Depression is a common mental health problem that affects approximately 4% of the global population (WHO, 2025). People who experience depression often describe a painful loss of social connection. One teenager described that:
There would be days that I just couldn’t get out of bed. I didn’t want to face people. I didn’t want to look at anybody… (Achterbergh et al., 2020)
Recent research increasingly shows that strong, supportive relationships are linked to lower risk of developing depression and better recovery when people do become unwell (Wickramaratne et al., 2022). Unlike factors such as genes, which are fixed, our social connections are something we may be able to change for people living with, or at risk of, depression.
However, we still do not know which approaches for improving social connection actually reduce depressive symptoms, especially for interventions that support people to build “natural” social networks, rather than formal therapies or social skills training.
A recent umbrella review by De Risio and colleagues (2025) brings together 12 systematic reviews and meta‑analyses to examine which kinds of natural social connection interventions help to reduce depression, for whom, and by how much.
Social connections matter, but how much can interventions that strengthen natural social networks help to reduce depression?
Methods
De Risio and colleagues (2025) carried out an umbrella review, meaning they undertook a review of systematic reviews rather than a review of individual studies. They searched four major databases for full-text English language reviews of interventions that aimed to improve participants’ natural social networks (i.e., those with family, friends, peers, or community groups, as opposed to formal or social skill-based interventions) and that reported depression outcomes compared with a control group. Reviews were only included if they were the most recently updated version.
Two reviewers independently screened, extracted and quality-checked the evidence, then combined results quantitatively where possible and summarised the rest narratively. They also looked at reference lists from relevant papers to make sure they didn’t miss anything.
Using the AMSTAR‑2 and GRADE tools, the authors judged how well each review was done and how certain we can be about the results. The included reviews ranged from critically low to high quality on the AMSTAR-2: two were rated critically low, four low, four moderate and two high. According to GRADE, certainty for depression outcomes were mostly moderate to high, while certainty for social connection outcomes were mixed.
Results
Twelve systematic reviews were included in this umbrella review, which covered three types of social connection program:
- social network and support;
- social engagement; and
- social inclusion.
Participants ranged from the general population to specific groups with complex mental health problems. Many reviews focused on older adults and children or adolescents. The interventions were drawn from studies across many countries, with a few focusing on specific countries or types of economies.
Four reviews evaluated the impact of social network and support interventions. Most of these were digital (e.g., apps, internet-based platforms, video calls) and aimed to expand people’s social networks or help them access support. Overall, these interventions had negligible effects on depressive symptoms. The authors suggest this may be because online contact often lacks the emotional depth and mutual support that characterise effective in‑person relationships. Online communities may increase the number of connections, but not necessarily the kind of meaningful connection that influences depression.
Five reviews examined social engagement interventions. Four focused on intergenerational programmes for older adults and one on the “clubhouse model” for people with severe mental illness, which offers social activities, work roles and housing support. These interventions aimed to increase meaningful participation in social and community life, and they showed the strongest benefits for depression. They may work particularly well because they target people at high risk of isolation and strengthen both the size and the quality of their social relationships.
Three reviews addressed social inclusion interventions that aimed to prevent bullying, increase people’s identification with a social group, and improve social inclusion through community, belonging and educational programs. Most of these programs demonstrated moderate effects on depression symptoms, except antibullying programs which only found negligible effects.
Different types of interventions may have different effects depending on the age group:
- Older adults benefited particularly from social engagement interventions that got them out in the community or involved cross-generational social activities.
- Antibullying programs for children and teenagers did not affect depression symptoms. Other social inclusion interventions were more effective. These included social identification-building interventions such as the formation of a collective decision-making group in a care home facility (Knight et al., 2010 in the review by Steffens et al., 2019).
Two review studies looked at whether social connection might help explain why some interventions improve depression or other emotional symptoms:
- One found a moderate positive link between social identification and mental health outcomes, suggesting that programs may be more helpful when they make people feel more connected to the group that they are part of.
- Another did not find evidence that reductions in bullying explain improvements in depression symptoms.
Simply increasing interpersonal contact is not enough; programs that improve the quality and meaning of relationships seem to impact depression symptoms the most.
Conclusions
In this umbrella review, De Risio and colleagues (2025) concluded that helping people feel more socially connected can reduce depression, but that the impact of social connection programs varies. Face‑to‑face interventions seem more helpful than purely digital ones, although blended approaches may suit people who face barriers to social contact. Effects also appear to depend on a person’s existing social network: some may need help strengthening relationships they already have, while others need support to build new ones from scratch.
However, the conclusions are limited by several factors, with more research needed to clarify how, for whom, and under what conditions social connection leads to better mental health, and how we can deliver these interventions at scale.
