Life satisfaction and suicide: A 20-year follow-up study

Objective: The authors investigated whether self-reported life satisfaction predicted suicide over a period of 20 years (1976-1995) in adults unselect ed for mental health status. Method: A nationwide sample of adults aged 18-64 years (N=29,173) from the Finnish Twin Cohort responded to a health questionnaire that included a lif e satisfaction scale (score range=4-20, with higher scores indicating great er dissatisfaction) that covered four items: interest in life, happiness, g eneral ease of living, and feeling of loneliness. "Dissatisfied" subjects ( life satisfaction score=12-20) were compared to "satisfied" subjects (score =4-6). Mortality data were derived from the national registry and analyzed with Cox regression. Results: Dissatisfaction at baseline (life satisfaction score=12-20) was as sociated with a higher risk of suicide throughout the 20-year follow-up per iod (age-adjusted hazard ratio=3.02, 95% confidence interval [CI]=1.83-4.98 ). The association was somewhat stronger in the first decade (hazard ratio= 4.46, 95% CI=1.95-10.20) than in the second (hazard ratio= 2.34, 95% CI=1.2 4-4.45). A dose-response relationship was also found. Men with the highest degrees of dissatisfaction (life satisfaction score=19-20) were 24.85 times as prone to commit suicide as satisfied men during the first 10 years of t he follow-up period. Throughout the entire follow-up, life dissatisfaction still predicted suicide after adjusting for age, sex, baseline health statu s, alcohol consumption, smoking status, and physical activity (hazard ratio =1.74, 95% CI=1.02-2.97). Subjects who reported dissatisfaction at baseline and again 6 years later showed a high suicide risk (hazard ratio=6.84, 95% CI= 1.99-23.50) compared to those who repeatedly reported satisfaction. Conclusions: Life dissatisfaction has a long-term effect on the risk of sui cide, and this seems to be partly mediated through poor health behavior. Li fe satisfaction seems to be a composite health indicator.