The Role of Healthy Relationships and Social Connectivity in the Mediterranean Lifestyle: An Umbrella Review of Reviews

Abstract

Introduction: Social connectivity and interpersonal relationships underpin all aspects of lifestyle. As part of a broader research collaboration on the Mediterranean lifestyle, we examined existing evidence on social connectivity patterns in Mediterranean regions and how they differed from those in non-Mediterranean regions to explore the role of social connectedness in health and well-being across two settings. Methods: We conducted a comparative narrative umbrella review of systematic, scoping and narrative reviews with no time limit, identifying papers using PICOS criteria (participants: adults; interventions: social connectivity and interpersonal relationships in Mediterranean countries; comparators: social connectivity and interpersonal relationships in non-Mediterranean countries; outcomes: well-being/lifespan, morbidity and mortality; studies: systematic review, meta-analysis, scoping review, evidence synthesis and narrative reviews). The umbrella review was prospectively registered with PROSPERO and followed PRISMA guidelines with a double-blind selection process and multi-researcher data extraction. AMSTAR2 criteria and ROBIS were used for quality and bias assessment. Studies with high risk of bias were excluded. Results: A total of 49 reviews were included (systematic n = 44, scoping n = 4 and narrative n = 1). Overall, 75% of reviews were high quality (AMSTAR2), and 71% of the studies had a low risk of bias (ROBIS). A positive association between social connectivity or healthy relationships and health outcomes was found in both Mediterranean and non-Mediterranean countries, especially in the elderly population. Conviviality and interdependence and family orientation were common features of Mediterranean relationships, and important social structures within families and local communities. Research on Mediterranean relationships explored various contexts, including protective effect of social support, loneliness and social isolation, family dynamics, gender norms, mental health and chronic disease-associated stigma. Conclusion: Social connectivity and healthy relationships, defined by both quality and presence, are positively associated with well-being and healthy aging and reduced mortality in all regions. Future studies should include measures of social connectivity and explore how enabling and strengthening interpersonal relationships can enhance health outcomes.