one area of psychology analyzes subjective well - being , people 's cognitive and affective evaluation of their lives . this includes what one calls happiness , peace , fulfillment , and life satisfaction ( ls ) . although personality can explain a significant amount of variability in subjective - well - being , not only personal dispositions but also life circumstances influence long - term levels of subjective well - being , e.g. , ls . this unique dimension can be seen in the context of the conceptualizations of quality of life . ferrans   differentiated five broad categories of quality of life , i.e. , social utility , happiness / affect , normal life , achievement of personal goals , and satisfaction . ls is influenced by individuals ' perception of certain aspects of life important to them , which may vary with respect to their importance between the individuals . these aspects can be regarded as external factors with an impact on quality of life , and thus can be considered as determinants . to define the term ' satisfaction ' , one may argue that satisfaction is the extent of an individual 's experience compared with his expectations . in terms of ' patients ' satisfaction ' , this facet refers to medical care and service quality ( which may impact health - related behavior ) , more specifically , to the extent to which general health care needs and condition - specific needs are met . even patients with impaired perception of health status , which may have more social needs , can have high satisfaction with various dimensions of life concerns . while it is true that patients with chronic disease may experience decreased quality of life and ls , it is not necessarily true for all individuals . specifically , there is an increasing evidence that cancer patients not only experience traumatic stress , but in several cases also personal growth ( reviewed in ) . moreover , in hiv infected individuals one may observe an increase of religiousness / spirituality which may predict slower disease progression . while several patients may experience posttraumatic growth , mostly in the domain of appreciation of life , it was nevertheless not related to the level of psychological distress . in six european countries , borg et al . investigated the relationship of ls to health , self - esteem , as well as social and financial resources among elderly with reduced functional capacity . in all national samples , overall health , self - esteem , and feeling worried , rather than activities of daily living capacity , the findings indicate the importance of taking not only the reduction in functional capacity into account but also the individual 's perception of health and self - esteem . personal rather than environmental factors are important for ls among people with reduced daily living capacity . on the basis of the ' 2005 behavioral risk factor surveillance system ' , an ongoing , state - based , random - digit telephone survey , 6% of us adults were dissatisfied with their lives . as the level of ls decreased , the prevalence of fair / poor general health , disability , and infrequent social support increased as did the mean number of days within one month of physical distress , mental distress , activity limitation , depressive symptoms , anxiety symptoms , sleep insufficiency , and pain ; also the prevalence of smoking , obesity , physical inactivity , and heavy drinking increased with decreasing level of ls . moreover , adults with chronic illnesses were significantly more likely than those without to report life dissatisfaction . notably , all of these associations remained significant after adjusting for socio - demographic characteristics . .   showed that health - related quality of life and health risk behaviors varied with the level of ls . in most cases of chronic illness , there is no option of healing in terms of full physical and psychical restoration . however , although the ' medical model ' refers to an optimal level of functioning , patients should not be reduced on their defects or illness - related deficiencies , instead one should bring forward concomitantly their potential for life and development . thus , one has to ask for the underlying aspects of ls , which is of outstanding importance not just because patients with high satisfaction may be more active in their own health care , but also to identify specific ( existential ) needs which may impact the health - related needs and quality of life . as ls appears to encompass many individual life domains , it may be an important concept for public health research . in fact , chronic illness affects not only physical and mental functioning , but also the working abilities , employment , and financial situation ; and finally may have an impact on family life , friendships etc . living with chronic disease and suffering consequently , it is of outstanding importance to improve physical and mental health conditions , and health - related quality