No man is an island: social resources, stress and mental health at mid-life

Abstract

Background

Positive social relationships are known to mitigate the negative effects of stress on mental health. However, the direction of association between social resources and mental health remains unclear, and it is not known whether higher than average levels of social resources confer additional benefits, in the short- and longer-term.

Aims

To investigate the concurrent and longitudinal contribution of higher levels of social resources in reducing the risk of mental health symptoms after exposure to stress at age 45, and to identify life-course precursors of mid-life social resources.

Method

The National Child Development Study (NCDS) is a prospective birth cohort of over 17,000 births in 1958. We tested concurrent and longitudinal associations between different levels of social resources at age 45 and mental health symptoms amongst individuals exposed to stress and verified whether prior mental health symptoms (age 42) explained these associations. We also tested a range of child, family and adult precursors of mid-life social resources.

Results

Higher than average levels of social resources were required to confer benefits to mental health amongst individuals exposed to high stress levels, both concurrently at age 45 and in the longer-term at age 50. In general, these associations were not attributable to prior mental health symptoms. Key predictors of mid-life social resources included evidence of early sociability.

Conclusions

Having a broad network of social ties and better personal support helps individuals withstand exposure to higher levels of stress. Given that sociable children had better mid-life social resources, early intervention may benefit individuals’ social resources later in life.

Declaration of interest

None.

Introduction

Adverse life events are among the best-known risk factors for common mental health problems across the life course^1–2. Positive social relationships may mitigate such adverse effects by providing networks of social ties and sources of emotional, informational and practical support³. However, some key issues remain to be clarified. First, although the majority of adults have some positive social relationships in their lives, it is unclear whether higher levels of personal support, including both qualitative and structural aspects of social relationships, confer additional benefits especially perhaps in the face of higher levels of stress. Such effects have been found for other health-promoting factors, for example, engaging in higher levels of physical activity provides additional benefits to health⁴; we hypothesized that similar processes operate in relation to a combination of quality and the extent of individuals’ social relationships, which we label here social resources. Second, current evidence rests heavily on cross-sectional studies, where the direction of association is uncertain⁵: mental health problems may impact the social resources available to individuals, as well as the reverse. Third, although child and adolescent precursors of social resources in earlier adulthood have been identified^6–7, little is known about whether they remain important at mid-life. Long-term longitudinal studies are needed to shed light on these issues and derive pointers for interventions. In this study, we used data from a prospective national birth cohort to investigate whether higher than average levels of adult social resources confer additional benefits to mental health among individuals experiencing stressful life events. Specifically, we examined the concurrent association between variation in social resources and affective symptoms at age 45. We further investigated prospective associations between resources at age 45 and psychological distress at age 50. In both cases, we took account of variations in prior psychological distress to clarify the direction of associations. Finally, we used follow-back analyses to explore child, adolescent and early adult precursors of higher than average social resources at mid-life.

Method

Participants

Participants were from the National Child Development Study, which surveyed 18,558 babies born in one week in 1958 (98% of live births) in England, Scotland, and Wales⁸. Subsequent sweeps took place when participants were ages 7, 11 and 16 during childhood, and throughout adulthood at ages 23, 33, 42, 45, 50 and 55. At age 45, a subsample of over 9,000 participants took part in a survey designed to provide more objective measures of biomedical risk, from which several of this study’s measures were derived. We drew on data from the childhood, adolescent, age 42 and age 50 sweeps (accessed adhering to the terms of the Economic and Social Data Service [ESDS] End User License [EUL] agreement), and the age 45 biomedical sweep, which had more stringent access requirements covered by a ‘special licence’ in order to meet the more stringent access requirements.

Measures

Social resources

There is considerable variation in how social resources are conceptualised and measured across studies⁹. By drawing on the Close Persons Questionnaire¹⁰ and the Berkman-Syme Social Network Index¹¹, we chose to incorporate both structural and qualitative aspects of a person’s social resources. At age 45, the Close Persons Questionnaire was used to assess the quality of personal support received from the individual reported as being closest to the participant during the previous 12-month period. In most cases, this person was a spouse (79.7%), followed by a parent (3.8%), an offspring (3.6%), or a sibling (3.3%). The questionnaire captures three main constructs of social support: confiding/emotional (e.g. ‘In the last 12 months, could you rely on this person when needed?‘), practical (e.g. ‘In the last 12 months, did this person give you help with small things when needed?‘), and negative (e.g. In the last 12 months, did talking to this person make things worse?). Items assessing negative aspects of social support were reverse-coded to ensure higher scores represented more positive support. A selection of items from the Berkman-Syme Social Network Index were also included to assess the structural aspects of a person’s social resources. The measure assessed the number of social ties, and the frequency of contact with family, friends and acquaintances outside the household, as well as the degree of participation in social, recreational, or political groups.

