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CONNECTION IS PROTECTION

THE SCAFFOLDING OF MENTAL HEALTH:

How Relationships Hold Australians Up A narrative literature review

2026

Abstract

Objective This review aims to examine the relationship between mental health and interpersonal relationships across several relationship types: from marriage, cohabitation, and dating, to friendships, familial relationships, and community connections. It also examines intervention evidence.

Method We conducted a narrative literature review. Following an initial scan to refine research questions, we searched multiple databases and narratively synthesised the findings. As a narrative review, the search was not intended to be exhaustive.

Results The review included 110 references, primarily peer-reviewed studies, supplemented by government and international agency reports. Due to a limited Australian evidence base, relevant international reviews and empirical studies were also included.

Discussion We found that relationships are central determinants of mental health, primarily by fulfilling needs for belonging and providing emotional and practical support. By providing

emotional intimacy, practical assistance, identity, and shared meaning, relationships help individuals cope with stress and maintain wellbeing. Relationship quality matters more than mere presence. Relationships characterised by conflict or lack of support are associated with increased depression, anxiety, and suicidality, whilst supportive, stable relationships protect mental health. We found that improving relationships through relationship-based interventions such as couples or family counselling, and relationship education can lead to improved mental health and wellbeing. Acadia Babister

Research and Evaluation Officer

Dr Glenn Althor

Head of Research and Impact

Michelle Irving

Senior Research and Evaluation Officer

Suggested citation Babister, A., Althor, G., & Irving, M. (2026). The scaffolding of mental health: How relationships hold Australians up. A narrative literature review. Relationships Australia NSW. https://www.relationshipsnsw.org.au/connection

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Introduction

Few things shape our wellbeing more profoundly than the quality of our relationships (Andersen et al., 2021). People have an inherent need to belong, to be in community, to navigate our lives alongside others. Society is structured through these connections; to be isolated or lonely is both a physical and mental health concern, with serious consequences on the quality and length of one’s life (Lim, 2018). We have many different social connections throughout our lives, from family and friends when we’re young and old, to the complicated eras of dating and finding our lifelong partner(s) to settle down with, long-lasting friendships, transient book club buddies, or neighbours you see every day over the mailbox or at the lobby door. The strength, frequency, and quality of these connections are important for our overall wellbeing. Strong, positive relationships help people feel connected and valued, and they offer stability during times of stress (Aaron et al., 2025). One of the key mechanisms for how relationships affect wellbeing is via their influence on mental health (Andersen et al., 2021). As such, to fully appreciate how relationships shape wellbeing, it is also necessary to understand how they interact with mental health. Mental health impacts everyone (WHO, 2025b). Positive mental health enables people to cope with the stresses of life, realise their abilities, learn well and work well, contribute to their community, and is an integral component of physical health and overall wellbeing (WHO, 2025b). Whereas poor mental health can have detrimental effects on an individual’s participation in society, quality of life, and ability to develop

“Few things shape our wellbeing more profoundly than the quality of our relationships.” or maintain employment and relationships, and can manifest as an ongoing mental disorder (WHO, 2025a). Across Australia, reported rates of poorer mental health are rising (Laß et al., 2025). According to recent statistics, 43 percent of Australians experience a mental disorder in their lifetime (ABS, 2020) and mental illness is people’s most frequently experienced long-term health condition (ABS, 2022). However, mental health does not occur in a vacuum. Environmental factors, such as the quantity and quality of a person’s relationships, can be critically important for its development and maintenance (Holt-Lunstad, 2022). Relationships and mental health are closely intertwined, with each influencing the other (Braithwaite and Holt-Lunstad, 2017). Having strong, meaningful connections is associated with lower rates of anxiety, depression and stress, higher self-esteem, and a greater sense of purpose and belonging (Thomas, Liu and Umberson, 2017; Andersen et al., 2021; Pezirkianidis et al., 2023). Inversely, stressed or challenged relationships can

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increase the prevalence of mental disorders, increase loneliness, lower self-worth, and decrease emotional regulation (Whisman, Sbarra and Beach, 2021; Holt-Lunstad, 2022). People’s lives intersect with a wide variety of relationship types, including intimate partners, friends, family, and the broader community, all of which can be important for mental health. However, Australians tend to report intimate partnerships as their most important relationship (Relationships Australia, 2024), which likely also makes them the most significant for mental health.

landscape, raises important questions. For people and organisations working to support Australians in this space, there is a need to better understand which types of relationships are impacting mental health, how, and which interventions are most effective for supporting both mental health and relationships. However, the literature has yet to clearly examine the connection between relationship types, mental health outcomes, and available supports. Addressing these gaps is the key purpose of this paper.

Given the importance of healthy relationships, it is no surprise that Australians highly value relationship support. Supports can include informal help from and between peers, or more formal interventions that range from couples counselling, mediation, pre- and post-separation services, to psychoeducation (Benson, McGinn and Christensen, 2012; Carr, 2025). The ability of these interventions to improve relationship satisfaction is well established (Roddy et al., 2020). Likewise, the connections between relationship qualities and mental health are well established (Braithwaite and HoltLunstad, 2017; Cleary, Lees and Sayers, 2018; Holt-Lunstad, 2022; Navaneetham and Kanth, 2022). However, the growing incidence of mental health challenges, when coupled with Australia’s modern relationship

To this end, we conducted this narrative literature review to understand how different types of relationships affect mental health and whether supports enhance the positive effects of relationships on mental health. We aim to highlight the potential for these interventions to simultaneously strengthen relationships and promote positive mental health. Our research questions are: 1.

How do relationships affect mental health?

2. Do these effects differ across relationship types? 3. What interventions address relational challenges to support mental health, and what is their evidence base?

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Methods

For this study we followed standard narrative literature review methodology. First, we conducted a limited screen of the literature to develop research questions, which we used to guide our searches and synthesis. Next, we developed a search string to find the most recent and relevant papers, which we used to search several literature databases. Last, we reviewed and narratively synthesised the findings across the literature. It is important to note that we did not intend for this paper to be a systematic review of the literature, and as such our search was not exhaustive. To limit our results to the most relevant and recent papers, we utilised inclusion and exclusion criteria. We only included English language papers published since 2015 that examined adult populations (18+). We excluded studies that focused exclusively on COVID-19 impacts (e.g. lockdown effects, pandemic-related social isolation) or exclusively on children. As the focus for our

study is Australia, we prioritised Australian research, but where relevant, we opted to also include studies from culturally similar contexts (USA, Canada, New Zealand, Western Europe). We searched for literature using three databases: PsycInfo, Google Scholar, and the University of New South Wales library search, and conducted a general web search using Google to identify relevant grey literature. Throughout, we also used forward and backward citation searching to find additional sources.

Our search string consisted of: (Relationship* OR Partner OR “Interpersonal relationships” OR Marriage OR Community OR “Social Support” OR Friendship OR Family) AND (“Mental health” OR Wellbeing) AND (Australia*).

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Results

After exclusion, our search resulted in 110 references. Our references largely consist of peer-reviewed papers, supplemented by a few Australian Government statistical summaries, and international agency reports. Our search initially identified a limited number of Australian studies, so we broadened our scope to include a range of international reviews and peer-reviewed studies. In this section, we provide a definitional overview of the literature, including the types of relationships examined and the conceptualisation of mental health and wellbeing across studies.

Relationships: types, definitions and trends in Australia The literature pertaining to how relationships interact with mental health covers a wide array of interpersonal relationships. We grouped these into three broad categories based on how they were studied and discussed: 1) intimate and romantic relationships (including marriages, de facto relationships, and longterm ‘living apart together’ arrangements); 2) non-romantic relationships – those that are close but not romantic (familial, friendships), and finally, 3) peripheral relationships (acquaintances, neighbours, and membership in community groups).

