Having a strong friendship would also limits this sense further. Interventions that focus on improving social skills and social support are one of the successful strategies that have been used to alleviate loneliness among adult population, as discussed in a previous meta-analysis [ 163 ]. This indicates that an individual with strong social skills can develop healthy friendships and hence few less lonelily than others. However, our conclusion from the included studies would have been of great value if it was supported by high-quality longitudinal evidence as there is a concern regarding the temporality of the associations observed. Therefore, this evidence should be interpreted with caution as it is only useful in developing a hypothesis that needs to be further tested.

This review also found a positive association between positive adolescents’ bonds and life satisfaction. A review conducted by Proctor et al. [ 164 ] discussed the value of social support from parents and friends to life satisfaction among youths. Their review showed that middle and late adolescence is the stage in which adolescents begin to rely more on their friends for social support. As human beings, non-material social assistance from friends and significant others is a need that when fulfilled can significantly impact on our perception of life satisfaction as shown in several researches [ 165 , 166 , 167 , 168 ]. However, considering that all, but one [ 90 ], of the studies included in this review are cross-sectional in nature [ 73 , 74 , 75 , 76 , 77 , 89 , 91 ], temporality could not be implied with high certainty. Further studies with a longitudinal design are needed to address the directionality concern, increase the validity of evidence, and better understand the mechanism that governs this relationship.

Our review supports the hypothesis that establishing a good relationship with peers can contribute significantly to better perception of happiness among adolescents. This beneficial association was observed cross-sectionally [ 67 , 70 , 76 , 81 ] and longitudinally [ 83 , 86 ]. This suggests that happiness level might be improved by investing on developing healthy friendship among adolescents. Along with our finding, a previous review conducted by Garcia et al. [ 169 ] reached the same conclusion. However, their work was limited to Latin American population and included all age groups. Therefore, considering the limited number of studies in this area and that almost half of these studies were conducted in New Zealand, one should not overemphasize or generalize this finding to all population.

This review also supports the hypothesis that healthy friendships can play a role in the adolescents’ perception of self-esteem and wellbeing. Almost all studies that have been found observed a positive association [ 66 , 67 , 78 , 79 , 82 , 91 , 93 ]. Previous review conducted by Gorrese and Ruggieri [ 170 ] on adolescents and young adults concluded that self-esteem can be boosted by secure peer relationships, especially if by friendships characterized by high level of trust and positive communication. This suggests that individuals’ sense of worthiness is partly formed and developed by perception of the quality of their social relationships, with better outcome for those with better friendship quality. However, there is a scarcity of studies, particularly longitudinal evidence, in this area. Further studies of good quality should be undertaken to better assess this relationship as the level of evidence obtained from those studies is not strong enough to reach a conclusive answer.

Strengths and limitations

The association between friendship quality and subjective wellbeing in adolescents has been addressed for the first time in our review. A range of important subjective wellbeing constructs relevant to adolescents have been considered in this review to offer a broader understanding of this area of research. However, this work is not without limitations.

The first limitation is that no language other than English has been considered in the inclusion criteria due to time restriction. Hence, the generalizability of our findings could be limited for non-English-speaking countries because some of the evidence generated in these places might have published in other languages. Second is the absence of a meta-analysis component in our synthesis of evidence. That is because of poor reporting of the results in majority of the included studies as only twelve studies, for different wellbeing outcomes, have reported the effect estimate with the standard error, while other studies did not offer it nor provide any measures from which we could obtain it, such as the exact p -value or confidence intervals. The synthesis of our findings would have been improved by the reporting of these measures.

Implications for future research and practice

There are two major gaps in the literature that future research should address: scarcity of longitudinal studies, and absence of studies on moderators and mediators – except in one study of mediators [ 58 ] – that underlies the association between friendship quality and subjective wellbeing. Therefore, future research should be more longitudinal in nature [ 21 ]. Moreover, there is a need for using advanced statistical analysis method [ 21 ], such as structural equation modeling and social network analysis, in order to better understand how quality of relation between friends impacts subjective wellbeing. Uncovering the underlying mechanism of this association and identification of the intermediary variables can be achieved by using structural equation modeling or similar approaches in which indirect mediational paths can be discovered. The difference in the association between study subjects in general and also based on their locations, such as their schools or communities, can also be accounted by using multilevel structural equation modeling. Social network analysis, on the other hand, can help visualizing the full friendship network structure and understanding how different patterns or levels of friendship between individuals play a role in shaping their wellbeing outcomes. Specific surveys should be developed to capture network data, hence, the complete network structure with relationships between individuals can be drawn and then examined. Future research examining the relationship between friendship feature (e.g., closeness, intimacy, and trust) and subjective well-being can also benefit from employing these methods. This would contribute to a better understanding of how different friendship characteristics influence subjective well-being during adolescence.

In practice, adolescents should be educated regarding the interrelation between friendship quality and subjective wellbeing outcomes. The role that good-quality social life and other potential risk factors could play in affecting their wellbeing should be highlighted. Such an educational intervention should involve schools where an atmosphere of learning, discussion, and development of healthy friendship during adolescence can be provided. Interventions can also take place where youth also tend to come together, such as community centers and places of worships. Caregivers, teachers, and other role models should also get involved and encourage adolescents to seek and nourish good quality friendships. They can engage formally – e.g., by participating in delivering interventions, workshops, campaigns, and other activities – and informally to educate about, and incentivize, the development of healthy friendships.

The results suggest potential positive association between healthy friendships and better perception of wellbeing outcomes. However, there is a considerable lack of longitudinal studies and studies of mediators and moderators that underlies this association. Further studies that employ study designs and analytical methods that are more suitable to investigate the causal relationship between friendship quality and subjective wellbeing constructs are needed.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the article and its additional files.

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Acknowledgments

The authors acknowledge support from the Deanship of Scientific Research at Taibah University. The authors are grateful for a full review of the data extraction part done by Dr. Christopher Tate from the Center for Public Health at Queen’s University Belfast.

The work is funded by studentship provided by Taibah University, Saudi Arabia.

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Alsarrani, A., Hunter, R.F., Dunne, L. et al. Association between friendship quality and subjective wellbeing among adolescents: a systematic review. BMC Public Health 22 , 2420 (2022). https://doi.org/10.1186/s12889-022-14776-4

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A qualitative study of friendships in old age: The case of a nursing home in Turkey

• Published: 21 August 2020
• Volume 40 , pages 2610–2620, ( 2021 )

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• Çiğdem Yavuz Güler   ORCID: orcid.org/0000-0002-1607-0789 1 ,
• Ilgın Çakmak   ORCID: orcid.org/0000-0002-6487-6891 2 &
• Yunus Ayyıldız   ORCID: orcid.org/0000-0003-0020-7311 2  

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This study aims to understand, discuss, and describe the unique friendship dynamics of the elderly. A qualitative method-phenomenological design was adopted to obtain in-depth information. The study group comprised nursing home residents ( n  = 17), with nine female and eight male residents over the age of 65. The data collected through two focus group interviews were analyzed using MAXQDA 2018-Version 2018. According to the data analysis, sub-codes for the definitions of friendship by the elderly could be separated into five generic categories: behavioral processes (assistance, sharing, boundaries, altruism, and graciousness); cognitive processes (trust, respect, commitment and fidelity, compatibility, and morality); affective processes (intimacy and requirement); structural characteristics (openness, vigilance, reciprocity, and support during good times and bad); and distinctive features (despair, references to the past, health competence, and caregiver as a friend). Although it has been recognized that the elderly offer similar statements as other age groups with regard to the emotional, behavioral and cognitive definitions of friendship, it has been observed that they often refer to the past when they are expressing their friendships and that establishing and maintaining friendships depend on their health status and capabilities. Establishing a friendship with the caregiver is a remarkable characteristic of this period. The results of this research, which aimed to examine the friendship dynamics of the elderly, can be a resource for researchers who discuss the theory of friendship and aging and can be used as a source for the development of elderly care, social support services, and preventive mental health programs for the elderly.