A summed score of items from both measures included confiding/emotional, practical and reverse-coded negative items assessing personal support received by the individual, along with items assessing their wider social network, to create an overall indicator of social resources (M = 49.27, SD = 8.51, range 13-70). Higher scores represent better quality support, as well as a greater number and more frequent contact with social ties. The reliability of the scale was α = 0.80. To facilitate comparisons among individuals with differing levels of social resources, we trichotomised the index^12–13 to identify those with poor (bottom 25%, range = 13 - 44), typical (middle 50%, range = 45 - 55) and rich (top 25%, range = 55.5 - 70) resources. People with typical social resources had some contact with a wider network of social ties and received good personal support. We refer to those in the upper quarter of the distribution as having ‘rich’ social resources as they represent individuals who had more frequent contact with a larger network and received better quality support than those with typical resources. We refer to those in the bottom quarter of the distribution as having ‘poor’ social resources, as they had relatively less contact with a smaller network and received poorer quality support than those with typical resources.

Men and women were equally likely to have rich resources (OR = 1.05, 95% CI 0.90 - 1.22, p>0.05). We did not find significant interactions between gender and social resources in association with affective symptoms at age 45 (χ² = 2.29, p>0.05) and psychological distress at age 50 (χ² = 0.79, p>0.05). Therefore, we presented findings for men and women combined.

Stressful life events

Stressful life events experienced in the last 6 months were self-reported at age 45, including events concerning health (e.g. Have you yourself suffered serious illness, injury or assault?), employment (e.g. Were you sacked from your job?), criminality (e.g. Have you had problems with police and a court appearance?), partnerships (e.g. have you broken off a steady relationship?), and other relationships (e.g. has a close family friend or another relative died?). Nearly half of the total sample reported no exposure to adverse events in the past six months, 41.3% reported experiencing one or two, and 13.4% had experienced 3 or more.

Mental health symptoms

Affective symptoms were assessed at age 45 using the Clinical Interview Schedule-Revised (CIS-R), a validated measure designed to identify common mental disorders using structured interviews¹⁴. A shortened version of the CIS-R was administered in this sample, focusing on symptoms of anxiety and depression experienced in the past week. Psychological distress was assessed at age 42 and at the age 50 follow-ups using a 9-item version of the Malaise Inventory¹⁵; this commonly used, self-reported screening tool has robust psychometric properties in this sample¹⁶.

Precursors

A comprehensive range of child, family and adult factors were examined as potential precursors of social resources at mid-life are listed and described in supplementary Table 1.

Statistical analyses

We tested the association between different levels of social resources and mental health symptoms amongst 4,997 participants who reported exposure to either 1 or 2 stressful life events, or 3 or more. We used negative binomial regressions to account for the overdispersed distribution of the outcome measures. First, we examined concurrent associations by comparing levels of affective symptoms at age 45 between individuals with typical and rich levels of social resources with people with poor levels. We made a further comparison between individuals with typical and rich levels of resources. Second, we tested longitudinal associations between different levels of social resources and psychological distress at age 50. We further adjusted for variations in prior mental health symptoms to shed light on the direction of association between social resources and mental health symptoms at ages 45 and 50. Third, we conducted multinomial logistic regression analyses to examine a range of potential child, family and adult precursors among the full range of participants with available data on social resources at mid-life (N=8,507). We aimed to identify domains of precursors that were associated with an increased likelihood of having rich resources, compared to typical levels, whilst also reducing the risk of having poor resources. We examined each domain separately by conducting a series of bivariate analyses with each variable. In a last step, we repeated the initial analyses looking at social resources and mental health outcomes adding controls for the significant precursors of social resources. We adjusted all analyses for gender and social class at age 42 (i.e., professional, managerial and technical, skilled non-manual, skilled manual, partly-skilled and unskilled occupation) to account for differences in mental health symptoms experienced by men and women, and across varying levels of social class. STATA V.15.0 was used for all analyses¹⁷.