Mental health or mental wellbeing?

relationships in Australia. However, we found that the literature does not use terminology consistently. Mental health was often conflated with mental wellbeing, diagnosable mental illnesses and symptoms, mental distress, or life-satisfaction (Heinsch et al., 2022; Evans, Gray and Reimondos, 2023; WHO, 2025b). As such, we adopted a continuum approach to mental health, allowing us to capture the full range of relational impacts identified in the literature. We define this approach as follows: Mental health refers to a state of psychological and emotional functioning that exists on a continuum (WHO, 2025b). At one end, positive mental health is characterised by emotional wellbeing, the absence of mental health conditions, and the capacity to cope with stress and negative experiences. At the other end, poor mental health is characterised by diminished psychological functioning, which may include mental distress or diagnosable conditions (WHO, 2025b). Mental illness, or mental disorder, refers specifically to clinically significant disturbances in cognition, emotional regulation, or behaviour (WHO, 2025a). Mental distress refers to subclinical symptoms that affect functioning and quality of life but may not meet diagnostic thresholds. Mental wellbeing is a broad term and generally used as a synonym for positive mental health. Its use can include notions such as life satisfaction, happiness, or selfesteem (Braithwaite and Holt-Lunstad, 2017).

We began this review intending to examine a clear link between mental health and THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

Discussion Our aims were to examine the connections between relationships and mental health, explore whether these connections differ across relationship types, and identify interventions that work to address relational challenges and support mental health. Our synthesis of the literature revealed three key findings that directly address these aims. First, relationships affect mental health by providing emotional and practical resources (such as social support) and by meeting our need to belong. Second, the mental health impacts of relationships vary in intensity and depth depending on relationship quality, levels of enmeshment, and perceived social support, with these differences observable across various relationship types. Third, while some interventions in this area have a strong evidence base, they vary considerably in both quantity and quality of evidence. We examine each theme in depth below.

1. How do relationships affect mental health? Relationships affect mental health primarily through the emotional and practical resources they provide, such as social support, companionship, and a sense of belonging (Andersen et al., 2021; Whisman, Sbarra and Beach, 2021; Navaneetham and Kanth, 2022). However, the mental health benefits depend not on the mere presence of relationships, but on their qualities and consistency. Different relationship types provide these resources in different ways. Variation in commitment levels, frequency of contact, and relationship quality shapes which resources are available and how reliably they can be accessed, leading to different patterns of mental health impact across intimate, non-intimate, and peripheral relationships (Andersen et al., 2021). These patterns align with established theoretical frameworks emphasising need fulfilment and resource provision (Baumeister and Leary, 1995; Nurullah, 2012; Feeney and Collins, 2015; Morelli et al., 2015; Andersen et al., 2021; Zell and Stockus, 2025).

“The mental health benefits depend not on the mere presence of relationships, but on their qualities and consistency.” Positive relationships have a well-established protective and promotive effect on mental health through several interconnected mechanisms (Andersen et al., 2021). Central to these benefits is the fulfilment of the fundamental human need to belong, which contributes to psychological wellbeing regardless of exposure to stress (Baumeister and Leary, 1995). Relationships also provide access to key resources, particularly social support, which enables individuals to develop mental resilience, regulate emotions, and cope more effectively with life’s challenges (Andersen et al., 2021; Zell and Stockus, 2025). Social support falls into different categories based on how they affect individuals. These include emotional support, defined as feeling valued, understood, and cared for (Morelli et al., 2015), which can enhance self-esteem and buffer against the negative impacts of stress, and instrumental support, which offers practical assistance during times of need (Morelli et al., 2015). In addition, regular positive interactions within relationships promote emotional regulation and psychological stability, and access to responsive attachment figures builds resilience in the face of adversity (Mikulincer and Shaver, 2008; Feeney and Collins, 2015; Andersen et al., 2021). Some relationships also offer economic and practical resources that alleviate financial strain and enhance stability, indirectly supporting mental health (Evans and Gray, 2021). Together, these

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processes contribute to improved mental wellbeing across the general population and better mental health in relation to specific conditions such as depression, anxiety, and post-traumatic stress disorder (Santini et al., 2015; Bjørlykhaug et al., 2022). Inversely, poor quality relationships can undermine mental health. Relationships characterised by conflict, rejection, criticism, or abuse act as direct sources of stress, amplifying negative emotions, undermining self-esteem, and impairing emotional regulation (Whisman, Sbarra and Beach, 2021; Navaneetham and Kanth, 2022). Also harmful are relationships that fail to provide adequate support. A lack of reliable or responsive support, particularly when expected but not received, contributes to feelings of rejection and loneliness, increasing vulnerability to depression, anxiety, and stress-related disorders (Cohen and Wills, 1985; Lakey and Orehek, 2011; Nurullah, 2012; Santini et al., 2015; Andersen et al., 2021). These connections between mental health and relationships are bidirectional. Australians who self-describe as having poor or terrible mental health are also more likely to report that their mental health had often affected their relationships, most commonly through difficulty communicating effectively, managing stress, being emotionally available, and maintaining self-esteem (Relationships Australia, 2024). However, evidence suggests that relationships have a stronger effect on mental health than mental health has on relationships (Braithwaite and Holt-Lunstad, 2017). Overall, relationships support positive mental health when they provide emotional and

“Evidence suggests that relationships have a stronger effect on mental health than mental health has on relationships.”

practical resources, but become a hindrance when of poor quality, potentially contributing to poor mental health, distress, or illness (Whisman, Sbarra and Beach, 2021).

2. Do these effects differ across relationship types? We identified three primary relationship types that influence mental health: intimate relationships (including marriages, de facto relationships, and long-term ‘living apart together’ arrangements), non-romantic close relationships (such as friendships and family), and peripheral relationships (such as community connections and neighbours). The mental health impacts of these relationship types vary depending on emotional closeness, commitment, frequency of contact, and relationship quality. These factors shape the extent to which each type provides support, stability, and belonging.

Intimate relationships

A recent survey showed 60 percent of Australians identified their partner as most important to them (Relationships Australia, 2024), reflecting the central role these relationships play in people’s lives. Intimate relationships are particularly significant for mental health because they typically involve the highest levels of emotional intimacy, interdependence, and daily interaction (Braithwaite and Holt-Lunstad, 2017; Esplin, Hatch and Braithwaite, 2024). This means romantic partners often serve as primary sources of emotional support, practical assistance, and daily companionship. Partnered Australians report lower rates of psychological distress than non-partnered individuals (Laß et al., 2025), and healthy intimate relationships are characterised by a strong sense of belonging and robust social support (Braithwaite and Holt-Lunstad, 2017). Conversely, absence of intimate partner(s) has been shown to adversely impact mental health (Purol et al., 2021). However, intimate relationships also have the potential to cause significant harm. High relationship distress is a causal risk factor for depression (Whisman, Sbarra and Beach, 2021), with unsupportive dynamics and conflict heightening vulnerability to mental health disorders, including depression and

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anxiety (Santini et al., 2015). Strained or unstable relationships may provide diminished social support whilst simultaneously creating adverse conditions that contribute to poor mental health outcomes. At the most severe end, intimate partner violence affects over 20 percent of Australian women and over 7 percent of men (ABS, 2021b) and shows strong links to PTSD and depression, particularly when involving psychological abuse, coercive control, or physical violence (Dokkedahl et al., 2022; White et al., 2023).

Evans, Gray and Reimondos, 2023; Fuchsman, 2023). Marriage is generally associated with better mental health, largely due to sustained social support, shared economic resources, social recognition, and perceived commitment (Perelli-Harris et al., 2019; Andersen et al., 2021; Evans and Gray, 2021; Evans, Gray and Reimondos, 2023). However, the mechanisms behind these benefits are not fully understood, with debate over the relative importance of social support, feelings of belonging, and selection effects (Andersen et al., 2021).

Relationship dissolution, including separation and divorce, can have significant negative impacts on mental health. Separation is associated with increased rates of depression, suicidal ideation, and other mental health difficulties (Gibb, Fergusson and Horwood, 2011; Evans, Scourfield and Moore, 2016; Wilson et al., 2025). The mental health impacts vary by relationship configuration, with divorce typically having more severe effects than the ending of cohabiting or living apart together relationships (Evans, Gray and Reimondos, 2023).

A key question is whether marriage causes better mental health or whether healthier individuals are simply more likely to marry. Research on mid-life Australians found negligible differences between cohabiting and married individuals’ mental health once controls for childhood experiences, rural/ urban location, and socioeconomic background were applied (Perelli-Harris et al., 2018), suggesting selection effects may explain much of the observed marriage advantage in Australia. The strength of these connections also explains why marital separation and divorce are particularly detrimental to mental health, as they represent the loss of multiple intertwined sources of support, resources, and identity (Gibb, Fergusson and Horwood, 2011; Braithwaite and Holt-Lunstad, 2017).