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Ilgın Çakmak & Yunus Ayyıldız

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Yavuz Güler, Ç., Çakmak, I. & Ayyıldız, Y. A qualitative study of friendships in old age: The case of a nursing home in Turkey. Curr Psychol 40 , 2610–2620 (2021). https://doi.org/10.1007/s12144-020-01012-8

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Published : 21 August 2020

Issue Date : June 2021

DOI : https://doi.org/10.1007/s12144-020-01012-8

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What does friendship look like in America?  

Americans place a lot of importance on friendship. In fact, 61% of U.S. adults say having close friends is extremely or very important for people to live a fulfilling life, according to a recent Pew Research Center survey . This is far higher than the shares who say the same about being married (23%), having children (26%) or having a lot of money (24%).

Pew Research Center conducted this analysis to understand Americans’ views of and experiences with friendship. It is based on a survey of 5,057 U.S. adults conducted from July 17-23, 2023. Everyone who took part in this survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

Here are the  questions used for the analysis , along with responses, and its methodology .

We decided to ask a few more questions to better understand how Americans are experiencing friendship today. Here’s what we found:  

Number of close friends

A narrow majority of adults (53%) say they have between one and four close friends, while a significant share (38%) say they have five or more. Some 8% say they have no close friends.

There’s an age divide in the number of close friends people have. About half of adults 65 and older (49%) say they have five or more close friends, compared with 40% of those 50 to 64, 34% of those 30 to 49 and 32% of those younger than 30. In turn, adults under 50 are more likely than their older counterparts to say they have between one and four close friends.

There are only modest differences in the number of close friendships men and women have. Half of men and 55% of women say they have between one and four close friends. And 40% of men and 36% of women say they have five or more close friends.

Gender of friends

Most adults (66%) say all or most of their close friends are the same gender as them. Women are more likely to say this than men (71% vs. 61%).

Among adults ages 50 and older, 74% of women – compared with 59% of men – say all or most of their close friends are the same gender as them. Among adults younger than 50, the difference is much smaller: 67% of women in this age group say this, as do 63% of men.

Race and ethnicity of friends

A majority of adults (63%) say all or most of their close friends are the same race or ethnicity as them – though this varies across racial and ethnic groups.

White adults (70%) are more likely than Black (62%), Hispanic (47%) and Asian adults (52%) to say this.

This also differs by age. Adults 65 and older are the most likely (70%) to say all or most of their close friends share their race or ethnicity, compared with 53% of adults under 30 – the lowest share among any age group.

Satisfaction with friendships

The majority of Americans with at least one close friend (72%) say they are either completely or very satisfied with the quality of their friendships. Those 50 and older are more likely than their younger counterparts to be highly satisfied with their friendships (77% vs. 67%).

The survey also finds that having more friends is linked to being more satisfied with those friendships. Some 81% of those with five or more close friends say they are completely or very satisfied with their friendships. By comparison, 65% of those with one to four close friends say the same.

The survey didn’t ask adults who reported having no close friends about their level of satisfaction with their friendships.

What do friends talk about?

Of the conversation topics asked about, the most common are work and family life. Among those with at least one close friend, 58% say work comes up in conversation extremely often or often, while 57% say family comes up this often. About half say the same about current events (48%).

There are differences by gender and age in the subjects that Americans discuss with their close friends:

Differences by gender

Women are much more likely than men to say they talk to their close friends about their family extremely often or often (67% vs. 47%).

Women also report talking about their physical health (41% vs. 31%) and mental health (31% vs. 15%) more often than men do with close friends. The gender gap on mental health is particularly wide among adults younger than 50: 43% of women in this age group, compared with 20% of men, say they often discuss this topic with close friends.

By smaller but still significant margins, women are also more likely than men to talk often about their work (61% vs. 54%) and pop culture (37% vs. 32%) with their close friends.

Men, in turn, are more likely than women to say they talk with their close friends about sports (37% vs. 13%) and current events (53% vs. 44%).

Differences by age

Those ages 65 and older (45%) are more likely than younger Americans to say they often talk with their close friends about their physical health.

There are two topics where young adults – those under 30 – stand out from other age groups.

About half of these young adults (52%) say they often talk with their friends about pop culture. This compares with about a third or fewer among older age groups. And young adults are more likely to say they often talk about their mental health with close friends: 37% say this, compared with 29% of those 30 to 49 and 14% of those 50 and older.

Note: Here are the  questions used for the analysis , along with responses, and its methodology .

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Among parents with young adult children, some dads feel less connected to their kids than moms do, how teens and parents approach screen time, most east asian adults say men and women should share financial and caregiving duties, among young adults without children, men are more likely than women to say they want to be parents someday, most popular.

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Friendship in Later Life: A Research Agenda

Rosemary blieszner.

1 Center for Gerontology, Virginia Tech, Blacksburg

Aaron M Ogletree

2 American Institutes for Research, Rockville, Maryland

Rebecca G Adams

3 Gerontology Program, University of North Carolina at Greensboro

Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.

Translational Significance

Social isolation places older adults in jeopardy for both poor health and low psychological well-being. Detailed research findings on crucial elements of friendship in late life can inform the design of social interventions aimed at enhancing personal skills and strategies for making and keeping friends, planning of community programs to foster friend interactions and advocacy for policies that promote rather than interfere with late-life friendship.

Why Is It Important to Study Friendship in Late Life?

What are the benefits of friendship to old people.

Friendship is a relationship that can endure across the entire life span, serving a vital role for sustaining social connectedness in late life when other relationships, such as with coworkers and organization members, may be relinquished. Although gaining new kin is common at earlier ages, in the later years the possibility of making new friends is greater than the likelihood of enlarging the kin network, at least in one’s own generation.

Friend ties have been revered as vital relationships since ancient times, when Confucius and Aristotle extolled the benefits of associating with those who encourage moral virtue, complement one’s own limitations, and provide cherished companionship. Aristotle, in particular, highlighted emotional and reciprocal aspects of friendship that are deemed important now ( Mullis, 2010 ), as contemporary adults focus on affection, trust, commitment, respect, reciprocity, and the like when defining friendship ( Blieszner & Adams, 1992 ; Dunbar, 2018 ; Felmlee & Muraco, 2009 ). At the same time, diversity in perceptions of important elements of friendship occurs across life cycle stage, gender, marital and parental status, geographic location and cultural context, and historical eras ( Adams, Blieszner, & de Vries, 2000 ; Blieszner & Adams, 1992 ; Gillespie, Lever, Frederick, & Royce, 2015 ). Early empirical studies of social relationships, including those in late adulthood, generally did not focus on friendship per se, so this nuanced awareness of friendship is a recent phenomenon.

Although it is clear that friendship has long been an important part of social life and important to well-being, this close relationship has not received nearly as much attention historically as family ties. In fact, in 1950s and 1960s when sociologists and family scientists examined close relationships, they tended to investigate marital and kin bonds, but typically did not include friends in their studies. Not until 1970s and 1980s did scholars begin to probe friendship as a social role in its own right, separate from ties with colleagues, neighbors, acquaintances, and other nonkin, and to study friendship as a relationship rather than friendliness as an individual attribute. They uncovered a range of friendship forms and functions and identified both unique aspects of friendship as distinct from other ties as well as similarities between friendship and other informal and close relationships ( Blieszner & Adams, 1992 ).

Studies consistently show that friend relationships are as important as family ties in predicting psychological well-being in adulthood and old age ( Chen & Feeley, 2014 ; Dunbar, 2018 ; Santini, Koyanagi, Tyrovolas, Mason, & Haro, 2015 ). Of course, the closeness of both relatives and friends varies, so studies examining specific relationships as opposed to global categories are especially helpful for understanding the relative impact of family members versus friends on well-being in the later years. For example, analyses by Lee and Szinovacz (2016) of 6,418 participants in the 2008 Health and Retirement study showed that although relationships with spouses tended to have the strongest association with mental health, ties with friends showed stronger associations with mental health than those with other relatives. Results such as these suggest the merits of investigations specifically addressing friendship and specifically focusing on old age.