Interventions that provide opportunities for everyday social relationships may be more powerful than we think, but we don’t know enough about how and why they lead to an improvement in depression symptoms.
Strengths and limitations
Umbrella reviews are considered a high standard of evidence because they bring together findings from multiple systematic reviews and meta-analyses. This gives a broader, more reliable picture of what the overall evidence shows and helps reduce the chance of drawing conclusions from what can in practice be a limited set of results.
This umbrella review had a clear research question and scope; focusing on interventions that strengthen natural social connections. The authors had a rigorous approach to the review, including pre-registration and following key reporting guidelines. They also converted different measures of effects to a common metric, which allowed them to directly compare findings from different reviews.
However, it is important to note the limitations to this review:
- Only English‑language, peer‑reviewed articles were eligible for inclusion, and the authors did not search for unpublished or in‑progress work. This means some evidence may have been missed and the findings may be biased towards English-speaking populations.
- The authors only assessed the quality of the included systematic reviews and meta-analyses based on the review methods used by the authors. They relied on the judgements made by the reviews’ authors about the risk of bias in the primary studies that made up the reviews and did not make their own assessments of the quality of the included primary studies.
- There was a lot of difference in how depression and social connection was measured across the included reviews. This made it hard to compare findings directly or combine them in a consistent way.
- Because the authors could not access the original study‑level data, they could not run new combined analyses, such as testing whether effects differed by gender, symptom severity or setting.
- The included reviews rarely reported adverse effects, unintended consequences or cost/resource implications. The umbrella review therefore cannot tell us whether potential benefits clearly outweigh harms or additional demands on services.
This umbrella review provides a clear summary of evidence by combining results from multiple systematic reviews and meta-analyses. However, the findings still depend on the quality, consistency and data availability of the underlying research, which is mixed.
Implications for practice
Social connection interventions address one of the most complex aspects of human experience: how people develop relationships that provide social support, alleviate loneliness and create a sense of community. Social connection is one of the most important factors for both physical and mental health, and there is strong evidence that it affects mortality risk (Holt‑Lunstad, 2024). However, while many social connections form naturally, programmes that aim to strengthen social connectedness for people who are isolated or depressed need to recognise both the multifaceted nature of social connection and the individuality of participants. Not everyone will benefit equally from the same intervention.
Programmes should prioritise meaningful, in-person engagement for those most at risk
This includes older adults and people living with dementia or serious mental illness. Findings from this umbrella review suggest that groups that are at high risk of isolation and depression benefit most from interventions that provide structured and meaningful social roles (Heaven et al., 2013). These could be intergenerational activity programs that link older adults to children and youth through shared arts, reading, gardening or technology sessions. Studies have found that older adults with more support from younger family members, better community services, and who use smart health devices tend to report fewer depressive symptoms (Mu et al., 2025).
We should be realistic about the limited effects of digital contact alone
While video calls, online groups and virtual communities may be valuable tools for some, they are unlikely to build the types of social networks that have meaningful impacts on symptoms of depression. These tools should be used as stepping stones to richer and ongoing in-person relationships by helping people to identify, navigate and engage with local groups, activities and services (a great example this is the GENIE tool piloted by Patel et al., 2022).
Young people need programmes that address broader social inclusion, not just bullying
While antibullying interventions address an important social and safety issue for children and teenagers, they may not improve social connection enough to address depression on a population scale. More promising findings came from programmes that addressed other aspects of social inclusion. An example of a program that both builds connection while providing life skills is the Live4Life Crew (Neelakantan et al., 2025).
The link between social connection and mental health is increasingly well-established. Future research should explore which components of these types of social network interventions drive improvements in depression symptoms, as well as how effects vary for different demographics. There is also limited research on whether benefits are sustained over time, or their cost-effectiveness compared to interventions that act on other key determinants of mental health. Finally, implementation research is needed to understand how to better embed these types of programmes into different sectors, as well as the training, resources and support required to deliver them at scale.
Some people might have strong social connections while others feel lonely. Some might need more social support while others are looking for a community. Effective interventions must consider the diverse existing social resources and needs of their participants.
Statement of interests
Nina Logan has no conflicts of interest to declare.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Luisa De Risio, Mauro Pettorruso, Alessandra D’Onofrio, Maria Chiara Vicinelli, Chiara De Troia, Marta Boffa, Mario Santorelli, Sara Spalletti, Roberto Guidotti, Pierluigi Politi, Giovanni Martinotti, Francesca Zoratto, & Marta Borgi (2025). Pathways to connection: Mapping the impact of social connection interventions on depression outcomes – an umbrella review. Psychiatry Research, 351, 116603. https://doi.org/10.1016/j.psychres.2025.116603.
Other references
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