Within intimate relationships, mental health effects vary across relationship configurations. Marriage shows strong protective effects on mental health (Braithwaite and Holt-Lunstad, 2017; Thomas, Liu and Umberson, 2017; Whisman, Sbarra and Beach, 2021), whilst cohabiting and living apart together arrangements show different patterns (Perelli-Harris et al., 2019; Brown, Manning and Wu, 2022; Evans, Gray and Reimondos, 2023). We examine each configuration below. Marriage Marriage is an evolving institution in Australian society, with rates declining since the 1970s (Qu et al., 2025). Despite this decline, understanding marriage’s relationship to mental health remains important, as it is still considered a goal for many Australians (ABS, 2024). Of the most common intimate relationship types, being married tends to have the largest positive effect on mental health (Evans and Kelley, 2004; Braithwaite and Holt-Lunstad, 2017; Perelli-Harris et al., 2019;

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De facto In Australia, de facto relationships refer to couples who live together long-term without registered marriage. These relationships are common, with more than 10 percent of Australians identifying as de facto partnered (ABS, 2021a). In family law, de facto relationships of more than two years are treated similarly to registered marriages. De facto relationships show positive mental health effects, though generally not as strong as those observed in marriage (Perelli-Harris et al., 2019; Brown, Manning and Wu, 2022; Evans, Gray and Reimondos, 2023). Cohabitation adds practical and economic support through shared living arrangements, pooled finances, and shared responsibilities (Evans and Gray, 2021), which appear to enhance mental wellbeing beyond non-cohabiting partnerships. However, since non-cohabiting relationships also show positive mental health effects, factors beyond economics, such as intimacy and social support, also play important roles (Rapp and Stauder, 2020; Evans, Gray and Reimondos, 2023). Australian research found that de facto couples initially showed lower wellbeing than married couples. However, after controlling for selection factors and relationship satisfaction, differences between marriage and cohabitation became nonsignificant (Perelli-Harris et al., 2019),

suggesting that selection effects, rather than relationship configuration itself, may largely explain the observed differences in mental health outcomes between de facto and married Australians. Non-cohabiting Non-cohabiting partnerships include both casual dating relationships and committed ‘living apart together’ arrangements, where couples maintain separate households despite being in a committed relationship. Living apart together arrangements may arise for practical reasons (such as employment locations or children from previous relationships) or as a long-term lifestyle choice. While traditionally underrepresented in relationship statistics, recent Australian data suggests approximately 8 percent of Australian adults are in living apart together relationships, making them almost as prevalent as de facto relationships (VeraToscano, 2021; Wilkins et al., 2021). Despite lacking the economic integration of cohabitation, non-cohabiting relationships are consistently associated with better mental health than being unpartnered (Brown, Manning and Wu, 2022; Evans, Gray and Reimondos, 2023). Australian research finds that both men and women experience improvements in mental health and life satisfaction when beginning a relationship, regardless of whether it involves cohabitation or not (Evans, Gray and Reimondos, 2023). This pattern suggests that emotional intimacy, social support, and companionship play more significant roles in mental health benefits than economic factors or social recognition (Morelli et al., 2015; Rapp and Stauder, 2020; Andersen et al., 2021).

Summary

Overall, the gradient in mental health effects across these relationship types reflects increasing levels of resource integration, commitment, and interdependence, rather than relationship status alone. While emotional and social support appear to play primary roles in the mental health benefits of intimate relationships, economic stability and perceived commitment provide additional protective effects in cohabiting and married partnerships (Perelli-Harris et al., THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

2019; Evans, Gray and Reimondos, 2023). However, the extent to which these benefits reflect causation versus selection remains debated. Australian evidence suggests that selection effects, where individuals with better mental health and more advantaged backgrounds are more likely to enter and maintain marriages, may explain much of the observed differences between relationship configurations (Perelli-Harris et al., 2019). The relationship between partnership and mental health is likely bidirectional and dynamic, with both selection processes and lived relational experiences shaping mental health outcomes (Braithwaite and Holt-Lunstad, 2017; PerelliHarris et al., 2019; DeMaris and Oates, 2022).

Non-romantic relationships

Intimate relationships are not the only significant connections for mental health. Non-romantic relationships, particularly friendships and family, also play important roles in psychological wellbeing. For example, when asked about their most important relationships, over ten percent of Australians identified their mother and almost eight percent said a friend (Relationships Australia, 2024). Similarly to intimate relationships, non-romantic relationships can positively influence mental health when characterised by support, trust, and emotional closeness, but may contribute to psychological distress when marked by conflict or strain (Cleary, Lees and Sayers, 2018; Heinsch et al., 2022; Esplin, Hatch and Braithwaite, 2024). We examine friendships and family relationships separately below, as each operates through distinct dynamics across the life course. Friendship Friendships are a significant source of support and wellbeing for Australians, with around 60 percent identifying friendship groups as playing an important role in their lives and over 7 percent selecting a friend as their most important relationship (Relationships Australia, 2024). However, the number of Australians reporting they have many friends has declined between 2010 and 2023 (Botha et al., 2025), and around one in six Australians over 15 now report often feeling very lonely (ABS, 2025). Whilst we found fewer Australian papers on the link between friendship and mental

health than intimate relationships, international evidence suggests a strong correlation between positive friendships and better mental health (Fehr and Harasymchuk, 2017; Navaneetham and Kanth, 2022; Pezirkianidis et al., 2023; Maddux, 2024). Close friendships are associated with higher happiness, selfesteem, psychosocial adjustment, and interpersonal sensitivity (Bagwell et al., 2005; Demir, 2015; King, Russell and Veith, 2016). The emotional, tangible, and informational support that friends provide can act as protective factors for mental health (Cleary, Lees and Sayers, 2018), and evidence suggests closer or more intertwined friendships are better able to provide support for and withstand challenges presented by mental health conditions (Knapp-Loker et al., 2026). Both friendship quality and perceived support are significantly associated with wellbeing, and the number of friends, time spent together, and relationship quality predict current and future wellbeing (Carmichael, Reis and Duberstein, 2015; Pezirkianidis et al., 2023). Friendships may also serve a compensatory function when intimate relationships are strained. When intimate partners negatively impact life satisfaction, friendships can provide psychological protection (Kaufman et al., 2022). This suggests that strong friendships can offset the detrimental mental health effects of negative experiences in intimate relationships. The importance of the role of friends extends across the life course. Research on young adults found that positive friendship

“The emotional, tangible, and informational support that friends provide can act as protective factors for mental health.”

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experiences were associated with higher selfesteem and reductions in depression, social anxiety, and loneliness (Navaneetham and Kanth, 2022), and additional evidence found that friendships remain important for mental wellbeing into older age (Blieszner, Ogletree and Adams, 2019). However, negative friendship experiences, or friendships characterised by conflict, criticism, or unreliability, are linked to decreased selfesteem, heightened interpersonal sensitivity, increased hostility, and symptoms of poorer mental health (King, Russell and Veith, 2016; Lee and Szinovacz, 2016; Navaneetham and Kanth, 2022). Family Family relationships remain important for mental health throughout the life course, whether or not members share a residence. Family relationships are typically defined as close relatives, including parents, siblings, grandparents, and children. When characterised by support and emotional closeness, family relationships are protective of mental health throughout the life course (Navaneetham and Kanth, 2022; Riem et al., 2023). However, conflict or unsupportive dynamics within families can negatively impact mental health (Thoits, 2010). High-quality family relationships can provide social and psychological support throughout all life stages (Grevenstein et al., 2019), though the significance can shift across them. In young adulthood, parental relationships remain central to mental health. When characterised by security and support, relationships with parental figures predict better mental wellbeing, life satisfaction, and stronger sibling and romantic relationships (Ponti and Smorti, 2019; Navaneetham and Kanth, 2022). However, negative family dynamics can be detrimental. High levels of psychological control by parents are associated with increased anxiety and difficulties with emotional regulation (Goger, Rozenman and Gonzalez, 2020), whilst frequent contact characterised by conflict, particularly with mothers, is associated with increased depressive symptoms (Londahl, Tverskoy and D’Zurilla, 2005; Navaneetham and Kanth, 2022). Young adulthood is also characterised by a reorientation of social ties, with intimate

relationships beginning to take on a more central role than family relationships (Navaneetham and Kanth, 2022). As these individuals move into parenthood, family relationships often regain prominence. Grandparental involvement, especially from maternal grandmothers, serves as a protective factor against postpartum mental health difficulties (Riem et al., 2023). Providing supplementary care for grandchildren is also generally beneficial for grandparents’ psychological wellbeing, with Australian grandmothers reporting higher life satisfaction when engaging more with grandchildren (Moore and Rosenthal, 2015; Kim, Kang and Johnson-Motoyama, 2017). Later in life, these caring responsibilities can shift once again, with adult children often becoming caregivers to their elderly parents. This can negatively affect mental health due to increased responsibility and stress (Merz, Schulze and Schuengel, 2010; Bangerter et al., 2018), but can also positively affect feelings of closeness, happiness, and life satisfaction (Thomas, Liu and Umberson, 2017; Luichies, Goossensen and der Meide, 2021). The positive aspects of caregiving appear dependent on the quality of parentchild relationships and whether adult children have adequate support to manage the additional responsibilities (Merz, Schulze