Along with investigation of structural aspects of friendship, such as friend roles and interaction frequency, came awareness of the need to examine friendship in the context of social networks; to view friendship as evolving over the life course and proceeding through phases over time; and to assess cognitive, affective, and behavioral processes as dynamic aspects of friend interactions. This more nuanced approach to friendship research emerged from moving beyond laboratory experiments and broad surveys to using in-depth interviews, which fostered a focus on quality of friend interactions, not just quantity ( Adams & Blieszner, 1994 ; Blieszner & Adams, 1992 ) and recognition that friends and interactions with friends involve individual characteristics that evoke differential responses according to individual preferences ( Adams & Blieszner, 1995 ). As a result, research on friendship has flourished in recent decades, including studies of friendship in middle-age and beyond, yielding a wide-ranging literature on both traditional (e.g., emerging from face-to-face interactions) and innovative (e.g., formed via social media networking) aspects of friend ties in later life ( Blieszner & Ogletree, 2018 ).

Among the friendship and aging topics investigated, a prominent focus has been on the contributions of friends to psychological well-being ( Blieszner, 1995 ; Blieszner & Ogletree, 2018 ). Late-life adults report liking and caring about their friends, laughing together and having fun, feeling satisfied with their relationships, being able to confide in each other, and reminding each other to stay healthy ( Blieszner & Adams, 1992 ). Friend ties alleviate loneliness ( Chen & Feeley, 2014 ; Nicolaisen & Thorsen, 2017 ), offer emotional and instrumental support ( Felmlee & Muraco, 2009 ), and provide companionship through mutual interests and shared activities ( Huxhold, Miche, & Schüz, 2014 ). The feelings of connectedness that these aspects of friendship convey give meaning to older adults’ lives, which is important for well-being ( ten Bruggencate, Luijkx, & Sturm, 2018 ). Indeed, exchanging many forms of social support is one of the most important benefits of friendship in the second half of life.

The advantages of late adulthood friendship reach beyond psychological well-being. Research shows that relational closeness and social support are also important for maintaining cognitive functioning and physical health in old age ( Béland, Zunzunegui, Alvarado, Otero, & del Ser, 2005 ; Holt-Lunstad, Smith, & Layton, 2010 ). Moreover, old age poses unique challenges, including health changes that might require assistance or caregiving. Thus, it is particularly important to study old age friendships, especially for those without family members, without proximal family members, or without family members willing to care for them. Indeed, some friends do assume direct caregiving responsibilities ( de Vries, 2018 ), particularly among lesbian, gay, and bisexual older adults who might experience strain in their family relationships ( Muraco & Fredriksen-Goldsen, 2011 ).

Although we can point to extensive evidence on the importance and benefits of friendship, unexplored research questions about friendship across the adult years abound. Key purposes of this article are to provide a comprehensive yet flexible conceptual framework to guide research on late-life friendship, synthesize into one framework the multiple aspects of friendship and its predictors suggested by various theoretical approaches, point to unanswered questions and useful research methods, and suggest friendship-related interventions that could successfully enhance experiences of friend partners in their special bonds. Our goal is to encourage scholars to study this rich and fascinating dimension of aging and engage in relevant translational science to sustain and enhance the quality of life for all elders. We begin with an examination of theories for investigating friendship.

What Theories Can Guide Friendship Research Toward Answering Unresolved Questions?

Foundational theories.

Although many theories of interpersonal attraction and relationship development could inform late-life friendship research, relatively few have guided these investigations. Social network theory, which focuses on predictors of the structure of relationships rather than on their dynamics, is relevant to understanding friendship opportunities and constraints at any stage of life. Relatively little is known about structural features of friendship dyads and networks, though, because empirical studies guided by social network theory usually have not distinguished between friends and other close ties. Nevertheless, some research on structural features of late-life friendship exists. For example, Adams (1987) studied changes in the friend networks of old women over 3 years and found interesting patterns of both expansion and contraction (not only contraction) of the network membership and also intensification and weakening (not only weakening) of emotional bonds among friends in the network. These changes in network size and closeness varied by the women’s demographic characteristics, namely social and marital statuses. Looking at additional structural features of late-life close friend networks, such as similarity of gender, race, religion, age, and extent of influence on the friend, Adams and Torr (1998) found variation in friend networks of both older women and men based on characteristics of the social and cultural environments in which the networks were embedded. This finding shows that friend bonds are affected not only by personal choice, but also by external influences. Thus, investigations of structural features of friend networks reveal the range of similarities and differences across groups of older adults based on cultural contexts, personal characteristics, and situational features of interactions with current or potential friends.

Social exchange theory, the convoy model of relationships, and socioemotional selectivity theory have been the most common guides for research on the processes of friendship development and sustainment. Early studies of friendship dynamics in old age were grounded in social exchange theory (e.g., Roberto, 1989 ; Roberto & Scott, 1986 ), which posits that social interactions involve costs and benefits that participants assess as they establish and sustain relationships. The types of resources exchanged ( Blieszner, 1993 ; Shea, Thompson, & Blieszner, 1988 ) and the preferred and actual extent of equity and reciprocity in social exchanges ( Dunbar, 2018 ) are also considered in friendship research conducted from this perspective. Li, Fok, and Fung (2011) examined age group differences in the association between emotional and instrumental support balance in relation to support received from friends versus family, and the implications for life satisfaction. Friendships were evaluated by older and younger adults as more reciprocal than family ties, in keeping with the more voluntary nature of friendship. However, older adults reported higher life satisfaction when they felt emotionally (but not instrumentally) over-benefited in friendships, whereas younger adults’ life satisfaction was associated with reciprocity in emotional support exchanges with friends. The general assumption that equity in exchanges is preferable did not apply to the older adults in this study, reflecting the premises of socioemotional selectivity theory, discussed later.

The convoy model of relationships ( Antonucci & Akiyama, 1987 ) provides another approach to analyzing old age friendship and support interactions, connecting both interactive and structural aspects of relationships. It focuses on differences in perceived level of closeness, allowing for comparisons across types and functions of friendships as well as across stages of the life span ( Antonucci & Akiyama, 1995 ). Using the convoy model, Piercy and Cheek (2004) investigated friendships among middle-aged and older women who belonged to quilting bees and guilds. They found evidence of strong and supportive friend convoys with interaction patterns suggesting these friends would have enduring positive effects on the women’s well-being into oldest age. Levitt, Weber, and Guacci (1993) examined social support (e.g., confiding, reassurance and respect, assistance, advice) from friends versus relatives across the social network structures of family triad members from three generations. The mothers and grandmothers tended to report fewer friends than relatives in their networks and to receive less support from friends as compared with the youngest women. This pattern held across cultures, as both English-speaking and Spanish-speaking women reported similar network structures and sources of support. A recent meta-analysis by Wrzus, Hänel, Wagner, and Neyer (2013) confirmed these cross-generational differences in network structure (i.e., size) via a meta-analysis of data in 277 studies from 28 countries.

More recently, socioemotional selectivity theory ( Carstensen, Isaacowitz, & Charles (1999) has underpinned research on friendship in the later years. This theory proposes changes in social interactions as older adults perceive their remaining lifetime becoming shorter. Specifically, old people adapt to their changing circumstances by reserving their emotional energy for their most important relationships, shedding those with less meaning and value. Sander, Schupp, and Richter (2017) found support for this theory in a study of German adults aged 17–85. Across age groups, the frequency of face-to-face contacts with relatives was similar, but such interactions with friends and others decreased in frequency. The study by Li and colleagues (2011) described previously also confirmed socioemotional selectivity theory, with findings suggesting that older persons in the study had higher life satisfaction in the context of nonreciprocal emotional support, probably because they prioritize emotionally meaningful exchanges over other interactions. These findings imply that very close friends can continue as central figures in older adults’ social networks even if the networks are shrinking, regardless, perhaps, of frequency of face-to-face contact.