of life . but the patients should not be reduced to their functional competence , i.e. , physical symptoms and deficiencies , and thus one has to ask for the putative positive fields of life dimensions such as family life , friendships , living location , work , financial situation , generally oneself and overall life , and future perspectives . for example , several patients with chronic diseases , particularly patients with cancer , highly value spirituality / religiosity as a resource to deal with illness [ 10 - 14 ] . also dimensions such as finding meaning and purpose in life are important issues , and how patients interpret their illness [ 16 - 18 ] . recently , we were able to verify that perceptions of illness in terms of the positive disease interpretations ' challenge ' and ' value ' are correlated with adaptive coping strategies , while negative interpretations such as ' interruption / loss ' and ' enemy / threat ' were associated with depression and anxiety , and inversely with mental health - related quality of life and ls . found evidence of significant positive relations between psychological well - being dimensions and ls and between physical conditions and ls as well . a structural model gave valuable information about the pattern of multivariate relationships among the variables . physical and psychological wellbeing had a large effect on ls , albeit psychological wellbeing was the major predictor of ls ; a second result was that the influence of socio - demographic variables on ls were low , and they operated through the effects that maintain either on psychological well - being ( or its individual indicators ) or on physical conditions . because ls captures dimensions that contribute to quality of life , we intended to design a brief add - on scale to existing health - related quality of life questionnaires and referred to the work of huebner and coworkers . this group has developed the ' brief multidimensional students ' life satisfaction scale ' , which refers to the much longer ' student 's life satisfaction scale ( slss ) ' . this longer scale , which was designed to measure students ' life satisfaction , demonstrated acceptable internal consistency and a uni - dimensional factor structure . in contrast to diener 's 5-item ' satisfaction with life scale '   with its very general domains , the ' brief multidimensional students ' life satisfaction scale ' addresses circumscribed aspects of students ' life . however , to address certain aspects of life important to patients with chronic diseases , we intended ( 1 ) to determine the reliability of a modified ls scale , the ' brief multidimensional life satisfaction scale ' ( bmlss ) , in a sample of patients with chronic diseases ( and some healthy individuals ) , and ( 2 ) to analyze the external validity of this instrument in terms of adaptive coping , mood , and health - related quality of life . for this multicenter cross - sectional anonymous survey we analyzed the data of 979 individuals from already existing data pools of the hospitals mentioned below . all subjects were informed of the purpose of the investigation , were assured of confidentiality , gave informed consent to participate , and completed the german language questionnaire by themselves which neither asked for names , initials , addresses or clinical details ( with the exception of a diagnosis ) . the questionnaires were anonymous ( and in accordance with similar instruments approved by the ethical commission of the university witten/ herdecke for current studies ) , and the pooled data could not be tracked back to the individual patients . to minimize the bias of a sample of convenience , different recruiting centers were chosen . patients with chronic diseases were recruited in the out - patient pain clinic of the communal hospital in herdecke , the orthopaedic clinic in bad bocklet and the baumrain clinic in bad berleburg , the psychotherapeutic oberberg clinics schwarzwald , weserbergland and berlin/ brandenburg , and at a conference of breast cancer support groups in magdeburg . medical doctors from several west - german hospitals and medical practices served as healthy controls if they stated the absence of health affections . because we intended to have a more complete picture , we had neither inclusion nor exclusion criteria ( with the exception of children and adolescents ) . the patients from the psychotherapeutic oberberg clinics were at the moment of recruitment no active substance abusers . the individuals ( 75% women ) had a mean age of 54  11 years . thirteen percent were < 40 years of age ( just 4 were < 20 years of age ) , 24% between 41 - 50 years , 34% between 51 - 60 years , 25% between 61 - 70 years , and 4% > 70 years . most subjects were married ( 63% ) or lived with a partner not married with ( 8% ) , 11% lived alone , 10% were divorced , and 7% were widowed . a christian affiliation was predominant ( 75% ) , 3% had other religious affiliations