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and Schuengel, 2010; Luichies, Goossensen and der Meide, 2021). While also important within the family dynamic, sibling relationships are understudied, though available evidence suggests higher quality sibling relationships are linked to higher wellbeing, whilst lack of closeness is associated with higher depression (Thomas, Liu and Umberson, 2017). Sibling relationships can be important sources of warmth and emotional support and contribute to lower levels of internalising and externalising mental health symptoms (Buist and van Berkel, 2026). Overall, family relationships appear more likely to contain mixed experiences than friendships. When characterised by robust social support, positive emotions, and high quality, they positively affect mental health and wellbeing (Grevenstein et al., 2019). However, conflict, low quality relationships, or feelings of burden can negatively impact mental health. This complexity may reflect the involuntary nature of family relationships and associated expectations of care and responsibility, which can make it difficult to distance oneself from negative family dynamics (Merz, Schulze and Schuengel, 2010; Navaneetham and Kanth, 2022).

Peripheral relationships

Beyond intimate partners, family, and close friends, peripheral relationships encompass weaker social ties including acquaintances, coworkers, neighbours, and community connections (AIHW, 2025). While these relationships typically involve less emotional intimacy and direct support than close relationships, they contribute to social integration and a sense of belonging that are important for mental wellbeing (Heinsch et al., 2022), with these effects being greater for vulnerable or socially disadvantaged Australians (Heinsch et al., 2022). Evidence suggests that greater social connectedness and wider social networks are protective against depressive symptoms and other mental health difficulties (Wickramaratne et al., 2022). Social connectedness has been found to directly impact mental health, with strong community connections such as being a part

of a club or group, contributing to feelings of belonging, wellbeing, resilience, and providing buffering support in adverse situations (Saeri et al., 2018; Heinsch et al., 2022; Holt-Lunstad, 2022). Community participation and mental wellbeing are also reciprocal: people who engage in more frequent community participation report having higher mental wellbeing the following year and being more likely to continue their engagement (Ding, Berry and O’Brien, 2015). Conversely, a lack of community connections and feelings of loneliness are linked to poor mental health outcomes, including depression and suicidal ideation (Kok and Fredrickson, 2013; Lim, 2018; Wickramaratne et al., 2022). Online communities can also be a source of social support, most often for people who do not have access to these kinds of support in real life (Cotten, Anderson and McCullough, 2013; Cole et al., 2017). People experiencing negative mental health use online peer-topeer communities as a source of social support (Rayland and Andrews, 2023). However, social media and unmoderated communities can also be harmful to mental health, causing increased levels of depression, anxiety, loneliness, and psychological distress (Sadagheyani and Tatari, 2020; Lu et al., 2021). Overall, these findings highlight the importance of inclusive and supportive community connections as a key component of better mental health.

“Across all relationship types, the extent to which relationships enhance or undermine mental wellbeing depends on the quality, stability, and reciprocity of the connection.”

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Summary

The evidence indicates that different relationship types influence mental health in distinct ways. Emotional closeness, commitment, frequency of interaction, and relationship quality shape how relationships provide support, stability, and belonging, which in turn affects their mental health impact. Intimate relationships have the strongest effects, both positive and negative, due to high levels of emotional closeness, interdependence, and shared daily life. This makes them powerful sources of support but also of strain when conflict or instability are present. Non-romantic close relationships, such as friendships and family ties, also play critical roles by providing belonging and practical support across the life course, though their impacts vary according to relationship quality, expectations, and strain. Peripheral and community relationships contribute to mental wellbeing through fostering social connectedness and reducing loneliness, with particularly important effects for vulnerable or socially disadvantaged populations. Across all relationship types, the extent to which relationships enhance or undermine mental wellbeing depends on the quality, stability, and reciprocity of the connection. Mental health is shaped not simply by the presence of relationships but by the specific relational mechanisms through which support, strain, and social connection are experienced. Additionally, the relationship between partnerships and mental health appears bidirectional, with mental health

“Couples counselling has been shown to improve relationship satisfaction and reduce symptoms of depression and anxiety, even when only one partner attends.”

also influencing the ability to form and maintain relationships.

3. What interventions address relational challenges to support mental health, and what is their evidence base? There is a strong relationship between relationship quality and mental health (Braithwaite and Holt-Lunstad, 2017). As such, interventions that improve relationships have the potential to also support positive mental health. Evidence suggests that therapeutic, educational, and communitybased approaches to relationships can lead to meaningful improvements in mental health outcomes (Barbato, D’Avanzo and Parabiaghi, 2018; Spencer and Anderson, 2021; Carr, 2025). Much of the literature pertains to relationship counselling, which is a well-established clinical intervention with a robust evidence base for addressing mental health difficulties through improving intimate and family relationships. Beyond this, other interventions include relationship education, social prescribing, social education programs, and mindfulness-based interventions, which show promise in supporting mental health by strengthening relational skills and fostering social connectedness. However, the evidence base for these approaches is smaller. We examine these different intervention approaches here.

Relationships counselling

Relationship counselling encompasses psychotherapeutic systemic interventions that seek to improve relationship health and satisfaction by addressing dysfunctional behaviour, shifting perspectives to more objective or dyadic views, increasing constructive communication, and emphasising relationship strengths (Benson, McGinn and Christensen, 2012). These approaches target relational dynamics and are primarily used with couples or families, with limited evidence for non-romantic relationships such as friendships (Burcham, 2024). There is a strong evidence base for these systemic therapy approaches for couples and families, with periodic meta-analyses

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demonstrating their effectiveness in treating adult mental health disorders (Carr, 2000, 2009, 2014, 2019, 2025). Common modalities include behavioural marital therapy, cognitive-behavioural couple therapy, and emotionally focused couple therapy (Roddy et al., 2020). Australian evaluations demonstrated that couples counselling is effective in improving relationship satisfaction (Petch et al., 2014), and reducing symptoms of depression and anxiety, even when attended by only one partner (Lohan et al., 2021). International evidence confirms couples therapy is effective across anxiety, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and depression (Monson et al., 2012; Barbato, D’Avanzo and Parabiaghi, 2018; Barbato and D’Avanzo, 2020; Wittenborn et al., 2022; Carr, 2025). Similarly, family-based systemic interventions have demonstrated effectiveness across a range of mental health issues (Carr, 2025). These interventions often focus on educating families about support systems and developing contexts where families can aid in recovery from mental distress. Family-focused therapy has shown effectiveness for mood disorders such as depression and in delaying or preventing relapse of bipolar and schizophrenia symptoms when used in conjunction with medication (Carr, 2025). These systemic approaches work by allowing clients to jointly examine recurrent interaction patterns, associated belief systems, and core relationship themes. This process supports clients to reflect on their experiences, build skills for independent use, and develop relapse-prevention plans to anticipate and manage situations that may trigger low mood, anxiety, or relationship distress (Carr, 2025). The therapeutic environment reduces the adverse context created by relationship distress, allowing relationships to more effectively support those experiencing mental health difficulties.

