Adherence to Mediterranean lifestyle, social participation, physical activity, sleep, and sociodemographic and health-related factors all contribute to life satisfaction and psychological distress, suggests a study.
Across psychological outcomes, sleep-related characteristics, particularly insomnia severity and subjective sleep quality, appear to be the most consistent factor.
“These findings support the value of an integrated Mediterranean lifestyle perspective and suggest that future mental health promotion strategies may benefit from addressing sleep, movement, social participation, and lifestyle behaviours together rather than in isolation,” the investigators said.
Specifically, higher life satisfaction correlated with greater adherence to Mediterranean lifestyle, better subjective sleep quality, higher social participation, higher education, marital or cohabiting status, and better self-reported health status. (β, 0.06‒0.18). [Nutrients 2026;18:2708]
By contrast, lower life satisfaction showed a significant association with higher BMI, greater physical activity expenditure, higher insomnia severity, and regional differences between Mediterranean and neighbouring/non-Mediterranean countries (β, ‒0.05 to ‒0.19). Notably, insomnia severity exhibited the strongest association with low life satisfaction (β, ‒0.19).
Furthermore, insomnia severity was found to be the most robust positive correlate of depression, anxiety, and stress (β, 0.43‒0.47) across psychological distress outcomes, followed by alcohol consumption (β, 0.12‒0.15) and residence in Mediterranean countries (β, 0.05‒0.08).
Older age, analysed as a continuous variable, better self-reported health status, and higher physical activity levels showed consistent correlations with lower levels of distress (β, ‒0.03 to ‒0.14).
In exploratory cross-sectional analyses, the investigators noted statistically significant indirect associations involving insomnia severity among Mediterranean lifestyle adherence, life satisfaction, and psychological distress. Indirect associations were also found among physical activity, social participation, and psychological distress outcomes, albeit of small magnitudes.
“These cross-sectional findings, including the exploratory indirect statistical associations, should be interpreted as hypothesis-generating and not as evidence of temporal ordering, causal mediation, or behavioural mechanisms,” the investigators said.
Public health
From a public health perspective, the findings back the promotion of integrated Mediterranean lifestyle instead of isolated behavioural recommendations, according to the investigators.
“Within this framework, sleep health appears to be an important behavioural domain, particularly because insomnia severity was consistently associated with distress and showed exploratory indirect associations with Mediterranean lifestyle adherence and psychological outcomes,” they added.
Similarly, physical activity and social participation may also be considered when developing interventions intended for life satisfaction and resilience improvement, the investigators said.
“This interpretation is consistent with broader frameworks emphasizing that mental health promotion requires integrated and context-sensitive public health approaches that address clusters of behavioural and psychosocial determinants rather than isolated habits,” they added. [World Psychiatry 2020;19:360-380; https://www.who.int/publications/i/item/9241562943]
Study details
A total of 4,010 adults (59.5 percent female) across 10 Mediterranean and neighbouring countries provided data via standardized multilingual e-survey for this study. Life satisfaction, the primary outcome, was evaluated using the Short Life Satisfaction Questionnaire, while psychological distress, the secondary outcome, was assessed using the Depression Anxiety Stress Scales.
The investigators assessed adherence to Mediterranean lifestyle using the validated MEDLIFE index, integrating dietary habits with brief indicators of physical activity, rest, and social/convivial habits, with complementary validated measuring adding more detailed assessments of physical activity, sedentariness, sleep, insomnia, and social participation.
Furthermore, correlates of the primary and secondary outcomes were identified through hierarchical multiple linear regression analyses. The investigators also conducted bootstrapped exploratory cross-sectional indirect-association analyses to examine selected statistical associations involving Mediterranean lifestyle adherence, physical activity, social participation, insomnia severity, life satisfaction, and psychological outcomes.
“Future research should prioritize longitudinal and intervention-based designs to determine whether these associations persist prospectively and to clarify temporal relationships,” the investigators said.
“[E]xpanding the analytical framework to include broader contextual and cultural determinants, such as sociocultural norms, dominant religious practices, social cohesion, and culturally embedded health behaviours, may further improve the understanding of lifestyle–well-being relationships across diverse populations,” they added.