and 22% had none . twenty - nine percent had a secondary education ( hauptschule ) , 20% a junior high school education ( realschule ) , 41% a high school education ( gymnasium ) , 9% other , and < 1% none . forty - two % had cancer , 22% chronic pain conditions ( among them , 20% fibromyalgia , 17% spine - associated pain syndromes such as chronic back pain etc . , 8% limp amputations and phantom pain , 6% polyarthritis , 4% migraine / headache , and various other chronic pain conditions ) , 10% depressive disorders with / without alcohol addiction , 6% other chronic diseases , and 20% healthy individuals . the items of the ls scale were derived from the 6-item ' brief multidimensional students ' life satisfaction scale '   and from physicians input , i.e. , family life ; friendships ; work ( replaced the item school ) ; myself ; where i live ; overall life ; and two new items , i.e. , financial situation and future prospects . the eight items of the bmlss ( table 1 ) refer to intrinsic dimensions ( myself , overall life ) , social dimensions ( friendships , family life ) , external dimension ( work , where i live ) , and the perspective dimension ( financial situation , future prospects ) . items referring to the health situation were intentionally not included and should be measured with a specific health - related quality of life tool . ( however , bmlss version 2 heeds three additional items , i.e. health situation , effectiveness of treatment , and own abilities to deal with daily life . ) mean values and reliability parameters one component extracted ( eigenvalue 4.2 ) : 53% of explained variance . each item was introduced by the phrase : " i would describe my satisfaction with ... " , and score don a 7 point scale from dissatisfaction to satisfaction ( 0 -terrible ; 1 -unhappy ; 2 -mostly dissatisfied ; 3 -mixed ( about equally satisfied and dissatisfied ) ; 4 -mostly satisfied ; 5 - pleased ; 6 -delighted ) . the bmlss sum score was referred to a 100% level ( " delighted " ) . the reliability of the scale was evaluated with internal consistency coefficients , which reflect the degree to which all items on a particular scale measure a single ( uni - dimensional ) concept . to combine several items with similar content , we relied on the technique of factor analysis ( extraction of main components with eigenvalues > 1 ) , which examines the correlations among a set of variables in order to achieve a set of more general ' factors ' . factor analyses were repeated rotating different numbers of items ( varimax rotation with kaiser normalization ) in order to arrive at a solution embodying both the simplest structure and the most coherent one . to analyze the external validity , the bmlss scale was correlated with the hospital anxiety and depression scale ( hads ) ; escape from illness , an add - on scale of the aku questionnaire ; the cancer fatigue scale ( cfs - d ) ; and physical and mental health - related quality of life as measured with the medical outcomes study short - form health survey sf-12 . adaptive coping styles were measured with the aku questionnaire ( aku is an acronym of the german translation of " adaptive coping with disease " ) , which refers to the concept of an internal respectively an external locus of disease control . the instrument differentiates 6 factors ( i.e. , conscious way of living ; positive attitudes ; reappraisal : illness as chance ; trust in medial help ; search for information and alternative help ; trust in god 's help ) . reliability and factor analyses , analyses of variance ( anova ) , correlation ( spearman rho ) and stepwise regression analyses were performed with spss 15.0 for windows ( spss gmbh software , munich ) . for this multicenter cross - sectional anonymous survey we analyzed the data of 979 individuals from already existing data pools of the hospitals mentioned below . all subjects were informed of the purpose of the investigation , were assured of confidentiality , gave informed consent to participate , and completed the german language questionnaire by themselves which neither asked for names , initials , addresses or clinical details ( with the exception of a diagnosis ) . the questionnaires were anonymous ( and in accordance with similar instruments approved by the ethical commission of the university witten/ herdecke for current studies ) , and the pooled data could not be tracked back to the individual patients . to minimize the bias of a sample of convenience , different recruiting centers were chosen . patients with chronic diseases were recruited in the out - patient pain clinic of the communal hospital in herdecke , the orthopaedic clinic in bad bocklet and the baumrain clinic in bad berleburg , the psychotherapeutic oberberg clinics schwarzwald , weserbergland and berlin/ brandenburg , and at a conference of breast cancer support groups in magdeburg . medical doctors from several west - german hospitals and medical practices served as