Other interventions

Beyond relationship counselling, several other interventions address relational challenges to support mental health. The evidence base for these approaches is smaller than for relationship counselling, but

“These diverse approaches demonstrate that interventions need not be clinical or intensive to support mental health through relationships.” they show promise. These include relationship education directed at couples and families, social prescribing, social education programs, and mindfulness approaches that are particularly useful for developing peripheral connections. Relationship education Relationship education is a psychoeducational approach that focuses on developing skills to prevent relationship distress and build healthy relationships, including communication skills, conflict management, and enhancing positive connections (Stanley et al., 2020). Programs can be delivered online (often self-led with psychoeducational content, activities, and skill practice opportunities) or through practitioner-led sessions (typically in group settings with psychoeducation, video demonstrations, skill practice with feedback, and homework activities). Online and groupbased formats may be more accessible and affordable for couples with logistical difficulties attending relationship counselling (Hawkins and Erickson, 2015). Evaluative studies and meta-analytic reviews have demonstrated that relationship education is effective at increasing relationship satisfaction and has positive effects on personal adjustment and mental health, including reductions in anxiety and depressive symptoms and increased quality of life (Spencer and Anderson, 2021; AdlerBaeder et al., 2022; Megale, Peterson and Friedlander, 2022).

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Social prescribing Social prescribing is the practice of health professionals referring clients to community support services to address psychosocial factors impacting mental health (Morse et al., 2022). These interventions can include referrals to community groups, social services, social activities, or more structured programs such as social education groups or mindfulness training. Social prescribing has been shown to be beneficial for those experiencing loneliness and lack of social connection by providing access to social communities and connection-building opportunities (Hayward et al., 2019; Reinhardt, Vidovic and Hammerton, 2021). Social education programs Social education groups involve empowering people with knowledge about the health benefits of social connection, and the skills and confidence to increase their social connectedness. There is evidence to suggest that these programs can improve mental health, group belonging and loneliness outcomes, and reduce social anxiety (Haslam et al., 2016, 2019; Cruwys et al., 2019). Mindfulness-based approaches Mindfulness interventions and loving-kindness meditations focus on enhancing opportunities for social interaction and cultivating prosocial emotions. Randomised studies have shown that these techniques can strengthen

relationships by increasing social closeness and connectedness (Kok and Fredrickson, 2013; Aspy and Proeve, 2017; Don, Van Cappellen and Fredrickson, 2022). Systematic reviews on mindfulness have also consistently shown the practice to have positive effects on mental health (Enkema et al., 2020).

Summary

These diverse approaches demonstrate that interventions need not be clinical or intensive to support mental health through relationships. Relationship education builds relational skills in accessible formats, social prescribing connects people to existing community resources, social education programs provide structured skill-building for connection, and mindfulness cultivates prosocial mindsets. Together, they highlight multiple pathways through which enhancing relational capacity can improve mental health and wellbeing.

“Across all types, we found that relationship quality matters more than mere presence.”

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Limitations and further research

Several limitations within the existing literature warrant consideration. First, there is inconsistency in how mental wellbeing is conceptualised and operationalised across studies, limiting comparability and synthesis of findings. Second, despite a growing international evidence base, there remains a relative lack of Australian research examining the underlying mechanisms through which social relationships influence mental health outcomes. Additionally, Australian studies have paid limited attention to the distinct roles of friendship and family relationships, and there is very little international evidence on non-traditional romantic relationship types. Finally, there is a notable gap in Australian research evaluating relationshipbased interventions and their effectiveness in improving mental health, restricting the translation of theoretical insights into evidence-informed practice and policy. Future Australian studies could address these gaps by building on emerging research that highlights the importance of understanding how social relationships influence mental health and well‑being and by further evaluating interventions that strengthen relationship quality and social connections. In this context, it is important

to clearly conceptualise mental well‑being as encompassing not only the absence of mental disorder but also the presence of positive psychological functioning. Additionally, as there is strong international evidence showing systematic interventions positively affecting mental health disorders, there is scope to expand Australian evaluations to better understand how these interventions can impact both mental distress and widen the approach to incorporate mental wellbeing; bringing together intervention evaluations, which currently primarily address mental disorders, and relationship studies that address mental wellbeing. Relationship support providers could meaningfully contribute to the evidence base by assessing clients’ mental health and wellbeing before and after engagement with services. There is also room for further research into the impact of these interventions on different populations, such as LGBTQIA+ populations and members of cultural minorities, and to expand beyond the predominant focus on romantic relationships by investigating how friendship and family relationships contribute to mental wellbeing and respond to relational interventions.

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Conclusion

In this review we addressed three research questions: how relationships affect mental health, whether these effects differ across relationship types, and what interventions address relational challenges to support mental health. We found strong evidence that relationships are central determinants of mental health, operating primarily through two mechanisms: meeting fundamental needs for belonging and providing emotional and practical resources. These mechanisms work through offering emotional intimacy, practical assistance, identity, and shared meaning, all of which help individuals cope with stress and maintain wellbeing. We identified clear differences across relationship types. Intimate relationships show the strongest mental health effects, both positive and negative, due to their high levels of emotional closeness, interdependence, and daily interaction. Non-romantic relationships, including friendships and family, provide critical support across the life course, though their impacts vary by relationship quality and life stage. Peripheral and community relationships contribute through fostering social connectedness and buffering loneliness, with particularly important effects for vulnerable populations. Across all types, we found that relationship quality matters more than mere presence. Relationships characterised by conflict, instability, or lack of support are associated with increased depression, anxiety, and suicidality, whilst supportive, stable relationships protect mental health.

Regarding interventions, we found that couples and family therapy have robust evidence bases demonstrating effectiveness in improving both relationship functioning and mental health outcomes, particularly for depression and anxiety. Beyond counselling, relationship education, social prescribing, social education programs, and mindfulnessbased approaches show promise, though their evidence bases are smaller. These interventions work by building relational skills, facilitating social connections, and cultivating prosocial mindsets. We found significant gaps in the Australian evidence base. Whilst international systematic reviews provide a strong theoretical rationale for relationship-focused interventions, Australian-specific evaluation remains limited. Expanding research and implementation of these interventions within the Australian context represents an important opportunity for mental health policy and practice. Our findings suggest that investing in relational wellbeing through accessible, evidence-based interventions could yield meaningful benefits for population mental health.

Declaration of interest statement This research was conducted by staff within the research department of Relationships Australia NSW.

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References Aaron, S. et al. (2025) ‘Depression and Relationship Satisfaction Among Emerging Adults’, The Family Journal, p. 10664807251346976. Available at: https://doi. org/10.1177/10664807251346976. ABS (2020) National Study of Mental Health and Wellbeing, 2020-2022 | Australian Bureau of Statistics. Australian Bureau of Statistics. Available at: https://www.abs.gov.au/statistics/ health/mental-health/national-study-mental-health-and-wellbeing/2020-2022 (Accessed: 3 February 2026). ABS (2021a) Household and Families: Census. Australian Bureau of Statistics. ABS (2021b) Personal Safety, Australia. ABS (2022) Long-term health conditions. Australian Bureau of Statistics. Available at: https:// www.abs.gov.au/articles/long-term-health-conditions (Accessed: 3 February 2026). ABS (2024) Marriages and Divorces, Australia. Australian Bureau of Statistics. Available at: https://www.abs.gov.au/statistics/people/people-and-communities/marriages-and-divorcesaustralia/2024. ABS (2025) Social connections | Australian Bureau of Statistics. Australian Bureau of Statistics. Available at: https://www.abs.gov.au/statistics/measuring-what-matters/measuringwhat-matters-themes-and-indicators/cohesive/social-connections (Accessed: 20 January 2026). Adler-Baeder, F. et al. (2022) ‘Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully’, Family Process, 61(3), pp. 986–1004. Available at: https://doi.org/10.1111/famp.12750. AIHW (2025) Social cohesion and social connection, Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/ reports/australias-welfare/social-cohesion-and-social-connection (Accessed: 20 January 2026). Andersen, L.M.B. et al. (2021) ‘The social route to mental health: A systematic review and synthesis of theories linking social relationships to mental health to inform interventions’, SSM - Mental Health, 1(100042). Available at: https://doi.org/10.1016/j.ssmmh.2021.100042. Aspy, D.J. and Proeve, M. (2017) ‘Mindfulness and Loving-Kindness Meditation: Effects on Connectedness to Humanity and to the Natural World.’, Psychological Reports, 120(1), p. 102. Available at: https://doi.org/10.1177/0033294116685867. Bagwell, C.L. et al. (2005) ‘Friendship quality and perceived relationship changes predict psychosocial adjustment in early adulthood’, Journal of Social and Personal Relationships, 22(2), pp. 235–254. Available at: https://doi.org/10.1177/0265407505050945. Bangerter, L.R. et al. (2018) ‘Everyday Support to Aging Parents: Links to Middle-Aged Children’s Diurnal Cortisol and Daily Mood’, The Gerontologist, 58(4), pp. 654–662. Available at: https://doi.org/10.1093/geront/gnw207. Barbato, A. and D’Avanzo, B. (2020) ‘The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice’, Family Process, 59(2), pp. 361–375. Available at: https://doi.org/10.1111/famp.12540. Barbato, A., D’Avanzo, B. and Parabiaghi, A. (2018) ‘Couple therapy for depression’, Cochrane Database of Systematic Reviews [Preprint], (6). Available at: https://www.cochranelibrary. com/cdsr/doi/10.1002/14651858.CD004188.pub3/full (Accessed: 24 November 2025). THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