An Integrative Conceptual Framework

Social network theory highlights the value of examining structural features of friendship, how they influence formation and retention of friendships, and whether those features change over time. Social exchange, convoy, and socioemotional selectivity theories share similar foci on availability and reciprocity of support in friendship and other close relationships. They point to numerous individual, interpersonal, and interactional characteristics that can have an impact on friend relationships and outcomes. Our conceptual framework for friendship research ( Adams & Blieszner, 1994 ; Adams, Hahmann, & Blieszner, 2017 ; Ueno & Adams, 2006 ) integrates the psychological and sociological perspectives highlighted in social exchange, convoy, socioemotional selectivity, social network, and other theories to provide a flexible and comprehensive guide for investigating many intersecting dimensions of friendship in old age. Propositions and hypotheses from the focal theory can be formulated around the concepts and variables identified in the friendship framework.

As shown in Figure 1 , the integrative friendship framework posits a series of reciprocal influences on friend partners that affect their typical modes of interacting and hence, their emergent and ongoing interaction patterns. The gray box and arrows signify that friendship patterns are dynamic and contextualized in time and space and across cultures; the dashed lines signify that individuals, friend dyads, and friend networks embedded in these contexts affect them and are affected by them. The left panel shows that friends bring their individual characteristics to the relationship, including both social structural positions and psychological dispositions, which are mutually influential through the social psychological interpretation and internalization processes described by Cooley and Mead ( Adams & Blieszner, 1994 ; Cooley, 1964 ; Mead, 1962 ). That is, propensities emerging from socialization experiences and personality affect how a person internalizes expectations associated with specific social locations, and social locations affect how a person interprets friendship-related opportunities and constraints. These personal characteristics lead to choices about where to spend time and how and when to interact with friends, as well as ways of thinking and feeling about friends and friendship, signified as interactive motifs and depicted in the middle of the figure. Cognitive, affective, and behavioral interactive motifs thus affect the friendship patterns (right panel) that occur between friend pairs and in larger friend networks in which the pairs are embedded. For either friend dyads or friend networks, internal structural features (homogeneity and hierarchy in dyads; size, density, homogeneity, and hierarchy in networks) facilitate and constrain interactive processes (cognitive, affective, behavioral), which in turn modify or sustain the internal structural features.

Integrative conceptual framework for friendship research. From Ueno and Adams (2006) , reprinted with permission from Routledge Publishing, Inc.

Friendships are not static, so Figure 2 demonstrates that the patterns exhibited in Figure 1 occur across the phases of friendship formation, sustainment, and dissolution. Friendships have a starting point, they can become closer or less close, and sometimes they end ( Adams & Blieszner, 1994 , 1998 ; Blieszner & Adams, 1992 , 1998 ). Use of the term phases avoids the notion of unidirectional stages of relationships, which does not apply well to friendship. Rather, movement across phases of friendship is fluid and potentially bidirectional. For example, an incipient friendship might wax and wane in the formation phase before becoming solidified as an ongoing friendship, or a dissolved friendship might be resumed later. Within any of the phases, closeness and other process aspects could increase, decrease, or remain stable. Finally, transitions across phases are influenced by internal structural features and interactive processes.

Friendship phases: changes over time in internal structure and interactive processes.

Studies Illustrating Elements of the Friendship Framework

The most common structural dimensions examined to date are friendship network size and frequency of contact (which is merely a proxy for interactive processes, revealing existence of connections, but nothing about the type or quality of the interactions). The typical interactive dimensions appearing in late-life friendship research are behavioral processes, such as provision of instrumental, emotional, and social support. Few investigators have examined the phases of friendship in late life intentionally and systematically.

Examples of research investigating structural aspects of friendship appear in the meta-analysis of social network size by Wrzus and colleagues (2013) described previously. They found reliable cross-cultural evidence that friendship networks decrease in size across the years of adulthood. Social structural position includes age group, and Wrzus and colleagues noted that both normative and nonnormative life events occurring at different ages have an impact on the friend network as needs, other relationships, and life circumstances modulate social interactions. Indeed, Litwin and Shiovitz-Ezra (2006) found that being embedded in friend-focused networks was a protective factor against mortality risk for older adults and de Vries, Utz, Caserta, and Lund (2014) found that friends were particularly helpful in providing social support and assistance in early widowhood.

Focusing on psychological disposition, Lecce and colleagues (2017) showed that individual differences in theory of mind skills (extent of awareness that thoughts, beliefs, and emotions affect social interactions) were associated with differences in friend but not family ties among older adults in Italy. Moreover, this theory of mind effect was moderated by social motivation (in this study, the importance of being liked by others), such that it occurred only for those who had a high or medium level of social motivation. Thus, understanding others and being motivated to use social skills to foster positive relationships influence friendship outcomes. Looking instead at the impact of one’s perceptions of aging on friendship outcomes and employing a longitudinal design, Menkin, Robles, Gruenewald, Tanner, and Seeman (2017) found that holding more positive expectations about aging to begin with was associated with greater perceived availability of social support from friends a year later and with having made more new friends, with more of them close, 2 years later. Thus, these findings showed that a personal attribute influenced cognitive, behavioral, and affective friendship processes, respectively over time.

Research on friendship phases as depicted in Figure 2 —how older adults form, sustain, and dissolve friendships—is scarce. Piercy and Cheek (2004) noted that quilting provided a context for older women to make new friends and Menkin and colleagues (2017) noted existence of new friends, but these researchers did not delve into aspects of interaction that contributed to older adults moving from being acquaintances to being friends. Insight into this phase transition comes from Blieszner (1989) and Shea and colleagues (1988) who reported on friendship initiation over 5 months among strangers who relocated simultaneously to a newly constructed retirement community. Key contributors to initiation phase transitions involved changes in feelings and activities. Spending time together in mutually appealing activities increased feelings of liking, loving, and commitment to the friendship. These affective processes built trust and promoted ongoing exchanges of social and instrumental support.

Blieszner (1989) and Shea and colleagues (1988) also found examples of older adults’ efforts to sustain both the new and previously existing friendships through expressing affection, disclosing personal information and feelings, helping one another, and engaging in activities together. Another example of activities and feelings that sustain friendship comes from a study of old male veterans by Elder and Clipp (1988) . They discovered that the process of veterans sharing memories of their intense combat experiences and losses with veteran friends served to perpetuate these very long-term friendships.

Finally, in a randomly selected sample of adults aged 55 and older ( n = 53) and data from face-to-face interviews, Blieszner and Adams (1998) inquired about dissolution-related phases of friendship. Some friendships were fading away (mentioned by 68% of participants), either because of circumstances unrelated to the dyad, such as relocation of one partner, or because one friend was intentionally letting the friendship drift apart due to a problem in the relationship. In addition, a small proportion of participants (25%) had ended a friendship intentionally, usually because of betrayal. As these research examples show, structural, cognitive, affective, and behavioral aspects of friendship interactions all came into play in the formation, sustainment, and dissolution phases of friendship.

The literature also contains studies relevant to the integrative friendship framework that address multiple dimensions simultaneously. Although we did not intend the friendship framework to be predictive, an early operationalization of one component shown in Figure 1 was conducted by Dugan and Kivett (1998) . Using a sample of 282 rural and urban adults aged 65–97 years, they sought to determine whether personal characteristics and behavioral motifs predicted interactive processes. Results of regression analyses showed that two personal characteristics (gender and education) predicted affective and behavioral processes; behavioral motif as indexed by social involvement in clubs, hobbies, and volunteerism, predicted behavioral processes but not affective or cognitive ones; and proximity predicted all three interactive processes. The effect of cultural context, assessed by rural or urban residence, was not significant in this sample. Although this research employed one part of the framework to predict other parts, the work of other investigators illustrates the application of framework components in studies of a diverse array of outcome variables.