healthy controls if they stated the absence of health affections . because we intended to have a more complete picture , we had neither inclusion nor exclusion criteria ( with the exception of children and adolescents ) . the patients from the psychotherapeutic oberberg clinics were at the moment of recruitment no active substance abusers . the individuals ( 75% women ) had a mean age of 54  11 years . thirteen percent were < 40 years of age ( just 4 were < 20 years of age ) , 24% between 41 - 50 years , 34% between 51 - 60 years , 25% between 61 - 70 years , and 4% > 70 years . most subjects were married ( 63% ) or lived with a partner not married with ( 8% ) , 11% lived alone , 10% were divorced , and 7% were widowed . a christian affiliation was predominant ( 75% ) , 3% had other religious affiliations and 22% had none . twenty - nine percent had a secondary education ( hauptschule ) , 20% a junior high school education ( realschule ) , 41% a high school education ( gymnasium ) , 9% other , and < 1% none . forty - two % had cancer , 22% chronic pain conditions ( among them , 20% fibromyalgia , 17% spine - associated pain syndromes such as chronic back pain etc . , 8% limp amputations and phantom pain , 6% polyarthritis , 4% migraine / headache , and various other chronic pain conditions ) , 10% depressive disorders with / without alcohol addiction , 6% other chronic diseases , and 20% healthy individuals . the items of the ls scale were derived from the 6-item ' brief multidimensional students ' life satisfaction scale '   and from physicians input , i.e. , family life ; friendships ; work ( replaced the item school ) ; myself ; where i live ; overall life ; and two new items , i.e. , financial situation and future prospects . the eight items of the bmlss ( table 1 ) refer to intrinsic dimensions ( myself , overall life ) , social dimensions ( friendships , family life ) , external dimension ( work , where i live ) , and the perspective dimension ( financial situation , future prospects ) . items referring to the health situation were intentionally not included and should be measured with a specific health - related quality of life tool . ( however , bmlss version 2 heeds three additional items , i.e. health situation , effectiveness of treatment , and own abilities to deal with daily life . ) mean values and reliability parameters one component extracted ( eigenvalue 4.2 ) : 53% of explained variance . each item was introduced by the phrase : " i would describe my satisfaction with ... " , and score don a 7 point scale from dissatisfaction to satisfaction ( 0 -terrible ; 1 -unhappy ; 2 -mostly dissatisfied ; 3 -mixed ( about equally satisfied and dissatisfied ) ; 4 -mostly satisfied ; 5 - pleased ; 6 -delighted ) . the bmlss sum score was referred to a 100% level ( " delighted " ) . the reliability of the scale was evaluated with internal consistency coefficients , which reflect the degree to which all items on a particular scale measure a single ( uni - dimensional ) concept . to combine several items with similar content , we relied on the technique of factor analysis ( extraction of main components with eigenvalues > 1 ) , which examines the correlations among a set of variables in order to achieve a set of more general ' factors ' . factor analyses were repeated rotating different numbers of items ( varimax rotation with kaiser normalization ) in order to arrive at a solution embodying both the simplest structure and the most coherent one . to analyze the external validity , the bmlss scale was correlated with the hospital anxiety and depression scale ( hads ) ; escape from illness , an add - on scale of the aku questionnaire ; the cancer fatigue scale ( cfs - d ) ; and physical and mental health - related quality of life as measured with the medical outcomes study short - form health survey sf-12 . adaptive coping styles were measured with the aku questionnaire ( aku is an acronym of the german translation of " adaptive coping with disease " ) , which refers to the concept of an internal respectively an external locus of disease control . the instrument differentiates 6 factors ( i.e. , conscious way of living ; positive attitudes ; reappraisal : illness as chance ; trust in medial help ; search for information and alternative help ; trust in god 's help ) . reliability and factor analyses , analyses of variance ( anova ) , correlation ( spearman rho ) and stepwise regression analyses were performed with spss 15.0 for windows ( spss gmbh software , munich ) . as shown in table 1 , reliability analysis of the 8-item pool revealed that the construct had a good internal consistency ( cronbach 's alpha = 0.869 ) . the item difficulty ( 4.12 [ mean value ] / 6 ) was 0.69 , and none of the items exceeded the acceptable range of 0.2 to 0.8 . factor analysis revealed a kaiser - mayer - olkin value of .887 , which as a measure for the degree of common variance , indicates that the item - pool seems to be