Attrition

Sample retention rates were high in childhood⁷, but fell during adulthood. Data were available on 53% of participants at age 50 (9788/18,558). We used logistic regression analyses to predict availability of complete data at mid-life; data availability was unrelated to exposure to stress and social resources at mid-life, but was predicted by male gender, low parental social class and lower child reading scores. We created outcome-specific inverse probability weights¹⁸ using the variables listed above, in order to take some account of bias associated with missingness. We used these weights in all analyses.

Results

As expected, levels of affective symptoms increased with greater exposure to stressful life events (Table 1). Higher levels of social resources were associated with lower levels of prior and subsequent psychological distress, and with lower levels of contemporaneous affective symptoms. Social resources were not associated with stressful life events.

Table 1. Correlations between social resources, stressful life events, and mental health symptoms.

	1	2	3	4	5
1. Stressful life events age 45	1
N	4347
2. Social resources age 45	-0.03	1
N	3992	3992
3. Psychological distress age 42	0.11	-0.09	1
N	4183	3854	4183
4. Affective symptoms age 45	0.17	-0.10	0.45	1
N	4333	3979	4171	4333
5. Psychological distress age 50	0.11	-0.06	0.57	0.47	1
N	3790	3519	3675	3782	3790

Significant findings are in bold, p<0.001.

Benefits of rich social resources on concurrent affective symptoms

Individuals with higher levels of social resources had lower levels of affective symptoms than those with poorer resources (see top panel of Figure 1). Amongst individuals exposed to 1 or 2 stressful life events, having either rich or typical levels of social resources was associated with a reduction in affective symptoms at age 45, compared to having poor resources (see supplementary table 2). Rich resources did not confer any additional benefits by contrast with typical levels. However, amongst individuals exposed to 3 or more stressors, only rich social resources conferred benefits in terms of symptom levels: individuals with typical and poor resources had similar high levels of symptoms, whereas it was only those with rich resources that had lower levels in this group.

Figure 1.

Mean scores for levels of social resources by stressful life events in affective symptoms (top panel) and psychological distress (bottom panel). * p<0.05, ** p<0.01, *** p<0.001.

Benefits of rich social resources on subsequent psychological distress

To assess whether the beneficial effects of rich social resources persisted over time, we examined levels of psychological distress five years after individuals were exposed to stress. The findings followed a similar pattern to those of the concurrent analyses. Amongst individuals who were previously exposed to 1 or 2 stressful life events, both rich and typical levels of social resources were associated with lower levels of psychological distress; rich resources did not confer any additional benefits (see bottom panel of Figure 1). However, amongst individuals previously exposed to 3 or more stressful life events, once again it was only those people with rich social resources who showed evidence of benefits: individuals with typical and poor resources had similar high levels of symptoms, whereas lower levels of psychological distress were only observed amongst those with rich resources.

Effects of accounting for prior psychological distress

We further tested whether the benefits conferred by rich social resources remained after adjusting for variations in individuals’ prior psychological distress assessed at age 42 (see supplementary Table 2). The benefits associated with having rich resources were reduced but remained. Overall, findings show that social resources reduced the risk of both concurrent and later symptoms, even for those who experienced prior psychological distress.

Life-course precursors of rich social resources

Our analyses identified precursors of rich mid-life social resources across development; they included greater sociability in childhood (e.g., seeing friends outside school) and in adolescence (e.g., going to discos or parties), as well as better quality social resources earlier in adult life (e.g., confiding relationships) (see Table 2). We tested the extent to which the effect of social resources on mid-life outcomes was attributable to these earlier precursors, focusing in particular on developmental indicators of sociability in childhood and adolescence (Table 3). Associations between social resources and measures of affective symptoms at mid-life became non-significant after adjusting for earlier sociability (i.e., seeing friends outside school in childhood, going to discos or parties during adolescence, and confiding relationships in adult life); while social resources are helpful at mid-life, determinants appear to be rooted in early life.

Table 2. Life-course precursors of social resources at age 45^a .

