{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:02:21Z","timestamp":1789610541479,"version":"build-2803163510"},"reference-count":79,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MEDIET4ALL PRIMA project"},{"DOI":"10.13039\/501100002347","name":"Federal Ministry of Education and Research","doi-asserted-by":"publisher","award":["02WPM1681"],"award-info":[{"award-number":["02WPM1681"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"award":["02WPM1681"],"award-info":[{"award-number":["02WPM1681"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Life satisfaction and psychological distress are associated with multiple lifestyle, sleep-related, psychosocial, and sociodemographic factors. However, multinational evidence simultaneously examining these positive and negative psychological dimensions within a comprehensive Mediterranean lifestyle framework remains limited. This study examined correlates of life satisfaction and psychological distress among adults from Mediterranean and neighbouring countries participating in the MEDIET4ALL survey. Methods: Data were collected from 4010 adults (59.5% female) across 10 Mediterranean and neighbouring countries using a standardized multilingual e-survey. Life satisfaction was assessed as the primary outcome using the Short Life Satisfaction Questionnaire (SLSQ), whereas psychological distress (depression, anxiety, and stress) was assessed as the secondary outcomes using the Depression Anxiety Stress Scales (DASS-21). Mediterranean lifestyle adherence was assessed using the validated MEDLIFE index, integrating dietary habits with brief indicators of physical activity, rest, and social\/convivial habits, while complementary validated measures provided more detailed assessments of physical activity, sedentarily, sleep, insomnia and social participation. Hierarchical multiple linear regression analyses were conducted to identify correlates of the primary and secondary outcomes. Bootstrapped exploratory cross-sectional indirect-association analyses were conducted to examine selected indirect statistical associations involving Mediterranean lifestyle adherence, physical activity, social participation, insomnia severity, life satisfaction, and psychological outcomes. Results: Higher life satisfaction was associated with greater Mediterranean lifestyle adherence, better subjective sleep quality, higher social participation, higher education, marital or cohabiting status, and better self-reported health status (\u03b2 \u2248 0.06\u20130.18). Conversely, lower life satisfaction was associated with higher body mass index, greater physical activity expenditure, higher insomnia severity, and regional differences between Mediterranean and neighbouring\/non-Mediterranean countries (\u03b2 \u2248 \u22120.05 to \u22120.19). Insomnia severity showed the strongest negative association with life satisfaction (\u03b2 = \u22120.19). Across psychological distress outcomes, insomnia severity emerged as the strongest positive correlate of depression, anxiety, and stress (\u03b2 \u2248 0.43\u20130.47), followed by alcohol consumption (\u03b2 \u2248 0.12\u20130.15) and residence in Mediterranean countries (\u03b2 \u2248 0.05\u20130.08). Older age, analysed as a continuous variable, better self-reported health status, and higher physical activity levels were consistently associated with lower distress levels (\u03b2 \u2248 \u22120.03 to \u22120.14). Exploratory cross-sectional indirect-association analyses identified statistically significant indirect associations involving insomnia severity among Mediterranean lifestyle adherence, life satisfaction, and psychological distress. Additional indirect statistical associations involving life satisfaction were observed among physical activity, social participation, and psychological distress outcomes, although their magnitudes were small. Conclusions: Mediterranean lifestyle adherence, social participation, physical activity, sleep-related characteristics, and sociodemographic and health-related factors were associated with life satisfaction and psychological distress. Sleep-related variables, particularly insomnia severity and subjective sleep quality, emerged as the most consistent correlates across the psychological outcomes. 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.<\/jats:p>","DOI":"10.3390\/nu18162708","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:14:01Z","timestamp":1787145241000},"page":"2708","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Life Satisfaction and Psychological Distress in Relation to Mediterranean Lifestyle Adherence and Behavioural Correlates: Findings from the MEDIET4ALL International Survey"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0347-8053","authenticated-orcid":false,"given":"Achraf","family":"Ammar","sequence":"first","affiliation":[{"name":"Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany"},{"name":"Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax 3000, Tunisia"},{"name":"Interdisciplinary Laboratory in Neurosciences, Physiology, and Psychology: Physical Activity, Health, and marLearning (LINP2), UFR STAPS, Paris Nanterre University, 92000 Nanterre, France"},{"name":"Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atef","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany"},{"name":"High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2623-9557","authenticated-orcid":false,"given":"Khaled","family":"Trabelsi","sequence":"additional","affiliation":[{"name":"Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"},{"name":"Department of Movement Sciences and Sports Training, School of Sport Science, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Montalvan","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Cat\u00f3lica de Santiago de Guayaquil, Guayaquil 090615, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3692-9482","authenticated-orcid":false,"given":"Bassem","family":"Bouaziz","sequence":"additional","affiliation":[{"name":"Multimedia InfoRmation Systems and Advanced Computing Laboratory (MIRACL), University of Sfax, Sfax 3038, Tunisia"},{"name":"Higher Institute of Computer Science and Multimedia of Sfax (ISIMS), University of Sfax, Sfax 3038, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ali","family":"Boujelbane","sequence":"additional","affiliation":[{"name":"Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany"},{"name":"High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kerkeni","sequence":"additional","affiliation":[{"name":"High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"},{"name":"Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwa","family":"Masmoudi","sequence":"additional","affiliation":[{"name":"Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3045-4153","authenticated-orcid":false,"given":"Hadeel Ali","family":"Ghazzawi","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7810-748X","authenticated-orcid":false,"given":"Adam Tawfiq","family":"Amawi","sequence":"additional","affiliation":[{"name":"Department of Movement Sciences and Sports Training, School of Sport Science, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3149-6630","authenticated-orcid":false,"given":"Bekir Erhan","family":"Orhan","sequence":"additional","affiliation":[{"name":"Faculty of Sports Sciences, Istanbul Ayd\u0131n University, Istanbul 34295, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-6469","authenticated-orcid":false,"given":"Raynier","family":"Zambrano-Villacres","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud y Desarrollo Humano, Universidad Ecotec, Km. 13.5 Samborond\u00f3n, Samborond\u00f3n 092302, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7346-4872","authenticated-orcid":false,"given":"Juliane","family":"Heydenreich","sequence":"additional","affiliation":[{"name":"Department of Experimental Sports Nutrition, Faculty of Sports Sciences, Leipzig University, 04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1564-2658","authenticated-orcid":false,"given":"Christiana","family":"Schallhorn","sequence":"additional","affiliation":[{"name":"Department of Sports Economics, Sociology and History, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-7393","authenticated-orcid":false,"given":"Tarak","family":"Driss","sequence":"additional","affiliation":[{"name":"Interdisciplinary Laboratory in Neurosciences, Physiology, and Psychology: Physical Activity, Health, and marLearning (LINP2), UFR STAPS, Paris Nanterre University, 92000 Nanterre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2228-0141","authenticated-orcid":false,"given":"Evelyn","family":"Frias-Toral","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad Esp\u00edritu Santo, Samborond\u00f3n 0901952, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-9573","authenticated-orcid":false,"given":"Piotr","family":"Zmijewski","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-1320","authenticated-orcid":false,"given":"Haitham","family":"Jahrami","sequence":"additional","affiliation":[{"name":"Government Hospitals, Manama 329, Bahrain"},{"name":"Department of Psychiatry, College of Medicine and Health Sciences, Arabian Gulf University, Manama 329, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3047-1834","authenticated-orcid":false,"given":"Waqar","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Humanities, COMSATS University Islamabad, Islamabad 45550, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3930-5285","authenticated-orcid":false,"given":"Giuseppe","family":"Grosso","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5482-9151","authenticated-orcid":false,"given":"Hamdi","family":"Chtourou","sequence":"additional","affiliation":[{"name":"High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia"},{"name":"Research Unit, Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4558-1991","authenticated-orcid":false,"given":"Wolfgang I.","family":"Sch\u00f6llhorn","sequence":"additional","affiliation":[{"name":"Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"Santomauro","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1037\/0022-006X.73.3.539","article-title":"Mental Illness and\/or Mental Health? 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