The Holmes and Rahe Stress Scale (), also known as the Social Readjustment Rating Scale, is a list of 43 stressful life events that can contribute to illness. The test works via a point accumulation score which then gives an assessment of risk. The American Institute of Stress, for instance, regards a score of 300 or more as an "80% chance of health breakdown within the next 2 years". While there is good evidence that chronic stress can lead to ill health, there is not much evidence to support the ranking of stressful life events in this manner.
Development In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive Correlation and dependence correlation of 0.118 was found between their life events and their illnesses.
Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.
Subsequent research Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness. The scale was given to 2,500 US sailors and they were asked to rate scores of 'life events' over the previous six months. Over the next six months, detailed records were kept of the sailors' health. There was a +0.118 correlation between stress scale scores and illness, which was sufficient to support the hypothesis of a link between life events and illness.
In conjunction with the Cornell medical index assessing, the stress scale correlated with visits to medical dispensaries, and the H&R stress scale's scores also correlated independently with individuals dropping out of stressful underwater demolitions training due to medical problems. The scale was also assessed against different populations within the United States (with African, Mexican and White American groups). The scale was also tested cross-culturally, comparing Japanese and Malaysian groups with American populations.
A 1975 article in Journal of Human Stress (Behavioral Medicine) by psychologist David Mechanic noted the Holmes stress inventory had proved useful but also identified several limitations, including:
Lack of differentiation between favorable versus adverse life events Ambiguity of life events described Confounding dependent and independent variables Lack of specificity in items listed
Adults The sum of the life change units of the applicable events in the past year of an individual's life gives a rough estimate of how stress affects health.
Life eventLife change unitsDeath of a spouse 100Divorce 73Marital separation 65Imprisonment 63Death of a close family member 63Personal injury or illness 53Marriage 50Dismissal from work 47Marital reconciliation 45Retirement 45Change in health of family member 44Pregnancy 40Sexual difficulties 39Gain a new family member 39Business readjustment 39Change in financial state 38Death of a close friend 37Change to different line of work 36Change in frequency of arguments 35Major mortgage 32Foreclosure of mortgage or loan 30Change in responsibilities at work 29Child leaving home 29Trouble with in-laws 29Outstanding personal achievement 28Spouse starts or stops work 26Beginning or end of school 26Change in living conditions 25Revision of personal habits 24Trouble with boss 23Change in working hours or conditions 20Change in residence 20Change in schools 20Change in recreation 19Change in church activities 19Change in social activities 18Minor mortgage or loan 17Change in sleeping habits 16Change in number of family reunions 15Change in eating habits 15Vacation 13Major holiday 12Minor violation of law 11
Score of 300+: At risk of illness.
Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).
Score < 150: Slight risk of illness.
Non-adults A modified scale has also been developed for non-adults. Similar to the adult scale, stress points for life events in the past year are added and compared to the rough estimate of how stress affects health.
Life eventLife change UnitsDeath of parent 100Unplanned pregnancy/abortion 100Getting married 95Divorce of parents 90Acquiring a visible deformity 80Fathering a child 70Jail sentence of parent for over one year 70Marital separation of parents 69Death of a brother or sister 68Change in acceptance by peers 67Unplanned pregnancy of sister 64Discovery of being an adopted child 63Marriage of parent to stepparent 63Death of a close friend 63Having a visible congenital deformity 62Serious illness requiring hospitalization 58Failure of a grade in school 56Not making an extracurricular activity 55Hospitalization of a parent 55Jail sentence of parent for over 30 days 53Breaking up with boyfriend or girlfriend 53Beginning to date 51Suspension from school 50Becoming involved with drugs or alcohol 50Birth of a brother or sister 50Increase in arguments between parents 47Loss of job by parent 46Outstanding personal achievement 46Change in parent's financial status 45Accepted at college of choice 43Being a senior in high school 42Hospitalization of a sibling 41Increased absence of parent from home 38Brother or sister leaving home 37Addition of third adult to family 34Becoming a full-fledged member of a church 31Decrease in arguments between parents 27Decrease in arguments with parents 26Mother or father beginning work 26
Score of 300+: At risk of illness.
Score of 150-299: Risk of illness is moderate. (reduced by 30% from the above risk)
Score < 150: Slight risk of illness.
See also Life-Events and Difficulties Schedule Diathesis–stress model CernySmith Assessment
Medical: Allostatic load Hypothalamic–pituitary–adrenal axis Psychoneuroimmunology
References
Further reading Rahe RH et al. (2000). The stress and coping inventory: an educational and research instrument. Stress Medicine 16: 199-208. Life, Change, and Stress (Holmes & Rahe) - The Neuron