Using data from the Wisconsin Longitudinal Study, Kahn, McGill, and Bianchi (2011) addressed the intersections of individual characteristics (age and gender) with the friend and other nonkin behavioral interactions (providing assistance) over time. Women were more likely to provide emotional support and men were more likely to provide instrumental support. Both women and men with more resources (e.g., more education) were more likely to provide help, and after retirement or widowhood, men increased their help giving.

Dunbar (2018) provided an overview of research illustrating the intersection of friendship structure at the dyadic and network levels with cognitive, affective, and behavioral processes. Emotional closeness affects the likelihood of engaging in companionship and sharing the social and psychological support that typically define friendship. Because developing emotional closeness and trust requires a significant time investment, the number of people in one’s circle of closest friends is limited. Moreover, cognitive processes—assessing implicit social contracts related to assumptions of ongoing support, inhibiting some of one’s own preferences and behaviors to enable friends to satisfy theirs, and the perspective-taking that fosters understanding of friends’ needs and motives – are crucial for establishing and sustaining emotionally close and satisfying friendships.

As these examples of late-life friendship research show, the integrative conceptual framework supports examination of myriad intersecting dimensions of friendship and its outcomes in a systematic way. Combining this framework with relationship theory permits development of hypotheses to evaluate, and also can illuminate the more subtle influences on friendship that warrant investigation.

What Novel Aspects of Friendship Demand Scholarly Exploration?

Despite a breadth of research on social networks across the life course, friendship in the second half of life remains underexplored when compared with information about kin relationships. Moreover, the entrance of new cohorts into old age along with social and cultural change over time suggests the need to examine new dimensions of late-life friendship. This section provides a brief overview of research questions that remain unanswered and are now ripe for further exploration.

Friendship, Health, and Well-Being

Much contemporary research has focused on contributions of friends to health and psychological well-being among older adults. At the structural level of analysis, for example, Sander and colleagues (2017) documented a connection between social contact frequency and health across adulthood. Visits with nonfamily members declined over the study waves relative to family visits, with an indication that poorer health in old age explains the less frequent visiting with friends, neighbors, and acquaintances exhibited at that stage of life.

Provision of social support is the most common behavioral process examined in old age friendship research. A useful resource for data on the connection of social support from friends and others and health with well-being outcomes is the review article by ten Bruggencate and colleagues (2018) . These authors analyzed how having social needs satisfied is a protective influence on the health and well-being of old people. Unmet social needs can lead to loneliness and social isolation, which in turn can cause health to decline. In contrast, older adults with strong ties to family and friends are more likely to retain independence, a sense of meaning and purpose in life, and effective physical and psychological functioning longer. Thus, understanding the connection between friend support and psychological problems such as depression is important for promoting health and well-being among older adults.

A review of 51 studies (published between 2004 and 2014) of associations among social support, social networks, and depression from around the world by Santini and colleagues (2015) confirmed that perceived emotional support within large and diverse social networks is protective against depression, as is perceived instrumental support. More research is needed, however, particularly prospective studies, to tease out causality in the associations among social support, social networks, and depression. Are those with fewer depressive symptoms better able to secure large friend networks and receive support than persons exhibiting depression? Is greater availability of social support from a robust social network protective against the development of depressive symptoms?

Being engaged in a friend network can also buffer the effects of life events that may occur in old age. Marital status has traditionally been used as a benchmark for well-being, so comparing the associations of marital status, friendship, and well-being is one approach to understanding the role of friends in buffering the effects of negative life events. Studies in this domain contrast friendship effects among married old people, those who are formerly married, and those who never married, at least in the traditional sense. They also illuminate variation in friendship structure and processes across different subgroups of the older adult population.

Han, Kim, and Burr (2017) used longitudinal data from the Health and Retirement Study to examine the connection between friendship and depression among married couples. Partners who had more frequent social interactions with their friends reported fewer depressive symptoms than those with fewer friend interactions, particularly in the context of poorer marital quality. Moreover, dyadic growth curve models showed that one partner’s responses to friendship had implications for the well-being of the other one, demonstrating that the effects of friendship extend beyond the focal person.

Concerning older adults who are no longer married, both de Vries and colleagues (2014) and Bookwala, Marshall, and Manning (2014) studied friendship in the context of marital loss through widowhood. The findings from de Vries and colleagues showed that higher friendship satisfaction was associated with more positive self-evaluation and more positive affective responses in the first half year of widowhood, whereas Bookwalla and colleagues found that having a friend confidante helped mitigate depressive symptoms and promote better health as reported up to 12 years after spousal loss.

Examination of friendship among committed partners comes from the work of Kim, Fredriksen-Goldsen, Bryan, and Muraco (2017) who demonstrated the importance of large and diverse social networks, including the availability of friends, for mental health among lesbian, gay, bisexual, and transgender older adults. Although these elders may not have as many family ties as others, having supportive social ties within friend networks are as essential for them as for anyone in preventing social isolation and reducing the likelihood of depressive symptoms.

However, marriage is not the only context in which friendship affects psychological well-being. Other structural factors besides marital status, such as cultural background, gender, racial ethnic status, and socioeconomic status, no doubt influence friendship opportunities and constraints that affect social integration or isolation and psychological well-being or depression. Research on the friendship patterns of such subgroups in the older adult population remains to be conducted. The integrative conceptual framework for friendship research offers guidance for investigating the effects of social locations and personality characteristics on friendship patterns.

Another perspective on the connection between friendship and well-being in old age is related to the notion that relational partners are interdependent; the actions of one affect the thoughts, feelings, and behaviors of the other ( Kelley & Thibaut, 1978 ). Thus, life events can have an impact not only on oneself, but also on one’s friends, leading to research questions such as whether someone’s misfortune rallies friendships or drives friends away. Indeed, Breckman et al. (2018) reported that family and friends who know about an older adult’s mistreatment also suffer distress, illustrating how friendship can have negative as well as positive impacts. However, this cross-sectional study did not follow the abuse victims and their social network members, so how the friends who knew about the abuse fared as time went on could not be assessed. What other personal events and circumstances that have not yet been examined for impact on others might interfere with friendship or be buffered by friendship support?

Friendship and Caregiving

Another crucial focus for contemporary friendship research is the contributions of friends to providing care for older adults. Given that offspring and other relatives may live a great distance away from loved ones who require assistance and caregiving, the potential for local friends to fill in when frailty emerges needs systematic examination. Questions about interest in helping one’s friends in this way and willingness to provide more than casual support, and questions about the efficacy of friend caregiving, remain largely unanswered.

Lilly, Richards, and Buckwalter (2003) found that some caregivers of loved ones with dementia mentioned the value of their friends in providing the caregivers with emotional support and social integration. No doubt, those helpful friends buoyed the family caregivers as they dealt with memory loss. Of course, friends are not always helpful, as Abel (1989) noted. In her interviews with adult daughters caring for frail elderly parents, some of the participants pointed out that friends (and relatives) often exacerbated caregiving stress instead of alleviating it, such as by trivializing the difficulties of caregiving. This type of research, however, does not focus directly on care provision by friends. In fact, most caregiving studies do not differentiate across family and friends when examining helpers for older adults. Our literature search on studies related to “friends and caregiving” uncovered 33 articles published since 2012, but all the analyses combined responses for relatives and friends. Therefore, whether it is practical for health care workers to involve friends in care planning, particularly when relatives do not live nearby, merits additional scholarly attention.