Baumeister, R.F. and Leary, M.R. (1995) ‘The need to belong: Desire for interpersonal attachments as a fundamental human motivation’, Psychological Bulletin, 117(3), pp. 497–529. Available at: https://doi.org/10.1037/0033-2909.117.3.497. Benson, L.A., McGinn, M.M. and Christensen, A. (2012) ‘Common Principles of Couple Therapy’, Behavior Therapy, 43(1), pp. 25–35. Available at: https://doi.org/10.1016/j.beth.2010.12.009. Bjørlykhaug, K.I. et al. (2022) ‘Social support and recovery from mental health problems: a scoping review’, Nordic Social Work Research, 12(5), pp. 666–697. Available at: https://doi.org/1 0.1080/2156857X.2020.1868553. Blieszner, R., Ogletree, A.M. and Adams, R.G. (2019) ‘Friendship in Later Life: A Research Agenda’, Innovation in Aging, 3(1), p. igz005. Available at: https://doi.org/10.1093/geroni/igz005. Botha, F. et al. (2025) Fewer friends, more time stress: the essential charts from this year’s HILDA survey, The Conversation. Available at: https://doi.org/10.64628/AA.eujq74wq6. Braithwaite, S. and Holt-Lunstad, J. (2017) ‘Romantic relationships and mental health’, Current Opinion in Psychology, 13, pp. 120–125. Available at: https://doi.org/10.1016/j. copsyc.2016.04.001. Brown, S.L., Manning, W.D. and Wu, H. (2022) ‘Relationship quality in midlife: A comparison of dating, living apart together, cohabitation, and marriage’, Journal of Marriage and Family, 84(3), pp. 860–878. Available at: https://doi.org/10.1111/jomf.12813. Buist, K.L. and van Berkel, S.R. (2026) “Sibling Relationships and Mental Health,” in L. Kramer, N. Howe, and B.L. Volling (eds.) Handbook of the Psychology of Sibling Relationships: Advancing Research and Practice. Cham: Springer Nature Switzerland, pp. 533–560. Available at: https://doi.org/10.1007/978-3-032-21296-2_21. Burcham, E. (2024) The perspectives of systemic therapists on using their relational skills to work with friends: A qualitative study. Carmichael, C.L., Reis, H.T. and Duberstein, P.R. (2015) ‘In your 20s it’s quantity, in your 30s it’s quality: The prognostic value of social activity across 30 years of adulthood.’, Psychology and aging, 30(1), p. 95. Carr, A. (2000) ‘Evidence-Based Practice in Family Therapy and Systemic Consultation II’, Journal of Family Therapy, 22(3), pp. 273–295. Available at: https://doi.org/10.1111/14676427.00152. Carr, A. (2009) ‘The effectiveness of family therapy and systemic interventions for adultfocused problems’, Journal of Family Therapy, 31(1), pp. 46–74. Available at: https://doi. org/10.1111/j.1467-6427.2008.00452.x. Carr, A. (2014) ‘The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems’, Journal of Family Therapy, 36(2), pp. 158–194. Available at: https://doi.org/10.1111/1467-6427.12033. Carr, A. (2019) ‘Couple therapy, family therapy and systemic interventions for adult-focused problems: the current evidence base’, Journal of Family Therapy, 41(4), pp. 492–536. Available at: https://doi.org/10.1111/1467-6427.12225. Carr, A. (2025) ‘Couple therapy and systemic interventions for adult-focused problems: The evidence base’, Journal of Family Therapy, 47(1), p. e12481. Available at: https://doi. org/10.1111/1467-6427.12481. Cleary, M., Lees, D. and Sayers, J. (2018) ‘Friendship and Mental Health’, Issues in Mental Health Nursing, 39(3), pp. 279–281. Available at: https://doi.org/10.1080/01612840.2018.1431444. Cohen, S. and Wills, T.A. (1985) ‘Stress, social support, and the buffering hypothesis’, Psychological Bulletin, 98(2), pp. 310–357. Available at: https://doi.org/10.1037/00332909.98.2.310. Cole, D.A. et al. (2017) ‘Online social support for young people: Does it recapitulate in-person social support; can it help?’, Computers in Human Behavior, 68, pp. 456–464. Available at: THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

https://doi.org/10.1016/j.chb.2016.11.058. Cotten, S.R., Anderson, W.A. and McCullough, B.M. (2013) ‘Impact of Internet Use on Loneliness and Contact with Others Among Older Adults: Cross-Sectional Analysis’, Journal of Medical Internet Research, 15(2), p. e2306. Available at: https://doi.org/10.2196/jmir.2306. Cruwys, T. et al. (2019) ‘The connecting adolescents to reduce relapse (CARR) trial: study protocol for a randomized controlled trial comparing the efficacy of Groups 4 Health and cognitive behaviour therapy in young people’, BMC Public Health, 19(1), p. 788. Available at: https://doi.org/10.1186/s12889-019-7011-y. DeMaris, A. and Oates, G. (2022) ‘The Trajectory of Subjective Well-Being: A Partial Explanation of the Marriage Advantage’, Journal of Family Issues, 43(6), pp. 1650–1668. Available at: https://doi.org/10.1177/0192513X211030033. Demir, M. (ed.) (2015) Friendship and Happiness: Across the Life-Span and Cultures. Springer. Available at: https://link.springer.com/book/10.1007/978-94-017-9603-3 (Accessed: 21 January 2026). Ding, N., Berry, H.L. and O’Brien, L.V. (2015) ‘One-year reciprocal relationship between community participation and mental wellbeing in Australia: A panel analysis’, Social Science & Medicine, 128, pp. 246–254. Available at: https://doi.org/10.1016/j.socscimed.2015.01.022. Dokkedahl, S.B. et al. (2022) ‘The psychological subtype of intimate partner violence and its effect on mental health: a systematic review with meta-analyses’, Systematic Reviews, 11(1), p. 163. Available at: https://doi.org/10.1186/s13643-022-02025-z. Don, B.P., Van Cappellen, P. and Fredrickson, B.L. (2022) ‘Training in Mindfulness or Lovingkindness Meditation Is Associated with Lower Variability in Social Connectedness Across Time’, Mindfulness, 13(5), pp. 1173–1184. Available at: https://doi.org/10.1007/s12671-022-01856-0. Enkema, M.C. et al. (2020) ‘Associations Between Mindfulness and Mental Health Outcomes: a Systematic Review of Ecological Momentary Assessment Research’, Mindfulness, 11(11), pp. 2455–2469. Available at: https://doi.org/10.1007/s12671-020-01442-2. Esplin, C.R., Hatch, S.G. and Braithwaite, S.R. (2024) ‘Close Relationships and Mental Health’, in M. Hojjat and A. Moyer (eds) Modern Relationships: Romance, Friendship, and Family in the 21st Century. Oxford University Press, p. 0. Available at: https://doi.org/10.1093/ oso/9780197655504.003.0020. Evans, A. and Gray, E. (2021) ‘Cross-National Differences in Income Pooling among Married and Cohabiting Couples’, Journal of Marriage and Family, 83(2), pp. 534–550. Available at: https://doi.org/10.1111/jomf.12721. Evans, A., Gray, E. and Reimondos, A. (2023) ‘Having a Partner or Living with a Partner: Differences in Life Satisfaction and Mental Health’, Applied Research in Quality of Life, 18, pp. 2295–2313. Available at: https://doi.org/10.1007/s11482-023-10186-9. Evans, M.D.R. and Kelley, J. (2004) ‘Effect of family structure on life satisfaction: Australian evidence’, Social indicators research, 69(3), pp. 303–349. Evans, R., Scourfield, J. and Moore, G. (2016) ‘Gender, Relationship Breakdown, and Suicide Risk: A Review of Research in Western Countries’, Journal of Family Issues, 37(16), pp. 2239– 2264. Available at: https://doi.org/10.1177/0192513X14562608. Feeney, B.C. and Collins, N.L. (2015) ‘A New Look at Social Support: A Theoretical Perspective on Thriving Through Relationships’, Personality and Social Psychology Review, 19(2), pp. 113–147. Available at: https://doi.org/10.1177/1088868314544222. Fehr, B. and Harasymchuk, C. (2017) ‘The role of friendships in well-being’, Subjective wellbeing and life satisfaction, pp. 103–128. Fuchsman, K.E.N. (2023) ‘Harvard Grant Study of Adult Development: 1938–2022.’, Journal of Psychohistory, 51(1).

THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

Gibb, S.J., Fergusson, D.M. and Horwood, L.J. (2011) ‘Relationship Separation and Mental Health Problems: Findings from a 30-Year Longitudinal Study’, Australian & New Zealand Journal of Psychiatry, 45(2), pp. 163–169. Available at: https://doi.org/10.3109/00048674.2010.52 9603. Goger, P., Rozenman, M. and Gonzalez, A. (2020) ‘The association between current maternal psychological control, anxiety symptoms, and emotional regulatory processes in emerging adults’, Journal of Behavior Therapy and Experimental Psychiatry, 68, p. 101563. Available at: https://doi.org/10.1016/j.jbtep.2020.101563. Grevenstein, D. et al. (2019) ‘Better family relationships––higher well-being: The connection between relationship quality and health related resources’, Mental Health & Prevention, 14, p. 200160. Available at: https://doi.org/10.1016/j.mph.2019.200160. Haslam, C. et al. (2016) ‘Groups 4 Health: Evidence that a social-identity intervention that builds and strengthens social group membership improves mental health’, Journal of Affective Disorders, 194, pp. 188–195. Available at: https://doi.org/10.1016/j.jad.2016.01.010. Haslam, C. et al. (2019) ‘GROUPS 4 HEALTH reduces loneliness and social anxiety in adults with psychological distress: Findings from a randomized controlled trial’, Journal of Consulting and Clinical Psychology, 87(9), pp. 787–801. Available at: https://doi.org/10.1037/ ccp0000427. Hawkins, A.J. and Erickson, S.E. (2015) ‘Is couple and relationship education effective for lower income participants? A meta-analytic study’, Journal of Family Psychology, 29(1), pp. 59–68. Available at: https://doi.org/10.1037/fam0000045. Hayward, A. et al. (2019) Connecting Communities: Tackling Loneliness and Isolation. The University of Sheffield: Red Cross. Heinsch, M. et al. (2022) ‘Protective factors for mental and psychological wellbeing in Australian adults: A review’, Mental Health & Prevention, 25, p. 200192. Available at: https://doi. org/10.1016/j.mhp.2020.200192. Holt-Lunstad, J. (2022) ‘Social Connection as a Public Health Issue: The Evidence and a Systemic Framework for Prioritizing the “Social” in Social Determinants of Health’, Annual Review of Public Health, 43, pp. 193–213. Available at: https://doi.org/10.1146/annurevpublhealth-052020-110732. Kaufman, V. et al. (2022) ‘Unique Ways in Which the Quality of Friendships Matter for Life Satisfaction’, Journal of Happiness Studies, 23(6), pp. 2563–2580. Available at: https://doi. org/10.1007/s10902-022-00502-9. Kim, H.-J., Kang, H. and Johnson-Motoyama, M. (2017) ‘The psychological well-being of grandparents who provide supplementary grandchild care: a systematic review’, Journal of Family Studies, 23(1), pp. 118–141. Available at: https://doi.org/10.1080/13229400.2016.1194306. King, A.R., Russell, T.D. and Veith, A.C. (2016) ‘Friendship and Mental Health Functioning’, in M. Hojjat and A. Moyer (eds) The Psychology of Friendship. Oxford University Press, p. 0. Available at: https://doi.org/10.1093/acprof:oso/9780190222024.003.0015. Knapp-Loker, S. et al. (2026) “Anxiety, Depression, and Friendship: Friends Don’t Run From Trouble,” Personal Relationships, 33(3), p. e70080. Available at: https://doi.org/10.1111/ pere.70080. Kok, B.E. and Fredrickson, B.L. (2013) Wellbeing Begins with “We”. John Wiley & Sons, Ltd. Available at: https://doi.org/10.1002/9781118539415.wbwell042. Lakey, B. and Orehek, E. (2011) ‘Relational regulation theory: A new approach to explain the link between perceived social support and mental health’, Psychological Review, 118(3), pp. 482–495. Available at: https://doi.org/10.1037/a0023477. Laß, I. et al. (2025) The 20th Annual Statistical Report of the HILDA Survey. Lee, H.J. and Szinovacz, M.E. (2016) ‘Positive, Negative, and Ambivalent Interactions With THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

Family and Friends: Associations With Well-being’, Journal of Marriage and Family, 78(3), pp. 660–679. Available at: https://doi.org/10.1111/jomf.12302. Lim, M. (2018) ‘Australian loneliness report: A survey exploring the loneliness levels of Australians and the impact on their health and wellbeing’. Lohan, A. et al. (2021) ‘Does relationship counselling for one work? An effectiveness study of routine relationship counselling services where only one individual attends’, Australian and New Zealand Journal of Family Therapy, 42(3), pp. 320–335. Londahl, E.A., Tverskoy, A. and D’Zurilla, T.J. (2005) ‘The Relations of Internalizing Symptoms to Conflict and Interpersonal Problem Solving in Close Relationships’, Cognitive Therapy and Research, 29(4), pp. 445–462. Available at: https://doi.org/10.1007/s10608-005-4442-9. Lu, Y. et al. (2021) ‘Does Usage of Online Social Media Help Users With Depressed Symptoms Improve Their Mental Health? Empirical Evidence From an Online Depression Community’, Frontiers in Public Health, 8. Available at: https://doi.org/10.3389/fpubh.2020.581088. Luichies, I., Goossensen, A. and der Meide, H. van (2021) ‘Caregiving for ageing parents: A literature review on the experience of adult children’, Nursing Ethics, 28(6), pp. 844–863. Available at: https://doi.org/10.1177/0969733019881713. Maddux, J.E. (2024) Subjective Well-Being and Life Satisfaction: A Social Psychological Perspective. Taylor & Francis. Megale, A., Peterson, E. and Friedlander, M.L. (2022) ‘How Effective is Online Couple Relationship Education? A Systematic Meta-Content Review’, Contemporary Family Therapy, 44(3), pp. 294–304. Available at: https://doi.org/10.1007/s10591-021-09585-7. Merz, E.-M., Schulze, H.-J. and Schuengel, C. (2010) ‘Consequences of Filial Support for Two Generations: A Narrative and Quantitative Review’, Journal of Family Issues, 31(11), pp. 1530– 1554. Available at: https://doi.org/10.1177/0192513X10365116. Michelle Irving (2025) Separation under the same roof. Relationships Australia. Mikulincer, M. and Shaver, P. (2008) ‘Adult attachment and affect regulation’, Handbook of attachment: theory, research, and clinical applications/Guilford [Preprint]. Monson, C.M. et al. (2012) ‘Effect of Cognitive-Behavioral Couple Therapy for PTSD: A Randomized Controlled Trial’, JAMA, 308(7), pp. 700–709. Available at: https://doi.org/10.1001/ jama.2012.9307. Moore, S.M. and Rosenthal, D.A. (2015) ‘Personal growth, grandmother engagement and satisfaction among non-custodial grandmothers’, Aging & Mental Health, 19(2), pp. 136–143. Available at: https://doi.org/10.1080/13607863.2014.920302. Morelli, S.A. et al. (2015) ‘Emotional and Instrumental Support Provision Interact to Predict Well-Being’, Emotion (Washington, D.C.), 15(4), pp. 484–493. Available at: https://doi. org/10.1037/emo0000084. Morse, D.F. et al. (2022) ‘Global developments in social prescribing’, BMJ Global Health, 7(5). Available at: https://doi.org/10.1136/bmjgh-2022-008524. Navaneetham, P. and Kanth, B. (2022) ‘Effects of Personal Relationships on Physical and Mental Health among Young Adults- A Scoping Review’, The Open Psychology Journal, 15. Available at: https://doi.org/10.2174/18743501-v15-e2208180. Nurullah, A.S. (2012) ‘Received and provided social support: A review of current evidence and future directions’, American Journal of Health Studies, 27(3), pp. 173–188. Perelli-Harris, B. et al. (2018) ‘Do Marriage and Cohabitation Provide Benefits to Health in Mid-Life? The Role of Childhood Selection Mechanisms and Partnership Characteristics Across Countries’, Population Research and Policy Review, 37(5), pp. 703–728. Available at: https://doi.org/10.1007/s11113-018-9467-3.

