Holmes And Rahe Stress Scale

Holmes and Rahe scale items

This stress assessment model was created in 1967 by psychiatrists Thomas Holmes and Richard Rahe as a method to evaluate the effect of stressor life events on the immune system and thus generate the likelihood for the patient to suffer from health issues that can be linked to stress.

During the assessment, the patient is asked to read the items of the scale and recall events that have happened during the previous year.

In the above calculator, the first tab introduces the scale for adults, the original social readjustment rating scale whilst the second tab introduces a non-adult version. The criteria is similar as well as the evaluation method.

The adult stress level scale with the associated number of points (Life Change Units) is depicted in the table below:

The following table introduces the non-adult version of the Holmes and Rahe stress scale:

The patients involved in the study have had their health parameters monitored during six months after assessment.

A positive correlation (0.118) was found between patient’s reported life events and an illness they developed.

A subsequent validation study attempted to correlate the scores in the scale with subsequent onset of illness.

It was revealed that although major life stressors may not be the cause of health problems, there is significant correlation involved.

It is important for clinicians to acknowledge that each individual has a different coping ability to major lifetime events or daily stressful situations and that stress management can have an influence on overall health.

Score interpretation

The items in the scale are each awarded a number of points that differentiate their stressor effect. These are called “Life Change Units”.

During the early phase of research, the 394 subjects were explained that the life event “marriage” is accounted as 500 LCU.

They were then asked to rate other stressful life events in comparison to this baseline, either with less points (if less stressful) or more points (if more stressful).

The average values of the points awarded were then used to construct the final LCU for the scale.

After the assessment is finished, the sum of life change units associated with chosen life events is interpreted via one of the following three categories:

■ Scores lower than 150 are considered to carry a low risk of illness with a low susceptibility to stress induced health breakdown in the following 24 months after assessment.

■ Scores between 150 and 299 carry a moderate risk with 50% chances of adverse health outcome.

■ Scores equal to or greater than 300 carry a high risk of illness with 80% chances of major health breakdown.

Limitations of the assessment model

■ The scale does not account for inherent variation, the fact that each individual perceives life events differently to others. In this case, more or less stressful. Critics have mentioned the possibility to include individual preference in the weighting of the scale.

■ The scale does not distinguish between positive and negative items in the final scoring, although in the evaluation both types of stressors are included.

■ As a self-report assessment, the scale carries the limitation of unreliability due to patients not recalling events or not acknowledging some life events as stressors.

■ Due to the fact that the original study was conducted predominantly on a male population of patients, some critics argue that it is not entirely specific or adapted for female patients.

■ The scale was tested cross-culturally with unsatisfactory results because it doesn’t account for cultural differences.

■ Some of the items in the scale may be outdated and need replacement with more accurate lifestyle issues of the modern society.

Original source

Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967; 11(2):213-8.

Other references

1. Rahe RH, Arthur RJ. Life change and illness studies: past history and future directions. J Human Stress. 1978; 4(1):3-15.

2. Rahe RH, Mahan JL Jr, Arthur RJ. Prediction of near-future health change from subjects' preceding life changes. J Psychosom Res. 1970; 14(4):401-6.