Friendship in the Digital Age

A clear avenue for innovative friend research is the inclusion of communication technology and social media as mechanisms for understanding how older adults establish and sustain friendships throughout adulthood. Current findings on Internet use and social media use through websites such as Facebook indicate that older people are less likely than their younger counterparts to be frequent users ( Barbosa Neves, Fonseca, Amaro, & Pasqualotti, 2018 ; Cotten, McCullouch, & Adams, 2011 ; Yu, Ellison, & Lampe, 2018 ). However, older people are adopting technology to sustain social relationships ( Tsai, Shilliar, & Cotten, 2017 ) and keep in contact with friends and relatives who may be geographically distant ( Tsai, Shilliar, Cotten, Winstead, & Yost, 2015 ). Internet use, for example, is associated lower rates of depression and loneliness ( Cotten, Ford, Ford, & Hale, 2012 ) and greater levels of social capital (e.g., quality and quantity of social ties) when compared with adults who did not use the Internet at all or who used it less frequently ( Barbosa Neves et al., 2018 ).

Additional research shows that older Facebook users have smaller numbers of online “friends” but a greater proportion of actual friends than younger Facebook users ( Chang, Choi, Bazarova, & Lockenhoff, 2015 ; Yu et al., 2018 ), a finding consistent with socioemotional selectivity theory ( Carstensen et al., 1999 ). Given the prevalence of social media, it is important that future work examines the extent to which virtual social networks complement actual friend networks and the types of support exchanged with both types of friends. Will friend networks become increasingly more diverse, including friends both in-person and online, proximal and distal? Will friendships last longer, reducing relationship dissolution, due to the ease of connection among long-distance older persons? Will social media influence the ways in which old people engage in friendship? Will completely virtual friendships interactions differ from past patterns in which friendships typically began with face-to-face interactions even if they were sustained over long distances via mail and telephone? Research on social media use among older adults is still in its infancy and will be a burgeoning area of research as digital natives age into midlife and beyond.

Friendship in the Age of the Brain

An additional area of innovation for friend research is the association between friendship and cognitive functioning. Our review of the literature yielded few studies that explicitly explored this topic, which contrasts with the preponderance of research on general social resources and cognitive functioning in old age ( Kuiper et al., 2016 ). The longitudinal study by Béland and colleagues (2005) showed that having friends was associated with slower cognitive decline in women but not men over the course of 7 years. Béland and colleagues argued that this finding might be due to women’s gender-based social roles that necessitated greater social integration over the years. A more recent study by La Fleur and Salthouse (2017) found that contact with friends, but not family, was positively associated with general intelligence. However, this finding approached nonsignificance after examining the effects of education, suggesting that individuals who are better educated spend more leisure time with friends.

These studies illuminate a path forward for friend research and lead to the following questions: How might cognition and, specifically, problem-solving skills and inhibitory control relate to the quality of interactions between older adult friends? For example, research demonstrates that inhibitory control is negatively associated with impulsivity ( Logan, Schachar, & Tannock, 1997 ), while additional research documents that impulsivity is related to negative interpersonal encounters in young adults ( aan het Rot, Moskowitz, & Young, 2015 ). Are older adults with poorer inhibitory control more likely to report negative interactions with friends? Conversely, are those with better inhibitory control more likely to report positive interactions with friends? Similarly, problem-solving skills are associated with memory, reasoning, processing, and global mental status; each of these domains is related to everyday functioning among older adults and translates to performance on common instrumental activities of daily living ( Gross, Rebok, Unverzagt, Willis, & Brandt, 2011 ). If a key domain of adult friendship is the exchange of instrumental and emotional support, then more research is needed to document the implications of cognition in late-life behavioral friendship processes.

Friendship as a Unique Relationship

Innovative findings on late-life friendship might also be uncovered through the intentional inclusion of friend-related variables as separate from family and neighbor relationships. For example, research on social relationships among lesbian, gay, bisexual, and transgender (LGBT) older adults has focused on the importance of friendship in aging, commonly using language such as “chosen families” ( de Vries & Megathlin, 2009 ). The same attention to the value of friendship in aging has not been applied in non-LGBT research. This gap in the literature implies that scholars presume the presence and supremacy of biological kin networks in old age, thus ignoring the value of non-biological relationships. Investigators have used the ambiguous grouping of friend relationships into categories, such as “friends/neighbors,” “friends or other relatives,” and “social resources,” with the latter going so far as to subsume all social relationships into one undifferentiated group. Yet research clearly shows that friends, neighbors, and kin relationships provide varying levels and types of support. For example, LaPierre and Keating (2013) found that among 324 nonkin caregivers, friends provided help with personal care, bills, banking, and transportation whereas neighbors were more likely to help with less personal tasks such as home maintenance. Further, friends were more involved in providing care for nonkin than neighbors were and assisted care recipients with a greater number of tasks for more hours per week. Such research indicates that friends are unique voluntary relationships that are more intimate than more emotionally distal ties that might occur with neighbors. Moreover, friends often contribute more positively to psychological well-being than family relationships do ( Huxhold et al., 2014 ). Thus, it is imperative that future research on older persons’ social network members focus specifically on friendship as a unique relationship and distinguish differential structures, functions, processes, and phases across types of relationships in great detail.

What Innovative Designs and Technologies Would Reveal Untapped Elements of Friendship and Its Value?

We identified three main ways in which friendship research might be advanced, thus revealing untapped elements of friend relationships and their value. First, more research is needed that goes beyond the structure of friendship (“How many close friends do you have?”) to explore interactive processes that convey deeper perceptions of, feelings about, and activities within older adult friendships—their cognitive, affective, and behavioral dimensions. Second, studies of friendship have been conducted in regional and cultural silos that were not being translated across disciplines and cultural boundaries. Third, most studies of friendship have incorporated cross-sectional designs, inhibiting understanding of changes and stability in friendship over the adult lifespan.

These three current limitations point to the value of linking Adams and Blieszner’s (1994) integrative conceptual framework for friendship with data harmonization techniques that permit combining regional, national, and international data sources. For example, Hofer and Piccinin (2010) described the potential for integrating multiple levels of analysis, theories, and designs to enable synthesis of results across multiple data sets, including longitudinal studies of aging, to broaden the scope of research on a given topic; Survey Research Center (2016) provided detailed guidelines for such work. Existing longitudinal data sets could be exploited for secondary analyses using Adams and Blieszner’s framework for guidance on the variable selection, thus enabling scholars to uncover prevailing trends in friendship as well as idiosyncrasies across data sources and across cultures and time.

To prompt this new kind of friendship research, we offer an analysis of the potential for finding structural, cognitive, affective, and behavioral variables as enumerated in the Adams and Blieszner (1994) conceptual framework within regional, national, and international data sets. First, we used the Inter-university Consortium for Political and Social Research to conduct a search of studies that included middle-aged and older adults. We then examined each data source for friendship variables and, for those that included friend variables, reviewed their list of publications for studies with friends as a focal topic. We also searched the major gerontological and relationship journals for articles related to older adult friendship and reviewed their data sources. This process yielded 11 large-scale longitudinal data sets suitable for pursuing cross-national and longitudinal research on adult friendship. The data sets are (1) Americans’ Changing Lives (ACL); (2) The Irish Longitudinal Study on Ageing (TILDA); (3) Longitudinal Aging Study Amsterdam (LASA); (4) Longitudinal Study of Generations (LSG); (5) Swedish Adoption/Twin Study on Aging (SATSA); (6) Wisconsin Longitudinal Study (WLS); (7) National Social Life, Health, and Aging Project (NSHAP); (8) Health and Retirement Study (HRS); (9) Midlife in the United States (MIDUS); (10) Survey of Health, Ageing, and Retirement in Europe (SHARE); and (11) German Ageing Survey (DEAS).