	Poor social resources vs typical levels	Rich social resources vs typical levels	N
Child factors	RRR (95% CI)	RRR (95% CI)
Female	0.80*** [0.71-0.89]	1.03 [0.92-1.16]	7414
Higher reading scores in childhood	0.99** [0.98-1.00]	1.00 [0.99-1.00]	7414
Higher cognitive scores in childhood	0.99*** [0.99-1.00]	1.00 [0.99-1.00]	6670
Higher internalising scores	1.05* [1.01-1.10]	0.95* [0.91-0.99]	7051
Higher externalising scores	1.02 [1.00-1.05]	0.97 [0.95-1.00]	7181
Personality
Impulsive	0.92* [0.86-0.99]	1.06 [0.99-1.14]	5845
Moody	1.03 [0.98-1.09]	1.01 [0.95-1.06]	5865
Aggressive	0.91* [0.84-1.00]	1.04 [0.96-1.14]	5851
Rigid	1.10* [1.02-1.20]	1.02 [0.94-1.11]	5837
Withdrawn	1.13*** [1.07-1.20]	0.96 [0.90-1.02]	5870
Lazy	1.00 [0.95-1.06]	0.99 [0.94-1.05]	5857
Disability	1.46** [1.12-1.91]	1.01 [0.74-1.36]	5362
Social resources in childhood/adolescence
Child sees friends outside school	0.75*** [0.66-0.84]	1.18* [1.03-1.34]	6459
Child does not get on with both parents	1.23* [1.01-1.50]	0.76* [0.60-0.95]	5360
Arguments with parents	0.95 [0.76-1.17]	1.02 [0.82-1.26]	5722
Often goes to discos/parties	0.79*** [0.69-0.90]	1.25** [1.09-1.42]	5588
Family environment
Child not living with both parents	1.18 [0.97-1.43]	0.94 [0.76-1.16]	5136
Child is/has been in care	1.59* [1.06-2.39]	0.89 [0.55-1.45]	5594
Higher parental social class	0.88 [0.77-1.00]	0.92 [0.80-1.05]	7402
Family difficulties	1.23* [1.00-1.52]	0.93 [0.74-1.17]	6972
Psychopathology in adulthood
More psychological distress	1.09*** [1.05-1.13]	0.95* [0.91-1.00]	6641
Socioeconomic status
Higher education level	0.90 [0.79-1.03]	0.83** [0.73-0.95]	6535
Higher social class	1.03 [0.98-1.08]	1.02 [0.97-1.07]	6241
Property ownership	0.88 [0.75-1.03]	0.99 [0.84-1.17]	6159
Ever unemployed	1.04 [0.90-1.19]	0.90 [0.78-1.04]	6361
Social resources in adulthood
Often volunteers	0.81** [0.71-0.94]	1.10 [0.96-1.26]	6477
Earlier social support
Domestic	0.76*** [0.67-0.86]	1.24** [1.10-1.40]	6316
Financial	0.74*** [0.63-0.86]	1.12 [0.97-1.29]	6237
Household	0.81** [0.71-0.93]	1.34*** [1.18-1.53]	6309
Personal	0.75*** [0.67-0.85]	1.15* [1.02-1.30]	6313
Confiding	0.77*** [0.67-0.89]	1.17* [1.02-1.34]	5909
Emotional	0.76*** [0.67-0.87]	1.29*** [1.14-1.46]	6220
Social difficulties
Drawn into arguments	1.03 [0.87-1.22]	0.96 [0.81-1.14]	6440
Can’t trust other people	1.35*** [1.19-1.54]	0.84* [0.73-0.97]	6250
Doesn’t get on with other people	1.60*** [1.41-1.80]	0.64*** [0.56-0.72]	6287
Often attends religious meetings	0.84 [0.70-1.02]	1.31** [1.10-1.56]	3460
Not married	1.52*** [1.34-1.73]	0.73*** [0.63-0.84]	6513

^aWeighted relative risk ratios are reported, CI = confidence interval. Significant findings are in bold. * p<0.05, ** p<0.01, *** p<0.001.

Table 3. Group comparisons across levels of social resources for participants exposed to a) 1 or 2, or b) 3 or more stressful life events, adjusted for earlier sociability^a .