suitable for a factorial validation . primary factor analysis pointed to a 1-factor solution ( initial eigenvalue = 4.2 ) , which explains 53.1% of variance ( table 1 ) . the more general item overall life had the strongest factor loading , the item work the lowest . the mean scores of the 8 items ranged from 3.81 ( " mostly satisfied " ) to 4.69 ( " pleased " ) , i.e. , the lowest scores were found for work and future prospects , and the highest for where i live and friendships ( table 1 ) . the various ls dimensions correlated strongly with overall life ( table 2 ) , particularly the items myself ( r = 0.69 ) and future prospects ( r = 0.66 ) , indicating that overall live is a broad and general dimension . correlation analyses between life satisfaction dimensions all variables were significant at the 0.01 level ( pearson correlation ; 2-tailed ) . as shown in table 3 the bmlss sum scores significantly differed with respect to the underlying disease ( f = 28.208 ) , family status ( f = 12.810 ) , duration of disease ( f = 6.592 ) , and age ( f = 6.224 ) , but not for gender ( f = 0.050 ; n.s . ) or religious denomination ( f = 2.258 ; n.s . ) . we observed higher ls score also in individuals with a higher educational level ( f = 3.103 ; df = 942 ; p = 0.015 ) ; but because the healthy individuals almost had the highest educational level , this variable should not be overinterpreted . the highest ls scores were found in healthy individuals , and the lowest in patients with chronic pain conditions and depressive disorders ( table 3 ) . moreover , individuals with higher age , those who were married or widowed , and patients with a shorter course of disease had better bmlss scores than individuals of younger age ( < 50 years of age ) , longer course of disease ( > 3 years ) , and those divorced or living alone . thus , from a theoretical point of view , these differences are plausible . among the patients , those with cancer had the highest ls scores . however , escape from illness was the lowest in cancer patients as compared to other patients ; the highest scores were found in patients with chronic pain conditions ( f = 37.953 ; df = 731 ; p < 0.001 ) . among the whole group of patients , we correlated the bmlss scores with adaptive coping styles ( aku ) and escape from illness . as shown in table 4 , ls correlated moderately particularly with intrinsic adaptive coping strategies such as positive attitudes and conscious living ( which are active cognitive - behavioral styles ) , and moderately negative with escape from illness ( which is an escape - avoidance strategy ) . the ls correlated strongly ( inverse ) with anxiety and depression , moderately ( inverse ) with fatigue , and moderately ( positive ) with mental health - related quality of life , while physical health correlated weakly ( table 4 ) . in patients with depressive disorders ( with or without alcohol addiction ) , the bmlss correlated negatively with beck 's depression index ( r = -0.669 ; p < 0.0001 ) , which confirms the results observed in the cancer patients . stepwise regression analyses revealed that ls can be predicted best by ( the absence of ) depression ( beta = -0.571 ; p < 0.001 ) , but also by conscious living ( beta = 0.163 ; p = 0.007 ) . excluded variables were anxiety ; escape from illness ; fatigue ; sf-12 's health related quality of life ; age ; duration of disease , and other adaptive coping strategies . as shown in table 1 , reliability analysis of the 8-item pool revealed that the construct had a good internal consistency ( cronbach 's alpha = 0.869 ) . the item difficulty ( 4.12 [ mean value ] / 6 ) was 0.69 , and none of the items exceeded the acceptable range of 0.2 to 0.8 . factor analysis revealed a kaiser - mayer - olkin value of .887 , which as a measure for the degree of common variance , indicates that the item - pool seems to be suitable for a factorial validation . primary factor analysis pointed to a 1-factor solution ( initial eigenvalue = 4.2 ) , which explains 53.1% of variance ( table 1 ) . the more general item overall life had the strongest factor loading , the item work the lowest . the mean scores of the 8 items ranged from 3.81 ( " mostly satisfied " ) to 4.69 ( " pleased " ) , i.e. , the lowest scores were found for work and future prospects , and the highest for where i live and friendships ( table 1 ) . the various ls dimensions correlated strongly with overall life ( table 2 ) , particularly the items myself ( r = 0.69 ) and future prospects ( r = 0.66 ) , indicating that overall live is a broad and general dimension . correlation analyses between life satisfaction dimensions all variables were significant at the 0.01 level ( pearson correlation ; 2-tailed ) . as shown in table 3 the bmlss sum scores significantly differed with respect to the underlying disease ( f = 28.208 ) , family status ( f = 12.810 ) , duration of disease ( f = 6.592 ) , and age ( f = 6.224 ) , but not for gender ( f = 