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Perelli-Harris, B. et al. (2019) ‘Mind the “happiness” gap: The relationship between cohabitation, marriage, and subjective well-being in the United Kingdom, Australia, Germany, and Norway’, Demography, 56(4), pp. 1219–1246. Petch, J. et al. (2014) ‘Couple Counselling Outcomes in an Australian Not for Profit: Evidence for the Effectiveness of Couple Counselling Conducted Within Routine Practice’, Australian and New Zealand Journal of Family Therapy, 35(4), pp. 445–461. Available at: https://doi. org/10.1002/anzf.1074. Pezirkianidis, C. et al. (2023) ‘Adult friendship and wellbeing: A systematic review with practical implications’, Frontiers in Psychology, 14. Available at: https://doi.org/10.3389/ fpsyg.2023.1059057. Ponti, L. and Smorti, M. (2019) ‘The roles of parental attachment and sibling relationships on life satisfaction in emerging adults’, Journal of Social and Personal Relationships, 36(6), pp. 1747–1763. Available at: https://doi.org/10.1177/0265407518771741. Purol, M.F. et al. (2021) ‘Loved and lost or never loved at all? Lifelong marital histories and their links with subjective well-being’, The Journal of Positive Psychology, 16(5), pp. 651–659. Available at: https://doi.org/10.1080/17439760.2020.1791946. Qu, L. et al. (2025) Marriages in Australia. Available at: https://aifs.gov.au/all-research/factsand-figures/marriages-australia-25 (Accessed: 23 October 2025). Rapp, I. and Stauder, J. (2020) ‘Mental and Physical Health in Couple Relationships: Is It Better to Live Together?’, European Sociological Review, 36(2), pp. 303–316. Available at: https://doi. org/10.1093/esr/jcz047. Rayland, A. and Andrews, J. (2023) ‘From Social Network to Peer Support Network: Opportunities to Explore Mechanisms of Online Peer Support for Mental Health’, JMIR Mental Health, 10(1), p. e41855. Available at: https://doi.org/10.2196/41855. Reinhardt, G., Vidovic, D. and Hammerton, C. (2021) ‘Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness’, Perspectives in Public Health, 141(4), pp. 204–213. Available at: https://doi.org/10.1177/1757913920967040. Relationships Australia (2024) Relationship Indicators 2024 Report National Survey of the state of relationships in Australia. Relationships Australia. Available at: https://www. relationships.org.au/wp-content/uploads/Relationship-Indicators-2024-Report-Final.pdf (Accessed: 5 January 2026). Riem, M.M.E. et al. (2023) ‘Grandparental Support and Maternal Postpartum Mental Health’, Human Nature, 34(1), pp. 25–45. Available at: https://doi.org/10.1007/s12110-023-09440-8. Roddy, M.K. et al. (2020) ‘Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators.’, Journal of Consulting and Clinical Psychology, 88(7), pp. 583–596. Available at: https://doi.org/10.1037/ccp0000514. Sadagheyani, H.E. and Tatari, F. (2020) ‘Investigating the role of social media on mental health’, Mental Health and Social Inclusion, 25(1), pp. 41–51. Available at: https://doi.org/10.1108/ MHSI-06-2020-0039. Saeri, A.K. et al. (2018) ‘Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey’, Australian & New Zealand Journal of Psychiatry, 52(4), pp. 365–374. Santini, Z.I. et al. (2015) ‘The association between social relationships and depression: A systematic review’, Journal of Affective Disorders, 175, pp. 53–65. Available at: https://doi. org/10.1016/j.jad.2014.12.049. Spencer, C.M. and Anderson, J.R. (2021) ‘Online relationship education programs improve individual and relationship functioning: A meta-analytic review’, Journal of Marital and Family Therapy, 47(2), pp. 485–500. Available at: https://doi.org/10.1111/jmft.12491.

THE SCAFFOLDING OF MENTAL HEALTH | Relationships Australia NSW

Stanley, S.M. et al. (2020) ‘Best Practices in Relationship Education Focused on Intimate Relationships’, Family Relations, 69(3), pp. 497–519. Available at: https://doi.org/10.1111/ fare.12419. Thoits, P. (2010) ‘Stress and Health: Major Findings and Policy Implications’, Journal of Health and Social Behavior, 51, pp. 41–53. Available at: https://pubmed.ncbi.nlm.nih.gov/20943582/. Thomas, P.A., Liu, H. and Umberson, D. (2017) ‘Family Relationships and Well-Being’, Innovation in Aging, 1(3), p. igx025. Available at: https://doi.org/10.1093/geroni/igx025. Vera-Toscano, E. (2021) Living apart together, Pursuit. University of Melbourne. Available at: https://pursuit.unimelb.edu.au/articles/living-apart-together (Accessed: 20 January 2026). Whisman, M.A., Sbarra, D.A. and Beach, S.R.H. (2021) ‘Intimate Relationships and Depression: Searching for Causation in the Sea of Association’, Annual Review of Clinical Psychology, 17(Volume 17, 2021), pp. 233–258. Available at: https://doi.org/10.1146/annurevclinpsy-081219-103323. White, S.J. et al. (2023) ‘Global Prevalence and Mental Health Outcomes of Intimate Partner Violence Among Women: A Systematic Review and Meta-Analysis’, Trauma, Violence, & Abuse [Preprint]. Available at: https://doi.org/10.1177/15248380231155529. WHO (2025a) Mental disorders. World Health Organisation. Available at: https://www.who.int/ news-room/fact-sheets/detail/mental-disorders (Accessed: 3 February 2026). WHO (2025b) Mental health. World Health Organisation. Available at: https://www.who.int/ news-room/fact-sheets/detail/mental-health-strengthening-our-response (Accessed: 2 February 2026). Wickramaratne, P.J. et al. (2022) ‘Social connectedness as a determinant of mental health: A scoping review’, PLOS ONE, 17(10), p. e0275004. Available at: https://doi.org/10.1371/journal. pone.0275004. Wilkins, R. et al. (2021) The Household, Income and Labour Dynamics in Australia Survey: Selected Findings from Waves 1 to 19. 16. The University of Melbourne: Melbourne Institute of Applied Economic and Social Research. Available at: https://melbourneinstitute.unimelb.edu. au/__data/assets/pdf_file/0009/3963249/HILDA-Statistical-Report-2021.pdf. Wilson, M.J. et al. (2025) ‘Suicidality in Men Following Relationship Breakdown: A Systematic Review and Meta-Analysis of Global Data’, Psychological Bulletin [Preprint]. Available at: https://doi.org/10.1037/bul0000482. Wittenborn, A.K. et al. (2022) ‘Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010–2019)’, Journal of Marital and Family Therapy, 48(1), pp. 129–153. Available at: https://doi.org/10.1111/jmft.12569. Zell, E. and Stockus, C.A. (2025) ‘Social support and psychological adjustment: A quantitative synthesis of 60 meta-analyses’, American Psychologist, 80(1), pp. 33–46. Available at: https:// doi.org/10.1037/amp0001323.

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