			Group comparisons
Number of stressful life events age 45
	Mid-life outcomes	Typical vs Poor resources	Rich vs Poor resources	Rich vs Typical resources	N
			IRR (95% CI)
	Affective symptoms (age 45)
1-2		0.96 [0.85-1.09]	0.88 [0.75-1.04]	0.92 [0.78-1.07]	1967
3 or more		0.99 [0.83-1.18]	0.90 [0.73-1.11]	0.91 [0.74-1.12]	616
	Psychological distress (age 50)
1-2		0.94 [0.83-1.07]	0.96 [0.82-1.12]	1.02 [0.88-1.18]	1803
3 or more		1.09 [0.90-1.31]	0.94 [0.74-1.19]	0.86 [0.68-1.09]	534

^aAnalyses are adjusted for gender, social class and prior mental health symptoms. Weighted incidence rate ratios are reported, CI = confidence interval. Significant findings are in bold, * p<0.05, ** p<0.01, *** p<0.001, # = p<0.10.

Note: Earlier sociability included the following variables: seeing friends outside school in childhood, going to discos or parties during adolescence, and confiding relationships in adult life.

Discussion

Our findings in a large-scale, representative cohort underscore the importance of more and good quality social resources in mitigating mental health difficulties under particularly stressful circumstances. We also contribute longitudinal evidence to show that individuals can benefit from positive social resources in the longer-term, as effects on mental health persisted five years following exposure to stress. In addition, we provide evidence that social resources mitigate risk for mental health symptoms even taking account of prior mental health. By taking a life-course approach, we show that individuals who display sociability during childhood and adolescence have the most advantageous social resources by mid-life. This finding highlights that there may be advantages to intervening prior to adulthood, to ensure individuals develop social resources that help them cope with stress later in life.

Benefits conferred by rich social resources

Previous studies commonly used either dichotomous or linear approaches to characterise variations in the size of networks, frequency of contacts, and the degree of personal support individuals received^19–20. We tested a more fine-grained approach, differentiating people with rich social resources from those with poor and more typical levels. This distinction mapped on to the distribution of social resources represented in the population we studied. It also made it possible to test whether the social resources available to the majority of adults are sufficient in mitigating risks, or whether richer resources are needed under especially stressful circumstances. Taking this approach, we corroborated previous findings that social resources have their limits²¹, as typical levels did not mitigate risks under particularly stressful circumstances. As most prior studies did not explicitly differentiate between rich and typical levels of social resources, the association between stress and social resources proved to be more nuanced in our case. Namely, we show that rich social resources are beneficial - and indeed necessary - under particularly stressful circumstances.

Our study contributes new evidence that people who are best able to weather exposure to multiple stressors are those who have access to better quality emotional and practical support from at least one person - typically their spouse or partner - as well as a broader network of social ties including friends, relatives and social groups. This suggests that a combination of better quality personal support and regular contact with a larger network of social ties is important. In practice, of course, these two aspects of social resources are often linked. Individuals who have regular contact with a larger network of social ties may have greater potential to access different types of support from several sources, and may consequently be better able to cope with stress²². This may be especially important in the case of relationship breakdowns or losses, which are not only stressors in themselves but may also entail a loss of key emotional and practical support. An individual with a larger social network may be best able to compensate for losses of this kind by drawing on the resources available to them from their wider social network.

Persisting effects of rich social resources

Our findings also show that individuals who have regular contact with a larger network of social ties and more supportive relationships reap the benefits, not only at the time of exposure to stress, but also over the longer-term. This was the case - although associations were statistically marginal - even for individuals who might be expected to be more vulnerable because of their prior mental health symptoms, and consequently may be more likely to be exposed to stress²³ and receive less support²⁴. There may be a variety of mechanisms involved in explaining how social resources yield health advantages in the longer-term. Supportive relationships may positively influence individuals’ response to stress by promoting use of healthy behaviours and discouraging risky behaviours; they may also bolster individuals’ beliefs that they are able to cope effectively with stress, and instill a sense of responsibility towards their social ties (e.g. needing to stay healthy to provide for a family)^25–26. It has also been proposed that social resources may reduce the burden of allostatic load – the cumulative ‘wear and tear’ on physiological systems as result of exposure to stress – on health²⁷. One such mechanism could be the reduction of harmful dysregulation of the hypothalamic-pituitary-adrenal (HPA) system through altering the individual’s appraisal of stress.

Life-course precursors of rich social resources

Whereas the majority of existing studies tend to follow-up into earlier stages of adulthood only, we show that early precursors may continue to be important for developing good social resources up to and including mid-life. We show that more sociable children and adolescents have more and better quality social resources by mid-life, providing further evidence to the growing body of studies showing that precursors of adult social resources are rooted in early life. Our findings also corroborate and future research showing that children and adolescents who spend more time with their peers procure health benefits in later life²⁸.