0.050 ; n.s . ) or religious denomination ( f = 2.258 ; n.s . ) . we observed higher ls score also in individuals with a higher educational level ( f = 3.103 ; df = 942 ; p = 0.015 ) ; but because the healthy individuals almost had the highest educational level , this variable should not be overinterpreted . the highest ls scores were found in healthy individuals , and the lowest in patients with chronic pain conditions and depressive disorders ( table 3 ) . moreover , individuals with higher age , those who were married or widowed , and patients with a shorter course of disease had better bmlss scores than individuals of younger age ( < 50 years of age ) , longer course of disease ( > 3 years ) , and those divorced or living alone . thus , from a theoretical point of view , these differences are plausible . among the patients , those with cancer had the highest ls scores . however , escape from illness was the lowest in cancer patients as compared to other patients ; the highest scores were found in patients with chronic pain conditions ( f = 37.953 ; df = 731 ; p < 0.001 ) . among the whole group of patients , we correlated the bmlss scores with adaptive coping styles ( aku ) and escape from illness . as shown in table 4 , ls correlated moderately particularly with intrinsic adaptive coping strategies such as positive attitudes and conscious living ( which are active cognitive - behavioral styles ) , and moderately negative with escape from illness ( which is an escape - avoidance strategy ) . the ls correlated strongly ( inverse ) with anxiety and depression , moderately ( inverse ) with fatigue , and moderately ( positive ) with mental health - related quality of life , while physical health correlated weakly ( table 4 ) . in patients with depressive disorders ( with or without alcohol addiction ) , the bmlss correlated negatively with beck 's depression index ( r = -0.669 ; p < 0.0001 ) , which confirms the results observed in the cancer patients . stepwise regression analyses revealed that ls can be predicted best by ( the absence of ) depression ( beta = -0.571 ; p < 0.001 ) , but also by conscious living ( beta = 0.163 ; p = 0.007 ) . excluded variables were anxiety ; escape from illness ; fatigue ; sf-12 's health related quality of life ; age ; duration of disease , and other adaptive coping strategies . even patients with impaired perception of health status , which may have more social needs , can have high satisfaction with various dimensions of life concerns . to operationalize this concept and to evaluate a brief and compact scale to measure ls , which can easily be incorporated as an important additive to existing health - related quality of life questionnaires this tool captures dimensions that contribute to quality of life but are not health related . we can state that the 8-item instrument had a good internal consistency coefficient , and a single - factor structure which explains 53% of variance . external validation revealed positive associations of the bmlss with health - related quality of life and intrinsic coping strategies , and negative associations with depression , anxiety , fatigue , and an escape - avoidance strategy . regression analyses revealed that ls can be predicted best by ( the absence of ) depression and by conscious living , which is a active cognitive - behavioral style in terms of adaptive coping . this is in line with the finding of others that particularly psychological well - being was is a major predictor of ls . among the patients , those with cancer had the highest ls scores this could be due to the fact that cancer patients were significantly older than the others , while healthy individuals and patients with depressive disorders were the youngest ( f = 87.279 ; p < 0.0001 ) ; thus , higher ls can be explained by higher age , too . another important finding of this analysis was that ls scores of cancer patients were similar to healthy individuals , despite of their fatal diagnosis . as reported previously , cancer patients do not necessarily regard illness as a dispensable interrupt of life , but also as a challenge , a chance to reflect and to change life and behavior . a recent review on posttraumatic growth in cancer patients confirms significant differences between patients with cancer and other traumas , among them differences in the interpretation of cancer as a future , ongoing and chronic integration threat , and also uncertainty and vulnerability . in contrast , patients with chronic pain conditions and depressive disorders had significantly lower ls scores than patients with cancer . one may suggest that hope , as an important aspect in health - related quality of live , is much higher in cancer patients , while particularly patients with chronic pain conditions may have experienced the limitations of the health care system in regard of an effective pain management . thus , their frustration might be much higher , which in turn decreases satisfaction