Holmes And Rahe Stress Scale

Assesses the impact stressful life events may have on individual health.

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:

Stressor LCU Stressor LCU
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:

Stressor LCU Stressor LCU
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.

 

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.


App Version: 1.0.1

Coded By: MDApp

Specialty: Psychiatry

System: Nervous

Objective: Evaluation

Type: Scale

No. Of Items: 43 (A) / 39 (Non-A)

Year Of Study: 1967

Article By: Denise Nedea

Published On: May 17, 2017 · 11:47 AM

Last Checked: May 17, 2017

Next Review: May 17, 2018