Next, we classified each data source’s friend-related questions and variables according to the Adams and Blieszner (1994) integrative conceptual framework, as shown in Table 1 . For reference, we also included the Adams and Blieszner Andrus Study of Older Adult Friendship ( Adams & Blieszner, 1993a ), which guided the formulation of the integrative conceptual framework for friendship and provides examples of structural, cognitive, affective, behavioral, and phase questions. Note that the information presented in this table is not exhaustive of each data source’s friend-related questions; rather, it highlights questions corresponding to the integrated conceptual framework for friendship. The variables derived from these questions could be addressed by data harmonization processes to enlarge the size of samples and scope of variables available for analysis of cognitive, affective, and behavioral friendship processes and phases over time and across cultures.

Friendship Variables in Regional, National, and International Data Sets

Note. Dates in italic font indicate verified availability of friend variables at that wave. Dates in roman font indicate either no verified friend variables or the questionnaire was not available in English.

a https://www.isr.umich.edu/acl/

b https://tilda.tcd.ie/

c https://www.lasa-vu.nl/index.htm

d https://www.icpsr.umich.edu/icpsrweb/NACDA/studies/22100

e https://ki.se/en/meb/satsa-the-swedish-adoptiontwin-study-of-aging

f https://www.ssc.wisc.edu/wlsresearch/

g http://www.norc.org/Research/Projects/Pages/national-social-life-health-and-aging-project.aspx

h http://hrsonline.isr.umich.edu/

i http://midus.wisc.edu/

j http://www.share-project.org/

k https://www.dza.de/en/research/deas.html

Review of these longitudinal data sources demonstrates that, indeed, there is immense potential for the future of older adult friend research using data harmonization techniques. Almost all the data sources included questions about structural components of friendship, including number of friends or close friends. Descriptive analyses might reveal similarities or differences in the size and composition of friend networks across multiple countries and regions and changes in networks across stages of adulthood. For cognitive processes, most (7 out of 11) data sources included reflective or comparative questions in reference to friends. For example, three studies (TILDA, HRS, MIDUS) asked, “How much do [friends] really understand the way you feel about things?” Affective processes were assessed in 7 of the 11 studies, as well. Four studies (TILDA, HRS, MIDUS, DEAS) tapped negative dimensions of friend relationships, inquiring whether friends “get on [their] nerves” or were “causing worry.” Two studies (LSG, SATSA) evaluated satisfaction with friends, a positive feeling. Finally, most studies (9 out of 11) included questions that assessed behavioral processes, such as support exchanged, frequency of contact, and availability of support from friends. Two studies (WLS, NSHAP) asked the question, “How much/often do [friends] criticize you?” Conversely, four studies (TILDA, LASA, MIDUS, SHARE) evaluated actual support exchanged between friends.

Exploring these structural elements and cognitive, affective, and behavioral friendship processes across large cross-national data sources could reveal novel insights regarding friends and aging. Are there cultural differences in support exchanges or in the size, composition, and closeness of friend networks? What groups of older adults are more likely to experience negative interactions with friends and might these exchanges have implications for health over time by affecting the availability of supportive resources? Further, how do friendship processes change over time and across places? There are many paths forward for the future of friend research, but we believe that more robust use of existing data sources is a feasible next step. Moreover, newly launched studies should incorporate friend variables that assess nuanced dimensions of friendship processes and phases rather than focusing solely on structural components.

What Interventions Can Be Employed to Increase Satisfaction With Friend Relationships and Improve Friend Interactions?

In 1992, Blieszner and Adams described how programs affecting the friendship patterns depicted in Figures 1 and ​ and2, 2 , and thus individual outcomes, could be implemented at the individual, dyadic, network, immediate environment, community, or societal levels. Although in a subsequent article Adams and Blieszner (1993b , p. 173) stated clearly that they did not “necessarily intend to advocate friendship intervention,” they conservatively cautioned policymakers, program planners, and human service providers not to design and implement interventions that would inadvertently undermine existing social relationships. The reasons for not fully endorsing friendship interventions at the time were twofold. First, research on friendship was not robust enough to suggest details of what sorts of interventions might be most needed, efficient, and effective. Second was recognition that friendships were culturally defined as voluntary and, though they are much more structurally constrained than many friends realize, some would find such interventions uncomfortable or inappropriate.

Although the friendship research literature is now more robust, the literature assessing the effectiveness of interventions is still scarce. Increased public focus on the consequences of loneliness and isolation is leading to more recognition of the necessity of promoting friendship, but systematic interventions into all aspects of friendship patterns described in the previous sections have not been introduced. That is, just as most research on friendship has focused on behavioral processes such as social support to the relative neglect of examining other behavioral processes as well as cognitive and affective processes, so too friendship intervention programs have emphasized behavioral strategies such as skill enhancement as approaches to developing friendships, with little attention to addressing the impact of thoughts and feelings on friendship interactions. Now that more recent research has demonstrated the importance of friendships to well-being, health, and longevity, it seems prudent to begin designing, intentionally implementing and assessing a broad range of friendship interventions among older adults. First, we present examples of research assessing intervention programs that address various parts of the integrative conceptual framework and levels of intervention, then cite literature pointing to other possibilities for enhancing friendship among older adults. This section ends with suggestions for enacting and assessing such friendship interventions.

Examples of Friendship Intervention Research

Stevens and colleagues in The Netherlands have been investigating intervention strategies for enhancing friendship at the individual level of analysis. For example, Stevens, Martina, & Westerhof (2006) showed that participating in a 12-week program designed to promote self-esteem (individual characteristic) and relational competence, social skills, and friendship formation skills (behavioral processes) enabled older women to establish new friendships and improve existing ones, thus reducing loneliness and improving well-being. These outcomes endured for at least a year. Building on that work, Martina, Stevens, and Westerhof (2012) used self-management of well-being theory to probe mechanisms underlying friendship-related improvements. Interview data from the intervention participants and control group members revealed that compared with control group members, women who completed the friendship enrichment program showed greater increases in behaviors related to taking the initiative and engaging in actions aimed at developing and improving friendships (behavioral processes). Extending the in-person friendship intervention approach to an online one, Bouwman, Aartsen, van Tilburg, and Stevens (2017) demonstrated the effectiveness of focusing on network development (structure), adapting personal standards for friendship, and reducing the salience of the discrepancy between actual and desired relationships (cognitive processes). Both follow-up studies showed continued promise for assisting old persons with honing friendship skills that can improve relationships and boost personal well-being. In related work, research by both Lecce and colleagues (2017) and Vargheese, Sripada, Masthoff, and Oren (2016) suggests interventions related to cognitive processes. The Lecce team focused on the importance of both increasing theory of mind skills, or the understanding of others’ mental states, and increasing social motivation to use those skills in friendship interactions, which could reduce loneliness and social isolation. The Vargheese group demonstrated that professionals can employ theoretically derived persuasive strategies to encourage older adults to participate in social activities.

Development and assessment of additional interventions addressing a broad range of affective, cognitive, and behavioral friendship patterns would offer more options for assisting lonely or isolated old people with improving their friendships. Acknowledging the dynamic nature of friendship, these programs should give attention to skills for initiating versus sustaining friendships, rejuvenation of faded friendships, and repair of problematic and conflictual ones.

Directions for New Friendship Interventions

Research on associations across older adults’ personal preferences for friendships and their social needs, health, and well-being point to many possibilities for friendship interventions related to the elements of the integrative conceptual framework for friendship research described previously. Earlier life experiences and current age-related life events can affect older adults’ social needs, their friend networks, and their friend-related cognitive, affective, and behavioral processes ( Blieszner & Ogletree, 2017 ; Wrzus et al., 2013 ). Older adults vary with respect to the number and types of friends they prefer to have, whether they desire only close or more peripheral relationships, the importance they place on various friendship interaction processes and forms of social support, and the amount of reciprocity they expect among their friendships—and those preferences can change over time ( Blieszner, 1995 ; ten Bruggencate et al., 2018 ). The contexts in which older adults are living, including the family versus friend composition of their social network, their residence (community-dwelling, assisted living, nursing home), and the presence or absence of socially isolating chronic health conditions, also affect their needs for friends and options available for interventions ( Blieszner & Ogletree, 2017 ; Litwin & Shiovitz-Ezra, 2006 ; Vargheese et al., 2016 ).