with life . a hint which would support this suggestion could be a significantly lower escape from illness in cancer patients than in patients with chronic pain conditions . within this context one may discuss also the concept of reframing ( which means to understand and use multiple perspectives ) , i.e. , patients with chronic diseases have to re - adjust their life expectations to the new condition , and in relation to that - reframed - expectation , they could be just as satisfied as other persons . in fact , to find meaning in the chronic illness process involves a patient 's assenting to the illness and reframing its implications positively . schroevers and teo   stated that " greater use of the coping strategies instrumental support , positive reframing , and humor was associated with more posttraumatic growth " . patients with chronic diseases are thus not exclusively ' functionally deficient ' ( albeit the symptoms of disease may persist ) , because several aspects of life concerns may be vital and important to them . the priority of these aspects may vary between the individuals depending on various variables . taken together , our bmlss scale has important strengths , i.e. , it is compact , multimodal , and applicable to patients with chronic diseases . its brief nature allows it to be easily added to large surveys that can include only a few extra questions on this dimension . in contrast to the general domains of diener 's 5-item ' satisfaction with life scale '   ( i.e. , in most ways my life is close to my ideal ; the conditions of my life are excellent ; i am satisfied with my life ; so far i have gotten the important things i want in life ; if i could live my life over , i would change almost nothing ) , the bmlss addresses individuals ' perception of circumscribed aspects of life important to them . a limitation of our study was the overrepresentation of women , and the fact that we had a dominance of patients with cancer and chronic pain conditions , which might not be representative for the general population of people living with chronic disease . nevertheless , further work has to be done in validating this instrument in longitudinal and interventional studies . the evaluation of the bmlss revealed that the instrument has good psychometric properties . the scale can be an important additive to existing health - related quality of life questionnaires , since it captures dimensions that contribute to quality of life but are not health related . the fact that ls was inversely associated with mood states , and positively with health - related quality of life and the intrinsic adaptive coping , indicates that this instrument may be used to examine the effect of positive coping with chronic disease on ls . we highly appreciate the contribution of hans - joachim balzat ( pain outpatient clinic , communal hospital in herdecke ) , dr . ralf - achim grnther ( orthopaedic clinic in bad bocklet and baumrain clinic in bad berleburg ) , prof . dr . gtz mundle ( oberberg clinic schwarzwald ) , and several others who encouraged their patients to fill out the questionnaires .
objectivewe intended to determine the reliability of a brief life satisfaction scale in a sample of patients with chronic diseases , and to analyze its external validity.methodsreliability and factor analysis of the 8-item ' brief multidimensional life satisfaction scale ' ( bmlss ) were performed according to standard procedures . 
 the test sample contained 979 individuals ( mean age 54  11 years ) . 
 forty - two percent had cancer , 22% chronic pain conditions , 10% depressive disorders , 6% other chronic diseases , and 20% were healthy.resultsreliability analysis of the 8-item pool revealed a good internal consistency coefficient ( cronbach 's alpha = .869 ) , and a single - factor structure which explains 53% of variance . 
 the bmlss sum scores significantly differed with respect to the underlying disease , family status , duration of disease , and age . 
 the highest scores were found in healthy individuals , and the lowest in patients with chronic pain conditions and depressive disorders . in cancer patients , 
 the bmlss correlated negatively with depression / anxiety ( hads ) , fatigue ( cfs - d ) , and positively with sf-12 's mental health and to a weaker content also with physical health . 
 stepwise regression analyses revealed that life satisfaction can be predicted best by ( the absence of ) depression , but also by conscious living ( aku ) , which is an active cognitive - behavioral style in terms of adaptive coping.conclusionsthe evaluation of the bmlss revealed that the instrument has good psychometric properties and can be regarded as a brief , reliable and valid measure of ls in patients with chronic diseases . 
 the instrument can be an important additive to existing health - related quality of life questionnaires , since it captures dimensions that contribute to quality of life but are not health related .