Holmes And Rahe Stress Scale
You can read more about the two versions (adult and non-adult) of the scale and how these are interpreted, in the text below the calculator.
The Holmes and Rahe stress scale or the social readjustment rating scale as it is also called, evaluates whether stressful situations in an individual’s life may carry a low or high likelihood of future health breakdown.
This is based on the social readjustment rating scale (SRRS), developed in 1967 by psychiatrists Thomas Holmes and Richard Rahe as a method to assess life stressors.
The original 43 item life stress inventory (for adults) and 39 item inventory (for non adults) is awarded a score based on the individual weight of each chosen item.
The possible result categories are defined in the table below:
|Holmes and Rahe Stress Scale result||Interpretation (susceptibility to stress induced health breakdown in following 24 months)|
|<150||Low risk of illness|
|150 - 299||Moderate risk (50% chances)|
|≥300||High risk (80% chances)|
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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:
|1. Death of a spouse||100||23. Child leaving home||29|
|2. Divorce||73||24. Trouble with in-laws||29|
|3. Marital separation||65||25. Outstanding personal achievement||28|
|4. Imprisonment||63||26. Spouse starts or stops work||26|
|5. Death of a close family member||63||27. Beginning or end school||26|
|6. Personal injury or illness||53||28. Change in living conditions||25|
|7. Marriage||50||29. Revision of personal habits||24|
|8. Dismissal from work||47||30. Trouble with boss||23|
|9. Marital reconciliation||45||31. Change in working hours or conditions||20|
|10. Retirement||45||32. Change in residence||20|
|11. Change in health of family member||44||33. Change in schools||20|
|12. Pregnancy||40||34. Change in recreation||19|
|13. Sexual difficulties||39||35. Change in church activities||19|
|14. Gain a new family member||39||36. Change in social activities||18|
|15. Business readjustment||39||37. Minor mortgage or loan||17|
|16. Change in financial state||38||38. Change in sleeping habits||16|
|17. Death of a close friend||37||39. Change in number of family reunions||15|
|18. Change to different line of work||36||40. Change in eating habits||15|
|19. Change in frequency of arguments||35||41. Vacation||13|
|20. Major mortgage||32||42. Major Holiday||12|
|21. Foreclosure of mortgage or loan||30||43. Minor violation of law||11|
|22. Change in responsibilities at work||29|
The following table introduces the non-adult version of the Holmes and Rahe stress scale:
|1. Death of parent||100||21. Breaking up with boyfriend or girlfriend||53|
|2. Unplanned pregnancy/abortion||100||22. Beginning to date||51|
|3. Getting married||95||23. Suspension from school||50|
|4. Divorce of parents||90||24. Becoming involved with drugs or alcohol||50|
|5. Acquiring a visible deformity||80||25. Birth of a brother or sister||50|
|6. Fathering a child||70||26. Increase in arguments between parents||47|
|7. Jail sentence of parent for over one year||70||27. Loss of job by parent||46|
|8. Marital separation of parents||69||28. Outstanding personal achievement||46|
|9. Death of a brother or sister||68||29. Change in parent's financial status||45|
|10. Change in acceptance by peers||67||30. Accepted at college of choice||43|
|11. Unplanned pregnancy of sister||64||31. Being a senior in high school||42|
|12. Discovery of being an adopted child||63||32. Hospitalization of a sibling||41|
|13. Marriage of parent to stepparent||63||33. Increased absence of parent from home||38|
|14. Death of a close friend||63||34. Brother or sister leaving home||37|
|15. Having a visible congenital deformity||62||35. Addition of third adult to family||34|
|16. Serious illness requiring hospitalization||58||36. Becoming a full fledged member of a church||31|
|17. Failure of a grade in school||56||37. Decrease in arguments between parents||27|
|18. Not making an extracurricular activity||55||38. Decrease in arguments with parents||26|
|19. Hospitalization of a parent||55||39. Mother or father beginning work||26|
|20. Jail sentence of parent for over 30 days||53|
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.
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.
Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967; 11(2):213-8.
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.
App Version: 1.0.1
Coded By: MDApp
No. Of Items: 43 (A) / 39 (Non-A)
Year Of Study: 1967
Published On: May 17, 2017 · 11:47 AM
Last Checked: May 17, 2017
Next Review: May 17, 2018