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The Holmes and Rahe stress scale (/reɪ/),[1] 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".[2] 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.[3]
Development
In 1967, psychiatristsThomas 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 of 0.118 was found between their life events and their illnesses.
Their results were published as the Social Readjustment Rating Scale (SRRS),[4] known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.[5]
Supporting research
Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness.[6] 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.[7]
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.[7] The scale was also assessed against different populations within the United States (with African, Mexican and White American groups).[8] The scale was also tested cross-culturally, comparing Japanese[9] and Malaysian[10] groups with American populations.
Criticism
The original scale, as well as its utility over time and differing circumstances, has faced scrutiny.
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 event
Life change units
Death of a spouse
100
Divorce
73
Marital separation
65
Imprisonment
63
Death of a close family member
63
Personal injury or illness
53
Marriage
50
Dismissal from work
47
Marital reconciliation
45
Retirement
45
Change in health of family member
44
Pregnancy
40
Sexual difficulties
39
Gain a new family member
39
Business readjustment
39
Change in financial state
38
Death of a close friend
37
Change to different line of work
36
Change in frequency of arguments
35
Major mortgage
32
Foreclosure of mortgage or loan
30
Change in responsibilities at work
29
Child leaving home
29
Trouble with in-laws
29
Outstanding personal achievement
28
Spouse starts or stops work
26
Beginning or end of school
26
Change in living conditions
25
Revision of personal habits
24
Trouble with boss
23
Change in working hours or conditions
20
Change in residence
20
Change in schools
20
Change in recreation
19
Change in church activities
19
Change in social activities
18
Minor mortgage or loan
17
Change in sleeping habits
16
Change in number of family reunions
15
Change in eating habits
15
Vacation
13
Major holiday
12
Minor 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.[12][13]
Life event
Life change Units
Death of parent
100
Unplanned pregnancy/abortion
100
Getting married
95
Divorce of parents
90
Acquiring a visible deformity
80
Fathering a child
70
Jail sentence of parent for over one year
70
Marital separation of parents
69
Death of a brother or sister
68
Change in acceptance by peers
67
Unplanned pregnancy of sister
64
Discovery of being an adopted child
63
Marriage of parent to stepparent
63
Death of a close friend
63
Having a visible congenital deformity
62
Serious illness requiring hospitalization
58
Failure of a grade in school
56
Not making an extracurricular activity
55
Hospitalization of a parent
55
Jail sentence of parent for over 30 days
53
Breaking up with boyfriend or girlfriend
53
Beginning to date
51
Suspension from school
50
Becoming involved with drugs or alcohol
50
Birth of a brother or sister
50
Increase in arguments between parents
47
Loss of job by parent
46
Outstanding personal achievement
46
Change in parent's financial status
45
Accepted at college of choice
43
Being a senior in high school
42
Hospitalization of a sibling
41
Increased absence of parent from home
38
Brother or sister leaving home
37
Addition of third adult to family
34
Becoming a full-fledged member of a church
31
Decrease in arguments between parents
27
Decrease in arguments with parents
26
Mother 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)
^Rahe RH, Arthur RJ (1978). "Life change and illness studies: past history and future directions". J Hum Stress. 4 (1): 3–15. doi:10.1080/0097840X.1978.9934972. PMID346993.
^Rahe RH, Mahan JL, Arthur RJ (1970). "Prediction of near-future health change from subjects' preceding life changes". J Psychosom Res. 14 (4): 401–6. doi:10.1016/0022-3999(70)90008-5. PMID5495261.
^ abRahe RH, Biersner RJ, Ryman DH, Arthur RJ (1972). "Psychosocial predictors of illness behavior and failure in stressful training". J Health Soc Behav. 13 (4): 393–7. doi:10.2307/2136831. JSTOR2136831. PMID4648894.
^Komaroff AL, Masuda M, Holmes TH (1968). "The social readjustment rating scale: a comparative study of Negro, Mexican and white Americans". J Psychosom Res. 12 (2): 121–8. doi:10.1016/0022-3999(68)90018-4. PMID5685294.
^Masuda M, Holmes TH (1967). "The Social Readjustment Rating Scale: a cross-cultural study of Japanese and Americans". J Psychosom Res. 11 (2): 227–37. doi:10.1016/0022-3999(67)90012-8. PMID6059865.
^Woon, T.H.; Masuda, M.; Wagner, N.N.; Holmes, T.H. (1971). "The Social Readjustment Rating Scale: A Cross-Cultural Study of Malaysians and Americans". Journal of Cross-Cultural Psychology. 2 (4): 373–386. doi:10.1177/002202217100200407. S2CID145729382.
