Respondents completed the four-item (range 4–20) Life Satisfaction Scale (LSS) in 1975 and 1981 to assess pre-existing depressiveness as a proxy for depressive illness. They were asked to rate on a five-point Likert scale interest in life (1 = very interesting, 5 = very boring), happiness (1 = very happy, 5 = very sad), ease of living (1 = very easy, 5 = very hard) and feeling of loneliness (1 = not at all lonely, 5 = very lonely). LSS scores have been linearly correlated with concurrently assessed Beck Depression Inventory (BDI) ratings in a general population sample (r = 0.60), and were found to be highly predictive of development of depressive illness in a 15-year prospective longitudinal study in a healthy community sample [dissatisfied (LSS 12–20) v. satisfied (LSS 4–6); odds ratio (OR) 6.7, 95% confidence interval (CI) 4.2–10.9] (Koivumaa-Honkanen et al. 2004a, b). LSS scores have demonstrated significant association with completed suicide over a 20-year follow-up, independent of age, sex, alcohol use, smoking status and physical activity (Koivumaa-Honkanen et al. 2001). In a mixed clinical sample, LSS scores