Equipping less sociable children with the skills to initiate and maintain relationships with their peers may have far-reaching benefits across the life course. It may also be possible to strengthen social resources at older ages as our findings showed that adults with several sources of personal support prior to mid-life (typically their partner or spouse, parents or in-laws, other relatives, and friends or neighbours) were also more likely to have good social resources later in life. Interventions designed to strengthen adult social resources may be useful in ensuring individuals have the tools to elicit more or better-quality support from their existing networks when needed²⁹.

Limitations

Our study has some limitations. First, we were only able to examine longitudinal effects at a five-year follow-up at mid-life. Although we showed that social resources are beneficial several years later, the extent to which these effects persist over longer time periods remains uncertain. This limitation is particularly salient given that the social resources available to individuals may become more limited with advancing age, due to health problems and the death of family. Second, our study did not include repeated measures of social resources at mid-life and so it remains unclear how the observed long-term effects operated. Cohorts with measures of social support assessed at different stages in the life-course would provide opportunities for the exploration of these issues.

Furthermore, the measure of support received focused on only one nominated person (typically the spouse or partner), thereby precluding reports of multiple sources of support. However, spouses and partners are the most probable source of support for adults and are most consistently shown to be important in protecting against depression⁵. We conducted sensitivity analyses to take account of whether individuals were in a partnership at age 45, and the findings remained unchanged (see supplementary Table 3).

Third, our study focused on two mental health outcomes given the data available in this 50-year longitudinal study. Future studies should explore the effect of social resources – in the context of stress – on other mental health outcomes. Fourth, common method variance may confound the results as we used self-reported information to identify stress exposure, levels of social resources and mental health symptoms. It may be useful for future studies to gather data from multiple informants to increase the robustness of findings. Fifth, attrition was unavoidable in our 50-year-long study. We used inverse probability weights to take some account of any associated selection bias. Sixth, our study did not assess the role of online communities and social media platforms. This is particularly important as young people today increasingly use these platforms to create and maintain social ties.

Implications

Our study has some clinical implications. We show that both the quality and quantity of social resources available to individuals may be important resilience-related factors. It may therefore be beneficial for clinicians to assess an individual’s close relationships, as well as the extent to which they engage with a wider network of social ties. This is especially relevant if the individual has been exposed to several stressful life events in quick succession, as the social resources available to the majority of people may no longer be effective in mitigating risk. Under these circumstances, prompt intervention is required to prevent the onset, or worsening, of mental health problems. Effective interventions for mental health include those designed to increase opportunities for individuals to elicit support from their community^30–31, underscoring the importance of encouraging activities that enhance social inclusion as outlined by the Care Programme Approach (CPA) framework. Examples of such interventions include, activities around social skills to facilitate ‘support creation’ including training in conversation skills, assertiveness and conflict resolution and group interventions that provide support through peers, including those that provide opportunity to give as well as receive support from others. Promoting social inclusion is increasingly important given recent societal changes, including technological advances, greater geographic mobility and rising economic pressures. Some individuals may consequently be at greater risk of being socially isolated (e.g. those who are unemployed) and experiencing mental health symptoms upon exposure to stress.

Our findings also emphasise the need for further longitudinal research to better understand the complex interplay between social resources, stress and mental health. Longitudinal studies offer unique opportunities to assess changes in the nature of a person’s social resources across age, which may inform a more targeted approach to addressing deficits in support at different life stages. It may also be possible to examine the extent to which interventions designed to improve access to support (e.g. peer support programs) engender resilience when people are exposed to stress.

Although bolstering adult social resources at the time of exposure to stress is worthwhile, our findings suggest that early interventions may provide the best opportunity to benefit future mental health. Schools and educational professionals should be aware that children with poorer social skills may be less well-equipped to cope with stress later in life. Engaging children in structured activities such as volunteering and active citizenship is one such intervention which bring the opportunity for children to lead or participate in a social action projects in the community (e.g. National Citizen Service/Supporting Inclusion Programme). Another example is peer-mentoring by older children matched with younger mentees based on gender, hobbies, personalities, academic subjects. Children may benefit from school-based (e.g. aggression or bullying prevention) or out-of-school (e.g. mentoring or arts/sports-based activities) social and emotional learning interventions³². Such interventions may provide children with the skills to forge more and better-quality social ties with others well into adulthood.