Taken together, these research findings indicate that different friendship-related intervention strategies are needed for different people and segments of late life. Developing interventions that are flexible and take the diversity of expectations and preferences among older adults into account is more likely to be successful than attending only to the practitioner’s perceptions of friendship or assuming a given intervention will be equally successful across all elders.

Enacting and Assessing Interventions

We suggest that gerontological researchers form partnerships with service providers interested in increasing the social connectedness of older adults to plan interventions and appropriate assessment components. Designing research-informed interventions aimed at addressing identified needs could lead to more nuanced, hence more effective, interventions. As shown by research findings described in this article, different groups of older adults would likely benefit from programs targeting specific aspects of friendship structure versus interactive processes and dyadic versus network outcomes. The results of such collaborations could also inform friendship research by increasing knowledge of the antecedents and consequences of friendship patterns and how these change across the life course.

This suggestion also is consonant with Cornwell, Laumann, and Schumm’s (2008) urging increased dialogue between social gerontological and social network researchers. The former researchers tend to have a more applied orientation and to have ties with those in direct contact with older adults, whereas the latter tend to have more appreciation for the complexity of friendships. Perhaps social gerontological researchers could act as bridges between professionals who work with older adults and social network researchers.

Gerontological practitioners are more likely to be interested in collaboration on friendship intervention design and evaluation now than in the past because today the importance of social connectedness for older adults is more widely recognized and the need for interventions is a subject of public dialogue. For example, in the introduction to an issue of the Public Policy & Aging Report , Hudson (2017 , p. 121) discussed isolation, loneliness, and a lack of social connection among older adults, noting that “[p]olicymakers, practitioners, and researchers have come to focus attention on this little-recognized and dangerous condition facing so many older people.” In the same issue, Ryerson (2017) described AARP’s Connect2Affect initiative ( https://connect2affect.org/ ), which is facilitating the type of collaboration between researchers and service providers we recommend. This collaborative effort with the Gerontological Society of America, Give an Hour, the National Association of Area Agencies on Aging, and the UnitedHealth Group provides tools and resources designed to assess risk and help isolated older adults become more involved with their communities. The initiatives Ryerson described use technology to improve connectedness—development of a ride-hailing app to increase the use of public transportation, examination of whether the use of hands-free voice-controlled communication devices decreases isolation, and evaluation of the effectiveness of phone outreach in helping retirees feel more connected to others. Although these interventions were designed to increase connectedness in general rather than in friendships per se, it is promising that AARP is facilitating collaboration among service providers and researchers, evaluating the effectiveness of selected interventions, and producing results that could lead to the systematic implementation of programs at the community, state, or national levels.

The clear benefits of social engagement among old people and concern about lack of social connectedness point to the value of and need for continued collaboration among researchers and service providers. The framework for conceptualizing friendship structure, processes, and phases discussed previously and illustrated in Figures 1 and ​ and2 2 provides guidelines for identifying needs and designing tailored interventions targeted to addressing them. Accumulating evidence that such programs are effective in increasing connections among friends, improving friendship quality, and benefitting older adults’ health and well-being is essential prior to advocating for policies to support systematic implementation of programs across groups of older adults in need of better social integration.

Friendship is a relationship that can last longer over the life course than any other. The majority of adults participate in friendship, even as the end of life draws near. The likelihood of older adults continuing to enjoy and benefit from interactions with friends combined with the potential for social isolation in old age suggests the importance of investigating friendship in creative new ways to advance understanding of friendship structure, processes, and phases along with their implications for health and well-being. In turn, findings from research on friendship can inform strategies for enhancing friendship opportunities and interactions in order to prevent or alleviate loneliness, social isolation, and depression.

As this review of theories relevant to friendship research in old age and available literature on late-life friendship shows, many unanswered questions about the roles of friends in supporting psychological well-being and health of older adults exist. The integrative conceptual framework combined with theory pertinent to social relationships offers guidance for additional work.

Some structural elements of friendship, such as number of friends and frequency of contact, may not require further investigation—at least, in Western cultures, yet relatively less information is available on the effects of other structural features on friendship, such as gender, racial ethnic status, subcultural group, and the contexts in which older adults enact friendship. Likewise, many studies have explored various forms of social support, but much less is understood about other behavioral processes. Data on cognitive processes in late-life friendship are scarce, including how people think about and analyze their friend relationships or how perceptions of friends and friend interactions influence friendship initiation, stability, or loss. Similarly, few studies have examined the influence of emotions on friendship quality and phases. An implicit assumption seems to be that friend relations are positive and beneficial, which is generally true. After all, being friends with a particular person is optional. Nevertheless, evidence shows that older adults can be quite troubled by problems with friends yet do not necessarily wish to terminate the relationship ( Adams & Blieszner, 1998 ; Blieszner & Adams, 1998 ). We need to know more about any dark sides of friendship.

As shown in the section on interventions, most programs aimed at improving friendship opportunities and outcomes for older adults address behavioral processes useful in the phases of forming new ties and enhancing those that exist, in service of preventing or mitigating loneliness and social isolation. Certainly more programs like those are needed as the population of elders increases around the globe. Nevertheless, it also important for community practitioners to focus on problem-solving in friendships, not just in family relationships, to help elders sustain rewarding friend ties that may entail minor disagreements and annoyances, as well as to provide strategies for dissolving friendships that are not merely uncomfortable, but actually toxic.

Friendship intervention programs must also be assessed for suitability to friendship styles in late adulthood as well as programs’ effectiveness in achieving desired outcomes. To build on the intervention research described previously, we suggest that expanding research on friendship in old age will yield useful data on potential suitability and effectiveness of existing programs and might suggest different approaches to explore. It is difficult to plan better-targeted interventions without knowing more about friendship structure and processes. We need studies on the social and psychological costs of friendship, not just benefits, and on what interferes with friendship enactment and satisfaction, not just what promotes it. We need investigations of similarities and differences in friendship across cultural subgroups both domestically and internationally so interventions can vary by context as needed.

The deeper understanding of friendship in old age will also result from mining the data sets identified in Table 1 and exploring data harmonization techniques to conduct cross-national comparisons. In addition to the countries represented in Table 1 , we cited friendship research from Spanish-speaking individuals, participants from Hong Kong, Israel, Italy, and Norway, and residents of rural versus urban communities. The articles by ten Bruggencate and colleagues (2018) and Wrzus and colleagues (2013) included data from multiple countries. Though we might rightly assume that friendship is a universal role found in every country, the literature on friendship in late life lacks a comprehensive global perspective.

Initiating more longitudinal studies to track friendship transitions across stages of adulthood and changes in health would confirm or expand cross-sectional findings. Employing designs that tap perspectives of friend dyads and friend networks and using statistical procedures such as latent growth curve analysis and hierarchical linear modeling would permit identifying reciprocal effects of friends on one another and the reciprocal impact of friend networks on dyads and individuals. The results of all these recommendations would offer important and useful new insights about this crucial relationship in the advanced years of life.

None reported.

Conflict of Interest

Acknowledgments.

R. Blieszner conceived of the manuscript, drafted sections, and integrated sections written by coauthors. A. M. Ogletree conducted an extensive literature review, drafted sections, developed Table 1 , and helped to review the manuscript. R. G. Adams contributed to the literature review, drafted the interventions section, and helped to review the manuscript. R. G. Adams and R. Blieszner developed and revised Figures 1 and ​ and2 2 over the course of their research collaboration. We appreciate the assistance of Koji Ueno in suggesting the concept of cognitive and affective motifs and drafting Figure 2 .

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